Every patient is different.  Research from STOPS.physio helps to get specific treatment right

Few if any research teams have investigated the effect of treatment specific to the pathoanatomical, impairment, psychosocial and neurophysiological barriers to recovery.  Clinical trials rarely publish detailed treatment protocols to allow practitioners to implement evidence-based care.  Read on to explore how the STOPS specific approach to low back pain is effective and then download (click on the image) the full text papers and treatment protocols to allow you to improve your clinical practice today!


STOPS.physio for back pain summary

A 2 page summary of the essential components of the STOPS.physio approach to back pain.


This study aimed to identify a model that predicted which patients would get better or not.  A comprehensive range of prognostic factors reflective of both the biomedical and psychosocial domains were evaluated.  The strongest factors were path-anatomical (eg type of provisional diagnosis) and physical (eg muscle function).  These findings are unique and will inform future research and clinicians on potential ways of optimising treatment outcomes in people with back pain.

ford et al 2018 - effectiveness of stops on lumbar zygapophyseal joint pain

The STOPS trial on lumbar zygapophyseal joint (LZJ) pain evaluated the effectiveness of individualised manual therapy (IMT) plus guideline-based advice compared to advice alone in people with low back disorders and clinical features indicative of LZJ origin. All participants improved over time on all primary outcomes but the IMT group had greater and more rapid improvements in back pain (at 5, 10 and 26-weeks) and activity limitation (at 26 and 52-weeks) that was statistically and clinically important.


The assertion by Travers et al that the results of the STOPS trial should be reconsidered based on the negative impact of advice incorporating a pathoanatomical explanation is not substantiated. Specifically, the recovery trajectory of participants in the STOPS comparison group (guideline-based advice) who were most comparable to the participants in Costa et al were very similar to the trajectories depicted in that meta-analysis. Further, our RCT design in which both groups received the same guideline-based advice, controls for any effect of that intervention. We therefore stand by the results of the STOPS trial and assert strongly that our trial provides high quality evidence that individualised physiotherapy with advice is statistically and likely clinically significantly better than advice alone in improving outcomes for people with LBD.

Hahne et al 2017 - stops is more cost effective than advice

Advice has been advocated in all guidelines as a simple and cost effective treatment. However this landmark paper shows that individualised physiotherapy, although more costly to provide, more cost effective than advice. Large cost savings were attributable to reduced days off work. An incremental cost effectiveness ratio was $422 per quality-adjusted life year gained. Full text will be here soon.

hahne et al 2017 - treatment effect modifiers from the stops trial

The STOPS trial showed that individualised physiotherapy was effective. However this pre-planned analysis of the STOPS data showed that individualised physiotherapy was even more effective in people with high Örebro scores (psychosocial risk factors) as well as longer or more severe back pain. So people with these features should be referred for individualised physiotherapy earlier rather than later.  Full text will be here soon.

hahne et al 2017 - effectiveness of stops on disc herniation 

The STOPS trial on disc herniation extends the seminal work of the Saal brothers by evaluating the effectiveness of pain contingent functional restoration to guideline-based advice. All participants recovered well but the STOPS group had more rapid reduction in back pain at 10 weeks and improvement in function at 52 weeks. 

Ford et al 2015 - the stops trial

This ground breaking study on 300 patients showed that specific physiotherapy was more effective than guideline recommended advice for early persistent pain. Between-group changes were sustained at 12 months for function as well as 6 months for back and leg pain and were also clinically important.

ford et al 2011 - manual therapy treatment protocol

The STOPS trial treatment program has been published in 4 separate papers (over 10,000 words each). These protocols explain through text, photos, tables and decision making algorithms how to implement the STOPS treatment. Part 1 outlines the manual therapy protocol based on the essential components of the Maitland approach including methods for clinical reasoning.

Ford et al 2011 - directional preference management protocol

This protocol outlines the essential components of managing low back pain according to the principles of Robin McKenzie. Learn how to diagnose reducible discogenic pain, provide directional preference strategies, progress forces, address lateral components and control posture. Highly effective in the STOPS trials for providing rapid relief from back and leg pain.

Ford et al 2012 - functional restoration treatment protocol

Some types of discogenic injuries are particularly resistant to standard physiotherapy methods. Learn how to diagnose the different types of discogenic problems and then apply functional restoration including precise specific muscle activation/motor control programs, management of inflammation, functional exercise progression, pacing, exacerbation management and sleep management.

ford et al 2012 - multifactorial persistent pain protocol

Functional restoration needs to be applied in a specific manner depending on the barriers to recovery. Learn how to diagnose psychosocial and neurophysiological barriers to recovery (in the absence of significant pathoanatomy) and then apply functional restoration including cognitive-behavioural methods, goal setting, graded activity/exercise, reducing passive treatment dependency and moving towards self management.

ford and hahne 2013 - the role of pathoanatomy

There is considerable controversy on the role of pathoanatomy particularly in low back pain.  This paper evaluates the arguments commonly used to dismiss the relevance of pathoanatomy in clinical decision making.

Ford and Hahne 2013

The management of back pain can be complex.  This paper explores that complexity for clinicians and researchers with some challenging results.

Richards et al 2013

This is the only high quality systematic review evaluating the effect of physiotherapy functional restoration in low back pain.


Slater, Ford et al 2012

This is one of the first systematic reviews to evaluate the effectiveness of manual therapy when applied in a specific manner.  Some promising evidence emerges but more research is required.

Surkitt, ford et al 2012

This is one of the first systematic reviews to evaluate the effectiveness of the McKenzie approach (directional preference management) when applied in an specific manner.  Some promising evidence emerges for the short term effect of this popular treatment.

Download full text articles from the STOPS.physio research team here