Evaluating the effect of the Online Jing Method on the Quality of Life in Adults experiencing Non-Specific Lower Back Pain.
Emma Wall
A dissertation submitted in partial fulfilment of the requirements of Jing Advanced Massage Training for the Professional Diploma in Advanced Clinical Massage and Sports Massage.
March 2025, Total word count: 4280.
Abstract
Background
The impact of low back pain (LBP) can be felt in our homes, places of work, and NHS, and shows no signs of abating; with the number of people struggling with LBP annually increasing on both a national and international level. The failings to combat these rising numbers using current biomedical treatment interventions, are most apparent when it comes to persistent LBP, whereby the psychological and sociological components of the pathology are often not met in treatment. This study therefore looks to evaluate the effect of the Online Jing Method, with its focus on the Bio-Psycho-Social treatment of pain, on adults experiencing non-specific lower back pain (NSLBP).
Method
Of those 15 participants recruited online who met the initial telephone consultation and inclusion criteria for NSLBP, 12 participants (3 men and 9 women) completed the within-subject design study. They then received a telehealth pre-intervention consultation. Each participant undertook a 6-week data gathering exercise, filling out the Bournemouth Backpain questionnaire (BBPQ) once a week, which was continued once a week for 16 weeks in total. The intervention lasted 6-weeks and involved participants being sent out a different follow along 30-mins pre-recorded video and educational PDF’s each week. Participants also had a live group Q&A Zoom meeting once a week. Closing telehealth consultations were also given once the intervention was over.
Results
This study demonstrated a consistently improving trendline of the study’s BBPQ data to show a decrease of 15.4 on the total score, which is considered a significant clinical improvement in LBP.
Conclusion
The positive outcomes achieved in this study when using an online multi-modal approach to treating NSLBP; with a focus on education and patient empowerment using the BPS modal, shows great potential for further future development. However, due to the small sample size of the study, working with a larger cohort across more population specific trials may prove beneficial for further refinement of the method.
” Nothing in life is to be feared; it is only to be understood.”
~ Marie Curie
Introduction
The global, national, and regional burden of low back pain (LBP) continues to be the leading cause of years lived with disability worldwide (Chen et al., 2022). The impact of which can be felt deeply throughout multiple levels of our society from work life to home (De Souza and Oliver Frank, 2011). With the number of people affected by LBP increasing annually and estimated to rise to as much as 843 million by 2050 (WHO, 2023), LBP stands out as one of the major public health issues of our time.
Non-specific low back pain (NSLBP) accounts for 90-95% of all cases of LBP (Bardin, 2017) and can interfere with multiple aspects of a person’s life; diminishing their mental wellbeing, influencing their ability to work and their productivity, and interfering with many day-to-day functions, which can greatly reduce their overall quality of life (QOL)(WHO, 2023).
With the prevailing biomedical model of healthcare and classical physiotherapy failing to counter the increases in NSLBP (Cuenca-Martínez, Cortés-Amador and Espí-López, 2018), there is clearly a major need to explore and develop alternative pain management strategies to those currently in place. The aim of this study, therefore, is to evaluate the effect of the online Jing method (OLJM) on the QOL of adults experiencing NSLBP pain.
Current Guidelines
Current NHS guidelines for the management of persistent (chronic) LBP in the UK include: a structured exercise programme overseen by someone such as a physiotherapist; manual therapy, including massage and spinal mobilisations; acupuncture; and psychological interventions such as Cognitive Behavioural Therapy (NHS, 2021;Kenny and Tidy, 2016).
Whilst the current scope of treatment options for NSLBP acknowledges the biopsychosocial model for the treatment of chronic pain via independent treatment modalities (Daren and Forward, 2008), there are still limited treatment interventions being offered to the public combining mind, body, and social support in one place.
