Sports Nutrition

Answer of the Authors „The Sustainable Effectiveness to Avoid Chronification in Non-Specific, Non-Chronic Back Pain“

Antwort „Die nachhaltige Wirksamkeit zur Vermeidung von Chronifizierung bei unspezifischen, nicht chronischen Rückenschmerzen“

Answer of the Authors

Thank you very much for your extensive interest in our work and your detailed criticism. In the following you will find explanations to your comments.

1) 2) The standards for performing a correct pilot oriented RCT were adhered to and reviewed in advance by the Ethics Committee (EC) responsible for this study. No violations of the rules were noted. Due to the guidelines of the journal, only 5 illustrations including tables were published.

3) The aims of this prospective RCT were to determine which therapeutic strategy is most effective and sustainable to reduce NLBP and avoid chronification of non-chronic NLBP patients in Switzerland (7). The explanations also contain the definition of the corresponding chronic condition (2, 3) (Introduction, section 1 and table 1).

4) The difference in 1 of the 2 COU in the MCG was clearly explained. The patients were not subjectively or negatively influenced at COU (against one type of treatment). This additional information was necessary to initiate the corresponding MT and is known to that effect (Material and Methods, section 11) (3,4, 5).

5) We used a treatment program following some results of studies (1, 2, 3, 4, 5, 6). Nevertheless, both groups improved. The ECG seems to achieve more sustainable results, which is in line with the results of other studies (Discussion and Critical Comparisons, section 1).

6) The therapeutic methods described in the study (MCG) do not refer to the whole Maitland concept, but only to a part of it (Materials and Methods, section 13).

7) The authors of this study selected the criteria shown to define the groups, which also applied to both groups and were therefore comparable. Other research showed that inactivity promotes the development of LBP and chronification (1).

8) With the Friedmann test, comparisons of measurements within the groups (dependent samples) are calculated, with the Mann-Whitney-U-Test (independent samples). This is clearly presented in the results section (Statistics, Results, section 1).

9) You're right. Table 2 shows the test statistic. In our opinion, these data are important. All relevant data can also be found written in the text. The decimal values have no influence on the results.

10) You're right. The gender definition in the tab. differs. This does not represent a significant difference in the results. However, we will pay attention to this in the future. Thank you!

In summary, our study showed limitations, as have many others. We learn from every feedback and it will influence our further work. We hope that these explanations are sufficient and we are very interested in new researches from you. Many thanks for your constructive criticism.


  1. BONTRUP C, TAYLOR WR, FLIESSER M, VISSCHER R, GREEN T, WIPPERT P-M, ZEMP R. Low back pain and its relationship with sitting behaviour among sedentary office workers. Appl Ergon. 2019 ;81: 102894.
  2. COULTER ID, CRAWFORD C, HURWITZ EL, VERNON H, KHORSAN R, SUTTORP-BOOTH M, HERMAN PM. Manipulation and mobilization for treating chronic low back pain: a systematic review and metaanalysis. Spine. 2018; 18: 866-879.
  3. GOMES-NETO M, LOPES JM, CONCEIÇÃO CS, ARAUJO A, BRASILEIRO A, SOUSA C, CARVALHO VO, ARCANJO FL. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Phys Ther Sport. 2017; 23: 136-142.
  4. FORD JJ, SLATER SL, RICHARDS MC, SURKITT LD, CHAN AYP, TAYLOR NF, HAHNE AJ. Individualised manual therapy plus guideline-based advice vs advice alone for people with clinical features of lumbar zygapophyseal joint pain: a randomised controlled trial. Physiotherapy. 2019; 105: 53-64.
  5. FURLAN AD, YAZDI F, TSERTSVADZE A, GROSS A, VAN TULDER M, SANTAGUIDA L, GAGNIER J, AMMENDOLIA C, DRYDEN T, DOUCETTE S, SKIDMORE B, DANIEL R, OSTERMANN T, TSOUROS S. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat Med. 2012; 2012: 953139.
  6. KAMALI F, PANAHI F, EBRAHIMI S, ABBASI L. Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain. J Back Musculoskeletal Rehabil. 2014; 27: 475-480.
Andreas Alt, M.Sc.
Manager, Department of Physiotherapy
Fit 4 Life AG
Hardstrasse 10
5301 Siggenthal, Switzerland