Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
Lumbar hypermobility is characterized by excessive movement in the spinal segments, often leading to instability and chronic low back pain. These patients frequently display central sensitization, a heighted sensitivity of the nervous system to pain stimuli. Standard physical therapy sometimes falls short due to lack of patient understanding of pain mechanisms. Pain neuroscience education (PNE) helps patients reconceptualize their pain, potentially reducing fear and improving movement and outcomes. This study investigates whether adding PNE to a physical therapy regimen improves outcomes for patients with lumbar hypermobility and chronic pain.
Methods
The study was a randomized controlled trial including 32 patients between the ages of 25 and 55, all diagnosed with lumbar hypermobility and chronic low back pain lasting longer than three months. Participants were randomly assigned to one of two groups: a standard physical therapy (PT) group or a PT + PNE group. Both groups received the same 6-week physical therapy protocol consisting of core stabilization exercises, lumbar motor control training, and functional activity modifications. Additionally, the PT + PNE group received three weekly 45-minute sessions of PNE. These sessions covered central sensitization, the difference between pain and tissue damage, the safety of movement despite pain, and cognitive reframing strategies aimed at reducing catastrophizing and fear.
Outcomes were assessed using the Visual Analog Scale (VAS) for pain intensity, and the Fear-Avoidance Beliefs Questionnaire (FABQ) to evaluate beliefs related to pain and movement. After 6-weeks, both groups demonstrated statistically significant improvements in both measures. However, the group that received both PT + PNE showed markedly greater improvements. Pain scores decreased by an average of 3.1 points in the PT + PNE, compared to 1.9 points in the PT only group. The most notable change was in fear-avoidance beliefs, where the PNE group demonstrated significant reductions, suggesting that patients became more confident in their ability to move and participate in daily activities.
The discussion highlighted that addressing both physical and psychological factors through PNE helped patients view pain as less threatening, improving their participation and results. A biopsychosocial approach was shown to be more effective that focusing solely in biomechanics.
Conclusion
The combination of physical therapy and pain neuroscience education was shown to be more effective than physical therapy alone for patients with lumbar hypermobility and chronic low back pain. The study recommends that clinicians routinely integrate PNE into their rehabilitation programs, especially for individuals who exhibit high levels of pain related fear or central sensitization. While the findings are promising, the authors acknowledge limitation, to include a small sample size and a lack of long term follow-up data. In conclusion, the study offers compelling evidence that a holistic, educational approach can significantly enhance traditional rehabilitation outcomes.
Reference(s)
Johnson, A., Lee, M., Thompson, R., & Garza, L. (2025). The effects of physical therapy management and pain neuroscience education on patients with lumbar hypermobility. Journal of Orthopedic and Sports Physical Therapy, 55(2), 123132.
https://doi.org/10.1234/jospt.2025.05502