Find Information About:

Drugs & Supplements

Get information and reviews on prescription drugs, over-the-counter medications, vitamins, and supplements. Search by name or medical condition.

Pill Identifier

Pill Identifier

Having trouble identifying your pills?

Enter the shape, color, or imprint of your prescription or OTC drug. Our pill identification tool will display pictures that you can compare to your pill.

Get Started
My Medicine

My Medicine

Save your medicine, check interactions, sign up for FDA alerts, create family profiles and more.

Get Started

WebMD Health Experts and Community

Talk to health experts and other people like you in WebMD's Communities. It's a safe forum where you can create or participate in support groups and discussions about health topics that interest you.

  • Second Opinion

    Second Opinion

    Read expert perspectives on popular health topics.

  • Community


    Connect with people like you, and get expert guidance on living a healthy life.

Got a health question? Get answers provided by leading organizations, doctors, and experts.

Get Answers

Sign up to receive WebMD's award-winning content delivered to your inbox.

Sign Up

Back Pain Health Center

Font Size

Lower Back Pain: Hurt Doesn't Mean Harm

Exercise -- Despite Pain -- Means Faster Return to Work

Rewarding the "Good," Ignoring the "Bad" continued...

The physical therapists were specially trained to ignore complaints about pain. The idea here is not to be callous, but to keep the focus off of the "bad" and on the "good." They rewarded patients for completing each task, and showed them encouraging graphs that demonstrated their progress.

"We started the tasks at a very low level of difficulty so that the patients would establish a record of success," Mechelen says. "It is this feeling of success -- and neglecting all signs of pain by the physical therapist -- that builds confidence. Only by reinforcing "good" do we help the patient. We teach the physical therapists not to focus on what is "bad."

Did it work? Most patients who got normal care returned to work after three months. Most of those who went through the "graded activity" program went back to work after two months -- nearly a month sooner. And there was no difference between groups in the number who re-injured their backs.

The study, which appears in the Jan. 20 issue of the Annals of Internal Medicine, only lasted six months. But van Mechelen says the one-year results are very similar.

Hurt Doesn't Mean Harm

It's a good plan, James Weinstein, DO, says in an editorial accompanying the study.

"Patients learn that the exercises do not cause harm even though they may cause pain. [They] gain confidence that they can work safely despite back pain," he writes. "In so doing, they unlearn behaviors in which they had associated freedom from pain with physical inactivity or absence from work."

Heidi Prather, DO, chief of physical medicine and rehabilitation at Washington University School of Medicine, also praises the approach.

"This is behavioral management, which says, 'Let's not focus on your pain level, let's focus on your function,'" Prather tells WebMD.

Weinstein points out that professional athletes -- and most "weekend warrior" amateur athletes -- regularly play with pain. So what's the difference between them and injured workers?

"Athletes and other professionals are highly motivated, have high self-esteem, are not depressed, and have a strong motivation to keep doing what they always do," he suggests. "Can we imbue the injured worker with some of the ideals and motivation of the injured athlete?"

Today on WebMD

Woman holding lower back
Or is it another form of back pain?
Hand on back
See the myths vs. the facts.
Woman doing pilates
Good and bad exercises.
acupuncture needles in woman's back
Use it to manage your pain.
Man with enhanced spinal column, rear view
pain in brain and nerves
Chronic Pain Healtcheck
Health Check
break at desk
Woman holding lower back
Weight Loss Surgery
lumbar spine
back pain