Physical Therapy

Sandra Utz et al. (2025) · Biomedicines

This prospective observational study followed 101 adults with long-standing fibromyalgia syndrome (FMS) through a two-week integrative inpatient stay in Bamberg, Germany, with no control group. FMS is a chronic condition marked by widespread pain, fatigue, sleep problems, anxiety and depression, and the authors describe it as the third most common rheumatic disease. The program was built on classical European naturopathy: water-based therapies and heat, exercise, plant-based nutrition or medical fasting, herbal remedies and mind-body practices such as relaxation. The question was whether such a combined approach would ease symptoms at discharge and six months later. Of 134 patients who joined (127 women, ages 22 to 80), 101 returned questionnaires on admission, at discharge and after six months. During the stay they took part in meditative movement, physical therapy, hydrotherapy, lectures and cooking classes, and some had whole-body heat sessions or a 5-day fast on under 300 kcal a day. Pain, fatigue, anxiety, depression, stress and quality of life were measured with standard questionnaires (such as the HADS for anxiety and depression and the MFI-20 for fatigue) and compared over time with repeated-measures statistics. Overall pain intensity dropped from 71.5 to 63.0 on a 0-100 scale at discharge (a moderate effect, dz = 0.62) and was still lower at six months (64.4). Current pain fell sharply during the stay (6.56 to 4.37 out of 10) but crept back to 5.96 at six months. Fatigue improved from 71.1 to 63.3 and then partly returned (68.0). Anxiety and depression scores each fell by roughly 2.5 points at discharge and were still lower than baseline at six months. Stress and feelings of helplessness improved mainly after discharge, and mental quality of life rose between discharge and follow-up. Patients who fasted kept their pain gains at six months (p = 0.006), whereas non-fasters did not (p = 0.062), although this difference was borderline (interaction p = 0.050) and not randomised. The results come from an uncontrolled, single-centre sample in which a quarter of the participants did not complete the six-month questionnaire, so the changes cannot be attributed to the program alone. More than half the patients reported obstacles to continuing the methods at home, such as lack of time and exhaustion. The authors call for randomised trials with long-term follow-up and propose a follow-up day-clinic programme to help consolidate the learned self-management skills and everyday routines.

Joyce Cristina Freitas et al. (2026) · Lasers in medical science

This randomized, sham-controlled trial with 48 physically active young men (45 analyzed for performance, aged 18 to 35) at a Brazilian university explored whether photobiomodulation (PBM) and osteopathic manipulation (OM) change recovery after exercise-induced muscle damage (EIMD). PBM applies red light from light-emitting diodes to the skin, a process the authors link to mitochondrial energy production in muscle fibers. OM is a manual therapy; here it meant high-velocity low-amplitude thrusts, quick, small-range joint manipulations. EIMD is the inflammation, strength loss and raised creatine kinase (CK, an enzyme leaking from damaged muscle fibers) that follow unaccustomed jumping or lowering exercise, usually peaking 24 to 72 hours later. Participants were randomized to placebo, PBM, OM, or PBM plus OM, 12 per group. PBM meant a 650 nm red light device pressed against 16 points on the right thigh and calf (144 joules in total, about 8 minutes). OM meant a lumbar roll and a pelvic manipulation by an osteopath. Both were given once before 100 drop jumps from a 50 cm platform, with sham versions for blinding. CK, quadriceps strength, knee flexibility and horizontal jump distance were measured before, right after, and at 24, 48 and 72 hours. The groups did not differ statistically on any outcome (CK group effect p = 0.950; strength p = 0.283; jump p = 0.199, meaning no measurable difference between the four arms). Within groups, CK rose immediately after exercise in placebo (p = 0.01) and OM (p = 0.02), but only at 24 hours in PBM and PBM plus OM, and the combined group showed a significant fall by 72 hours (p = 0.001, suggesting faster clearance of the damage marker). Strength dropped 6.3% to 12.4% after exercise; in exploratory tests the combined group regained significant strength by 48 hours (p = 0.036) and sat 1.4% from baseline. Jump distance rose 8.5 to 11.9 cm in all groups. CK did not track functional recovery. No adverse events were reported. The authors describe a possible modest, complementary benefit of combining the two approaches, while labeling the strength trend exploratory and non-significant. Limitations include 12 participants per group, a single session, only young men, red light that penetrates tissue less deeply than near-infrared light, and no formal check of blinding. Findings apply to physically active young men under acute jumping stress. The authors propose testing other light wavelengths and doses, repeated sessions, and a broader osteopathic approach in future trials.

