Treating Low Back Pain: Medication vs Exercise?

Written by:
Tyler Joyce
March 21, 2023

Instant gratification is all around us every single day. We get our news immediately from our phones. Our meals come prepared and ready to heat up and eat in several minutes. And we get anything we want from Amazon with literally the click of a button. Our world is moving so fast compared to years ago. So why would recovering from a lower back injury be any different? Are we able to speed up the healing process? Is there a "quick fix" pill to take, or should you see a physical therapist and learn how to heal yourself through exercise?

To answer these questions, I’m going to talk about a 27-year-old research study that was way ahead of its time. The results of this study can help you make an informed decision when it comes to the health of your spine.

Published in 1996, this study is still very much applicable today. In my opinion, it's a good example of how the world of physical therapy has finally caught up to these 3 professors of physiotherapy from Australia: Julie Hides, Carolyn Richardson and Gwendolen Jull.

These pioneering professors conducted a research study called Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First Episode Low Back Pain. The objective of this study was to look at the natural recovery of the multifidus muscle in patients with low back pain. The multifidus is an important stabilizing muscle located along each side of the spinal column.

But why is the multifidus important? As part of our body's deep stabilizing system, the multifidus works together with the transversus abdominis, pelvic floor, diaphragm and other local joint stabilizer muscles that support the spine and pelvis to allow for upright posture and functional mobility. If any of these muscles are weakened or turned off (deactivated), our body will naturally compensate with the larger global muscles around the lower back. It's why our back stiffens up when injured. It's a process known as "neuromuscular deactivation" which often leads to restricted and painful joint mobility.

So now let's get back to the research study. Two different treatment approaches were compared: 1) medication and rest, versus 2) medication and doing a simple multifidus activation exercise.

I love this study because, in today's fast paced world, I believe most people would take the “quick fix” pill option versus having to see a physical therapist. But I’m going to show you there isn't an easy button to press when it comes to truly resolving low back pain.

So let’s talk about the medical treatment group first. This group of low back pain sufferers received advice on bed rest and taking days off from work. They were prescribed medicine that ranged from aspirin and low doses of codeine, to NSAIDs and Valium. The researchers tracked each participant’s pain, disability, range of motion and the size of the multifidus muscle on the painful side of their lower back.

The exercise group also received medication. But they were taught how to find their neutral spine and engage the multifidus muscle. In fact, they even received visual feedback by using a real time ultrasound machine to help them see the contraction of their multifidus.

The study lasted a total of 10 weeks.

I was surprised to learn that both groups experienced pain resolution after 4 weeks. No matter if they medicated, rested or exercised, the acute pain went away around the same time. This doesn't say much for the benefits of physical therapy. Although maybe it does, if we dive deeper into the anatomy? I'm talking about the size of the multifidus muscle.

According to the researchers, the group that only received medical treatment had minimal improvement in muscle size at the 4 week mark; and then they basically plateaued until the end of the study. So they never actually regained control of one of the most essential stabilizers of the spine.

On the other hand, the exercise group brought the multifidus muscle back to normal in 4 weeks; and then they maintained this muscle size during the duration of the study.

In a follow-up study, these researchers found that after one year, the medical treatment group had an 84% recurrence rate of low back pain, compared to the exercise group which only had 30% recurrence. The amazing thing is that, after 3 years, the medical treatment group still had a very high rate of low back pain at 75% compared to the exercise group only having 35%.

The authors concluded, “Multifidus muscle recovery is not spontaneous on remission of painful symptoms. Lack of localized, muscle support may be one reason for the high recurrence rate of low back pain following the initial episode.” Basically they're saying that a deep stabilizer muscle doesn't always bounce back just because the pain is gone; and that a lack of spinal stability could be contributing to the recurring pain.

This study supports the value of physical therapy. It reveals there are many ways to reduce pain. But if you don’t reactivate the multifidus (or whatever muscle has shut down), then you are a ticking time bomb just waiting for the pain to come back.

So how hard is it to get people to exercise? Apparently very hard, since most would rather take medication and deal with having more episodes of low back pain than making an appointment with a PT who can put an end to chronic symptoms.

This study clearly tells me that getting rid of acute pain is the easy part. It's far more difficult to restore underlying muscle control for true long-term relief. That's why I use the Redcord suspension system to reactivate the multifidus and other deep stabilizing muscles along each myofascial chain!


Hides JA, Richardson CA, Jull GA. Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First Episode Low Back Pain. SPINE 1996; 21(23):2763-9

Hides JA et al. Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. SPINE 2001;26 (11):243-8

Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

Tyler Joyce

Co-Founder | Physical Therapist
Tyler Joyce is a 20+ year experienced physical therapist who specializes in helping competitive baseball players and weekend athletes overcome chronic pain and injury through application of the Redcord suspension system. He works at Activcore in Princeton, New Jersey, located just 2 miles from Princeton University.


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