The Jing Method
Fairweather and Mari (2015: 4-5) describe The Jing Method as an interdisciplinary treatment approach to chronic pain, fusing Eastern and Western massage practices and threading them through a strong therapeutic alliance whereby clients ‘feel heard’ and are empowered to take control of their own healing through education and self-help strategies. Fairweather and Mari’s (2015: 6) ‘combination of modalities’ that make up the Jing method can be summarised by H F M A S T:
Table 1 – The Jing method of HFMAST for the treatment of chronic pain (Fairweather, Mari 2015)
| H: refers to the application of heat or cold. |
| F: using both direct and indirect fascial techniques. |
| M: treating all the muscles, both above and below the affected joint in question, to release aggravating trigger points. |
| A: the inclusion of acupressure in treatments. |
| S: using a variety of stretching techniques, including: PNF, AIS and joint mobilisations. |
| T: teaching client self-help strategies, such as mindfulness meditation, breathwork, self-trigger point with balls, and basic rehab exercises. |
The importance of creating a collaborative person-centred treatment approach, so fundamental to the Jing Method, whereby the therapist supports the patient’s emotional wellbeing and empowers them to take control of their health, is further supported by (Lebert et al. 2022; Sheppard 2018) and is a cornerstone to this study.
The Bio-psycho-social model
The foundation of the Jing Method is that it is rooted in the Biopsychosocial (BPS) model of healthcare. The BPS model recognises that pain, and in particular chronic pain, is not only created in the body as a response to structural issues. In fact, pain is a decided response by the brain to current and previous stressors, learned experiences, belief systems and lifestyle factors (Moseley and Butler, 2015;Lowe, 2023;Varallo et al., 2021; Borell-Carrió, Suchman and Epstein, 2004).
A systematic review of BPS factors for chronicity of individuals with NSLBP pain by Otero-Ketterer et al. (2022) highlights the need for a more in-depth understanding of the ‘complex dynamic relationships between BPS factors.’ The study’s findings were indicative of the importance of a ‘multidimensional’ approach being implemented when managing individuals with NSLBP with their ‘sometimes tenuous relationship with tissue damage’ (Lotze, Moseley and Moseley, 2015). Tom et al. (2022), for example, recognise in their systemic review of determinants of QOL with chronic LBP, how in particular, the psychological status of an individual with chronic LBP was a denoting contributor to their QOL. This current study theorises, therefore, that by creating a self-treatment modality, using the OLJM, which is both multi-dimensional in its approach and grounded in the BSP, a greater positive impact on a person’s QOL with NSLBP could be achieved.
The implications for our Western healthcare systems, designed around acute biomedical care models, is that they are struggling to improve patient-reported outcomes and reduce healthcare costs. Frustratingly, despite the BPS model offering huge scope for the management of persistent pain presentations such as NSLBP, ‘politically powerful acute medical and surgical domains’ remain as a barrier to the more widespread of its acceptance (Wade and Halligan, 2017).
Online self-treatment
Since the international COVID pandemic there has been a shift towards working from home and the need for even more flexibility within a worker’s daily life. As NSLBP is now considered the leading cause of disability worldwide (Hartvigsen et al., 2018) ‘Physical activity and exercise programs could play a role in decreasing the socio-economic burden associated with chronic pain’ (Lebert et al., 2022). With the flexible non-location specific nature of an online intervention echoing the current trend in working life, could online treatment modalities such as OLJM help to lessen the disabling burden of LBP on both the NHS and workforces? A randomised control trial by Villatoro-Luque et al. (2023) demonstrates that a mobile app is as effective as delivering a rehab programme as the same exercise program supervised by a clinic. This points towards the potential for dramatic cost reductions for health services, along with easing the impact of time taken off work for attending health care appointments.
That said, this study is investigating more than just the delivery of exercises online, as mental health is an integral aspect of managing NSLBP; the recognition of which, sets the Jing method apart from traditional biomedical therapeutic approaches. Aherin (2023) in her study into OLJM for mental health, and Allen (2021) for academic burn out, show the strengths of the OLJM for improving QOL from a mental health perspective. Preston, (2021) acknowledges an ‘overall positive response to online therapy and rehab’, for NSLBP in her paper, but also highlights how adherence to home exercises can present a challenge. However, she supports the notion that a good therapeutic alliance (TA), which is fundamental to the Jing Method, can still be built online and can create stronger patient adherence to rehab programmes. Rujipong et al. (2021) also highlights how patients needed a significant amount of knowledge around the causes of pain and pain self-management strategies to successfully implement their self-care practice. This presents the need for a variety of instructional material, provided in different formats, for different learning styles.