Luis González-Gómez et al. (2025) · European journal of pain (London, England)

This systematic review and meta-analysis asked a practical question for people with chronic low back pain (CLBP, pain lasting more than three months): if you had to choose between exercise therapy and hands-on manual therapy alone, which works better? Clinical guidelines actually recommend combining both approaches with psychological support, but in real clinics, people often receive just one or the other, so the researchers pooled every trial that tested exercise against manual therapy head-to-head, without either being combined with the other. After a comprehensive search of five research databases, the researchers found six qualifying randomized trials, covering 743 people with CLBP total, published between 2007 and 2022. The exercise treatments ranged from general aerobic and strengthening exercise to specific 'motor control' exercises that retrain deep core muscles; the manual therapies ranged from joint mobilization and massage to formal osteopathic and chiropractic spinal manipulation. The researchers combined the trial results statistically and also checked whether results changed depending on how long people had been followed up, and whether patient characteristics like age or sex explained some of the differences. Overall, there was no clear winner. For pain relief, exercise and manual therapy performed about the same across all six trials, though when two trials involving chiropractic or osteopathic-style manipulation were set aside, manual therapy showed a small edge in the first three months. For disability (how much back pain limits a person's daily activities), the two treatments were also similar in the short and medium term, but exercise therapy showed a small advantage after six months or longer. Neither treatment stood out for physical function, based on the two trials that measured it. Notably, trials with more women in them tended to show exercise working somewhat better for disability but manual therapy working somewhat better for pain, and older participants tended to respond somewhat better to exercise for pain — though these are patterns across studies, not conclusions about any one person. The researchers rate the overall quality of this evidence as very low, mainly because there are still very few well-designed trials that isolate exercise from manual therapy without mixing the two, and the studies used inconsistent doses and often didn't fully describe what patients actually received. Their bottom line is that picking exercise or manual therapy alone is not clearly better-supported than the other, and that combining exercise, manual therapy, and psychological support, as major clinical guidelines already recommend, remains the better-evidenced path rather than choosing one alone.

Gregory E Hicks et al. (2024) · The Lancet. Rheumatology

This clinical trial focused on a specific, higher-risk group of older adults with chronic low back pain (LBP): those who also have hip pain and weak hip muscles, a combination the researchers had previously linked to worse pain and disability outcomes over time. Older adults are usually left out of low-back-pain research entirely, so there has been little evidence to guide their care. This trial, called MASH, asked whether physical therapy specifically targeting the hips would work better for this subgroup than standard physical therapy focused on the spine. 184 adults aged 60 to 85 (average age 70) with this hip-and-back pattern were randomly assigned to one of two physical therapy programs, delivered twice a week for eight weeks by trained therapists at three US research sites. One group received hands-on therapy and stretching for the hips plus hip-strengthening and core exercises (hip-focused); the other received hands-on therapy for the lower back plus some of the same core exercises and gentle stationary cycling (spine-focused). Both groups also did home exercises. The two main measures tracked were self-reported back-pain disability (using a standard 0-100 scale) and walking speed, checked at 8 weeks (the main comparison point) and again at 6 months. At 8 weeks, people who got the hip-focused therapy reported meaningfully less disability than those who got spine-focused therapy, though this difference faded by 6 months - not because the hip-focused group got worse, but because the spine-focused group kept catching up. Walking speed improved similarly in both groups the whole time. However, several other measures did favor hip-focused therapy throughout the study: people in that group walked farther in a 6-minute walk test, stood up from a chair more times in 30 seconds by 6 months, and reported less pain and better physical function, mood, and quality of life at 8 weeks. Both treatments were about equally safe, with mostly mild, expected muscle soreness; a small number of more serious health events occurred in each group, but none were linked to the therapy itself. The researchers see this as encouraging evidence that matching physical therapy to a person's specific pattern of hip and back impairments, rather than giving everyone the same generic back-focused program, can produce faster improvement, especially in physical performance. Both approaches were active, hands-on treatments (there was no do-nothing comparison group), participants obviously knew which type of therapy they were receiving, and the 16-session program is a substantial time commitment, so the researchers say more work is needed on cost and on whether a shorter or more flexible version could achieve similar results before this approach could be widely recommended.

