Heatwrap and exercise in acute low back pain: a multi-arm randomised controlled trial

Musculoskelet Sci Pract. 2026 May 22;84:103587. doi: 10.1016/j.msksp.2026.103587. Online ahead of print.

ABSTRACT

BACKGROUND: Superficial heat is recommended in acute low back pain (LBP) to reduce pain and disability. Exercise is recommended in chronic LBP, but its relevance in acute LBP remains debated. Heatwrap could potentiate the effect of exercise in acute LBP, and this combination might help preventing the transition to chronic pain.

OBJECTIVE: To compare the effect of heatwrap alone or combined with exercise to a sham heatwrap on disability at short-, mid- and long-term in acute LPB.

DESIGN: A multi-arm randomised controlled trial with follow-ups at 1, 4, 12, 26 and 52 weeks took place at a research center in [country]. Out of 315 interested individuals, 99 adults with acute LBP were recruited. Participants were assigned to one of three groups for a 7-day intervention: Heatwrap plus exercise (n = 34), heatwrap alone (n = 33) or sham heatwrap (n = 32). The main outcome was pain-related disability measured at one week with the Oswestry Disability Index (0 to 100; higher scores imply more disability).

RESULTS: At one week, heatwrap plus exercise was not better than heatwrap alone (mean difference (MD) -1.6 [95% CI -6.2 to 3.0]) or sham heatwrap (MD -0.5 [95% CI -5.0 to 4.2]). Likewise, heatwrap alone had no effect compared to sham heatwrap (MD 1.2 [95% CI -3.4 to 5.8]).

CONCLUSIONS: A combination of heatwrap and exercise was not statistically superior to heatwrap alone or a sham heatwrap in the treatment of acute LBP, contrasting with the existing literature and guidelines.

PMID:42208097 | DOI:10.1016/j.msksp.2026.103587