Physical therapy utilization of graded exposure for patients with low back pain.

SYNOPSIS: The fear-avoidance model of musculoskeletal pain suggests that elevated pain-related fear is a precursor to chronic low back pain. Recent prospective studies support the predictive validity of this model, and treatment approaches based on the model have also been reported in the literature. Graded exercise/activity is one treatment approach that has been well described in the literature, with reports describing physical-therapy-specific application. Graded exposure is another intervention with the potential to reduce pain-related fear, yet physical-therapy-specific application of graded exposure has not been widely described in the literature. The purpose of this clinical commentary was to provide information on the theoretical aspects of graded exposure, to briefly review available evidence for graded exposure, and to describe physical therapy application of graded exposure for 2 patients enrolled in a physical therapy clinical trial. LEVEL OF EVIDENCE: Therapy, level 5. J Orthop Sport Phys Ther 2009;39(7):496-505, Epub 24 February 2009. doi:10.2519/jospt.2009.2983.