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Physiotherapy for Long-Term Back Pain: What Works

For back pain lasting more than 3 months without an underlying disease, the World Health Organization recommends exercise programmes, education, and some hands-on therapy such as spinal manipulation and massage. It says belts, braces and traction should not be offered routinely.

What WHO recommends

  • Exercise programmes
  • Education to help you understand and manage the pain yourself
  • Some physical therapies, such as spinal manipulation and massage
  • Psychological therapy, such as cognitive behavioural therapy
  • Some medicines, such as anti-inflammatory painkillers

The guideline covers chronic primary low back pain: pain lasting more than 3 months that is not caused by another disease or condition. [1]

What WHO says not to offer routinely

  • Lumbar belts, braces and supports
  • Traction
  • Opioid painkillers, which can lead to overdose and dependence

WHO lists 14 treatments that should not be offered routinely. [1]

How common it is

About 1 in 13 people, or 619 million people, had low back pain in 2020, 60% more than in 1990. [1]

What to ask a physiotherapist

  • Will you check with a doctor whether something else is causing my pain?
  • What exercises will I do at home, and how often?
  • How many sessions do you expect, and what is the fee per session?
  • Will you rely on machines and belts, or on exercise and hands-on treatment?
  • Can sessions be at home if I cannot travel?

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Questions

Does physiotherapy help chronic back pain?

WHO recommends exercise programmes and some physical therapies, such as spinal manipulation and massage, for chronic primary low back pain.

Should I wear a back belt for low back pain?

WHO says lumbar belts, braces and supports should not be offered routinely for chronic primary low back pain.

Is traction good for back pain?

WHO lists traction among the treatments that should not be offered routinely for chronic primary low back pain.

Sources

  1. WHO releases guidelines on chronic low back pain, World Health Organization (Dec 7, 2023)

This guide is general information, not medical advice. It summarizes the sources above, which were last checked on October 23, 2026. Talk to a doctor or physiotherapist about your own situation.

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