Meng-Si Peng et al. (2022) · JAMA network open

This assessor-blinded randomized clinical trial with 113 adults explored whether exercising in water (therapeutic aquatic exercise) works better over the long term than common physical therapy modalities for chronic low back pain, meaning pain lasting at least 3 months. The modalities were transcutaneous electrical nerve stimulation (mild electrical pulses applied through the skin) and infrared ray thermal therapy (heat delivered by infrared light). Aquatic exercise meant guided, active exercise in a pool, where buoyancy and water resistance change how the body carries load. The authors note that low back pain is common and costly, and that no earlier trial had compared these two approaches or followed participants for a full year. Participants were 18 to 65 years old (average 31 years; 59 women, 54 men) and were randomly placed into an aquatic exercise group (56 people) or a modalities group (57 people). Both groups attended 60-minute sessions twice a week for 12 weeks. The aquatic group did a 10-minute warm-up, 40 minutes of water exercise at moderate effort (about 13 on the Borg scale) and a 10-minute cool-down; the modalities group received 30 minutes of nerve stimulation and 30 minutes of infrared heat. Measurements at baseline, 3, 6 and 12 months used the Roland-Morris Disability Questionnaire (24 yes/no items on daily activities limited by back pain) and a 0-to-10 pain rating scale. The aquatic group had lower disability scores than the modalities group at every check: 1.77 points lower at 3 months (P = .006), 2.42 lower at 6 months (P = .006) and 3.61 lower at 12 months (P = .001), so the gap widened over time. At 12 months, 46.43% of the aquatic group improved by at least 5 disability points (a change the authors treat as clinically meaningful) versus 7.02% of the modalities group. Most-severe pain was 0.79, 1.34 and 2.04 points lower in the aquatic group at 3, 6 and 12 months. Sleep quality, fear of movement and overall quality of life (SF-36) also improved more with aquatic exercise (P = .02, P < .001 and P = .003 for the overall group-by-time effect). Not every measure separated the groups: overall SF-36 scores were nearly identical at 3 months (P = .92), and work-related fear-avoidance scores did not differ. Treatment-related pain was uncommon in both groups (3.6% versus 7.0%). The authors suggest that water-based exercise may offer longer-lasting benefit than passive modalities for chronic low back pain, in part because it is active exercise. They state clear limits: participants were mostly young with fairly low pain, no one could be blinded, the comparison group did not exercise so the water itself cannot be credited alone, and costs were not examined. The authors call for trials that add a land-exercise group, combine both approaches, and include older people with more severe pain.

Nicolas Vaillancourt et al. (2026) · Pain management

This two-arm randomized controlled trial with 36 adults compared 10 weeks of aquatic (pool-based) exercise therapy against a standard land-based care program for chronic low back pain (CLBP) — pain lasting more than three months without a clear structural cause. Beyond the usual measures of pain and disability, the study also tracked psychological factors that keep chronic pain going: pain catastrophizing (dwelling on and magnifying pain), kinesiophobia (fear of movement or reinjury), anxiety, depression, and sleep disturbance — factors most exercise trials for back pain don't examine. Participants, aged 18 to 65, trained twice a week for 60 minutes over 10 weeks, one-on-one with a certified athletic therapist. The aquatic group did dynamic lumbar-stabilization, core, hip and aerobic circuit exercises in a therapeutic pool, where water's buoyancy takes weight off the spine and its resistance still builds strength. The standard-care group received an individualized land-based mix of hands-on manual therapy (spinal mobilization, myofascial release) and progressive stabilization and strength exercise — reflecting the real-world care most people with CLBP actually receive. Thirty-four people completed the study; both groups attended more than 85% of sessions, and no one had an adverse event. Both programs worked: pain, disability, physical and overall quality of life, pain catastrophizing, and anxiety/depression all improved significantly in both groups by 10 weeks, with disability improvements (18-point and 13-point drops) comfortably clearing the threshold considered clinically meaningful, and neither group pulling statistically ahead of the other on any of these. The one place aquatic therapy stood out on its own was kinesiophobia and sleep: only the aquatic group's improvement in fear-of-movement scores and sleep-disturbance scores reached statistical significance, likely because moving safely and painlessly in water helps people rebuild confidence that movement won't hurt them. That said, the aquatic group wasn't statistically better than standard care on these two measures either — it simply crossed the bar for significance within its own group while standard care came close but didn't. These results support aquatic therapy as a genuinely comparable — and possibly, on fear of movement and sleep, slightly favorable — alternative to standard hands-on and land-exercise care for chronic low back pain. The study is small (34 completers), was originally powered to detect a different outcome in its parent trial, and its therapists weren't blinded to which treatment they were giving, so these encouraging psychological findings need confirmation in larger, purpose-built trials before they can be treated as settled.

Georgios Mavropalias et al. (2022) · Breast cancer (Tokyo, Japan)

