Cognitive Functional Therapy: New hope for low back pain sufferers


Chronic low back pain (LBP) is a common complaint of adults of all ages, genders and nationalities. Yet pain in the lumbar region is only rarely associated with trauma or pathology. Most chronic LBP is non-specific in nature, meaning there is no evidence of structural or mechanical dysfunction.

For people who suffer from chronic LBP, the inability of medical practitioners to identify the underlying cause, and the failure of costly surgical interventions, can be highly frustrating. Yet, out of desperation to eliminate pain, many people who underwent a failed surgery for LBP go back for subsequent surgeries, even though the results do not alleviate their pain.

Moreover, a herniated disc or bone spur detected on an Xray or MRI does not necessarily indicate the need for surgery. The truth is, some degree of degeneration of the spine is common as we age, and many people whose imaging results indicate structural damage do not experience back pain at all.

The Fallacy of the Fragile Spine

Most of us who live in Western countries have adopted a broad cultural view that pain is bad, and must be treated. We feel a certain sense of entitlement to a pain-free life, and we expect medical practitioners to fulfill our expectations. In fact, many of us fear pain, and at the slightest twinge, our first impulse is to immobilize the painful area to protect it from further damage.

In the case of the spine, we have been conditioned to believe that our spinal columns are fragile structures that must be protected at all costs. At the first sensation of back pain, we take to our beds, call out from work, and cancel our social obligations. However, new inroads in research are rapidly debunking the notions that the spine is delicate, and that back pain is a signal to stop moving.

The Complexities of Pain

Most people believe pain to be a signal that something is structurally wrong, or that our body is somehow being threatened. And in certain instances of trauma or disease, that is most certainly the case. But the perception of pain can be deceiving, and it is influenced by many factors other than pathology or trauma.

Some factors that influence an individual’s pain perception include:

  • Family attitudes about pain
  • Cultural and social influences
  • Emotional factors
  • Past experience with pain
  • Misconceptions about how the body works
  • Lifestyle behaviors
  • Fear of pain

When you experience non-specific chronic back pain, or non-specific pain of any nature, for that matter, there may be a number of underlying factors at play that influence the sensation and intensity of pain.

Cognitive Functional Therapy for Chronic LBP

In order to get to the bottom of your pain, it is important to understand the mechanisms of the nervous system that contribute to pain perception. Your central and peripheral nervous systems interact to send endless messages back and forth about the state of your body. When nerves in your periphery encounter a stimulus, a message travels to your brain, and the brain decides how to interpret it. Essentially, your brain forms an opinion about the stimulus, drawing information from a variety of sources, including those listed above. If your brain perceives a threat, it may respond by producing a pain response.

Pain influences behavior, and behavior in turn influences the perception of pain. If you compensate for pain by changing the way you move and limiting your activities, you are in fact reinforcing the idea that something is wrong. In effect, you are substantiating your brain’s interpretation of a particular stimulus as a threat, and reinforcing the pain response.

Cognitive functional therapy (CFT) considers not only movement mechanics, posture and exercise. It is a person-centered approach that takes into account other cognitive factors. CFT is geared to correcting faulty posture and deficient movement patterns while at the same time discouraging pain behaviors, and retraining the way the brain perceives peripheral stimuli. While still in its developmental stages, clinical trials have yielded positive outcomes, and CFT holds promise for sufferers of chronic non-specific LBP.

Low Back Pain Treatment in NYC

Chronic low back pain can be frustrating and debilitating, affecting your relationships, causing you to miss work, and generally undermining your overall quality of life. At NYDNRehab, our back pain specialists pull out all the stops to get to the bottom of your pain and eliminate it.


We use the latest technologies and innovative non-invasive therapies to treat low back pain. We approach each patient as an individual, and take our time to get to know you, so we can create a personalized treatment plan, just for you. Don’t waste time and money trying to fix your back pain. Contact NYDNRehab today, and take control of your low back pain so you can get back to doing the things you love.

Research at NYDNRehab

Conference: the 12th World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM 2018) At: Paris, France

In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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