This randomized trial with 106 women getting radiation therapy for breast cancer tested whether a 12-week program of home-based exercise -- with no gym or supervision required -- could reduce cancer-related fatigue and improve quality of life during and after treatment. Cancer-related fatigue is an overwhelming tiredness affecting most breast cancer patients undergoing radiotherapy, and unlike ordinary tiredness, it does not resolve with rest alone. Conducted in Australia, the trial split participants into an exercise group, who received a one-on-one session with an exercise specialist plus biweekly phone check-ins, a resistance band, a pedometer, and an exercise guide, or a usual-care group with no exercise support. Eighty-nine women (43 exercise, 46 usual care) completed the full study. Fatigue was tracked weekly during the 6-week radiation course and at several points afterward using validated fatigue and quality-of-life questionnaires, along with measures of sleep and physical activity, over a full 12 months of follow-up. Women in the exercise group felt less fatigued than the usual-care group at several points during radiation treatment and recovered faster once treatment ended, while the usual-care group's fatigue did not meaningfully improve until 6 weeks after finishing radiation and took a full year to fully resolve. Quality of life followed a similar pattern, improving sooner and more in the exercise group. Sleep quality was poor in both groups throughout the study and did not improve with exercise. Notably, the women only managed modest amounts of exercise -- about 1 to 2 strength sessions and 30 to 40 minutes of cardio per week, less than typical guidelines recommend -- yet still saw real benefits, and no one was hurt by the program. These results suggest that even a small, home-based, unsupervised amount of exercise can meaningfully speed up recovery from cancer-related fatigue and improve quality of life during breast cancer radiotherapy, without needing a gym, a trainer, or a large time commitment. However, the study lacked a group that skipped radiotherapy entirely, so it cannot fully separate the effects of exercise from the natural course of treatment, and the fatigue and quality-of-life benefits appeared to fade once the structured 12-week program ended, suggesting ongoing activity is needed to keep the benefits going.

Eduardo J Fernandez-Rodriguez et al. (2023) · International journal of environmental research and public health

This randomized clinical trial with 48 cancer patients explored whether a one-month, home-based program combining supervised exercise with functional rehabilitation could reduce cancer-related fatigue and help patients regain independence after being discharged from an oncology hospital stay. Cancer-related fatigue, also called asthenia (tiredness without a clear physical cause), affects most cancer patients yet is often dismissed by care teams as an unavoidable side effect rather than something that can be actively treated with structured therapy. Conducted in Salamanca, Spain, the trial split 48 recently hospitalized patients (average age about 63, with lung, digestive, prostate and breast cancers) into two equal groups. Both received standard cancer care, but one group also completed daily home exercise sessions (short aerobic-and-strength workouts, twice a day) plus hands-on retraining in daily activities like dressing and moving safely, energy-saving strategies, and sleep coaching. Independence, fatigue, quality of life, physical performance and fear of movement were measured before treatment, at 15 days, and at 1 month by evaluators who did not know which group each patient was in. Patients in the exercise-and-rehabilitation group showed significantly better independence, less cancer-related fatigue, and stronger physical performance than the control group at both check-ins (p<0.001 for the final comparisons on all three), while the control group's scores stayed flat or worsened over the same month. Fear of movement related to fatigue also improved more in the treatment group by the one-month mark. Pain levels did not differ meaningfully between groups. Quality-of-life results were more mixed: one specific overall-wellbeing rating improved more with treatment, but the broader quality-of-life questionnaire actually improved slightly more in the control group, a puzzling result the researchers think may reflect that instrument's limits for this population. These results suggest a structured, home-based exercise and rehabilitation program can meaningfully help newly discharged cancer patients regain daily independence and feel less fatigued. However, patients could not be kept unaware of which group they were in, the study ran for only one month so longer-term benefits are unknown, it took place at a single hospital, and adherence relied on patients' own reports. Larger, longer trials with cancer-specific quality-of-life tools are needed to confirm and extend these findings.

Filip Gedin et al. (2025) · BMC musculoskeletal disorders

This Swedish trial asked whether a chiropractor, a physiotherapist, or advice to stay active works best for low back pain lasting months — and the honest answer is that it could not tell the three apart. Eighty-eight people at ten primary care clinics around Stockholm were randomly assigned to one of four things: advice only, physiotherapy, chiropractic care, or both together. Six months later, everyone was better. Disability scores dropped in every group — most in the chiropractic group, least in the physiotherapy group — but the gaps between groups were well within what chance alone would produce. Pain scores and quality of life told the same story: improvement everywhere, no clear winner. Where the groups did differ was cost. The advice-only group ended up costing the health system about three times more than the others — around SEK 11,000 per person versus roughly SEK 3,000 — mostly because those patients went on to see doctors more, and one of them had spine surgery. Getting hands-on treatment early appeared to head off more expensive care later, though with numbers this small a single surgery moves the whole average. Combining chiropractic care with physiotherapy came out best on the economics: slightly more quality-adjusted life years for slightly less money. But "slightly" is doing a lot of work — the difference across all four groups was eight thousandths of a QALY, which is roughly three days of perfect health. The researchers are unusually candid about the limits. They wanted far more participants than they got, nearly half the people dropped out before six months, and the four groups were not well matched at the start. They present this as a lesson for whoever runs the definitive trial next, not as a result to act on. What it does support, gently: for chronic low back pain, staying active matters, and both chiropractic care and physiotherapy are reasonable, comparably effective options — with some signal that getting treatment rather than advice alone may save money downstream.