Massage, Mindfulness & Mind-Body Interventions for LBP
The prognosis for treating NSLBP with massage therapy alone, demonstrates improvements in pain outcomes and functionality from massage as being only short-term (Tsao,2007; Trivedi et al.,2022; Furlan et al.2015). Whilst other studies including manual therapy as part of the broader Complementary and Alternative Medicine (CAM) cohort; including cranio-sacral therapy, yoga, Pilates, and acupuncture, acknowledge their efficacy for improving pain and disability (Yang et al., 2023;Crawford et al., 2016;Eaves et al., 2015). This supports the role of CAM therapists to orchestrate a positive effect on clients’ QOL but represents the need for continued active patient participation in their healthcare journey. Teaching clients self-massage techniques could play a role in facilitating this.
Movement Therapy for LBP
A recent ‘very robust’ randomised trial in the Journal of Physiotherapy of 100 people with NSLBP (Turci et al., 2023) theorised that ‘Perhaps the nature of exercise is not important other than it means the patient is not receiving passive treatments or restricting their movement;’. Shipton (2018) further supports the idea that movement programmes that focus on improvement in function are paramount to managing chronic LBP, but that the type of physical intervention is based primarily on patients’ preferences and the therapists experience.
These studies highlight the importance of helping patients to find movement and self-treatment strategies that work for them as an individual, and not presenting them with cookie cutter approaches that could potentially set them up for failure through lack of engagement. By offering a variety of interventions for each movement goal, as per graded exposure (George and Zeppieri, 2009), this study gives online participants options regarding how to move in a way which is right for them.
Education and pain science
We can encourage patients to engage in self-treatment and movement strategies for managing their LBP long term by arming them with an understanding of how pain is created and why it exists (Hernandez-Lucas et al., 2022)). Phenomena such as pain catastrophising and fear avoidance mechanisms known as Kinesiophobia ‘might play a significant role in enhancing pain-related disability and the pain intensity in individuals with chronic lower-back pain’ (Varallo et al., 2021).
Both Varallo et al. (2021), and Lotze, Moseley and Moseley, (2015) discuss the important therapeutic role managing patients’ beliefs and cognition to pain plays in interdisciplinary pain management interventions. With BPS pain rehabilitation now taking preference over conventional pain treatment and management. Barbari et al. (2020) also recognise the most effective interventions for long term behaviour modification and compliance with exercise as a combination of pain science education, graded exposure, and multimodal interventions.
Modalities such as the OLJM are part of this new paradigm shift towards BPS pain rehabilitation and could play an important role in patient empowerment and sustainable health outcomes with NSLBP. This would have a positive knock-on effect in our greater society including reduced pressure on the NHS and improved workplace productivity. The current push in the research landscape towards finding treatment strategies that implement the BPS model, is gaining momentum. However, there is still a need for future research around BPS rehabilitation outside of a one-to-one therapeutic setting and around how to ‘conceptualise personification’ (Ceulemans et al., 2024) within a group therapeutic environment.
The evidence presented so far suggests that multimodal approaches to treating non-specific lower back pain are necessary for tackling its increasing burden on our societies. Online modalities offer the opportunity to further develop patients’ education around pain science and BPS factors, than may not be possible to do in a clinical setting due to time restraints. With research supporting both the ability of TA to be built online and the potential of online rehab programmes, the OLJM may offer an alternative for improving the quality of life in adults experiencing back pain.
Method
Ethical approval was received for the following study, evaluating the quality of life in adults aged 38-74 experiencing NSLBP, from Jing Advanced Massage Training (See Appendix A). A group of 15 participants with NSLBP were recruited via social media and business mailing for an online-based study, of which 3 dropped out in the control phase. The 12 participants who completed the study were from a diverse employment demographic and geographical location across the whole of the UK: 9 participants were female and 3 males. Each participant received a telephone call to explain the study and discuss their suitability before joining. All participants gave written, informed consent (See Appendix B)
NSLBP for the purposes of the study was defined as:
Table 2: NSLBP inclusion criteria
| LBP having been experienced for 3 months or more. |
| LBP that could not be contributed to a specific disease or systemic pathology such as Fibromyalgia, MS, or a current Cancer diagnosis. |
| Those with a severe injury that had occurred within the past 6 months, as such cases may require a more individualised rehabilitation approach specific to their trauma. |
| Those who had undergone surgery in the past year. |
| Pregnant ladies or ladies 1-year post-partum could also not participate, due to their unique needs that would not be met for the purpose of this intervention. |
The inclusion criteria required that participants’ LBP was interfering with their QOL on some level. The study was particularly interested in recruiting those with NSLPB, who may have tried other treatment methods of healing their LBP, but to no avail. All the participants agreed not to make any changes to their lifestyle that could impact upon the study throughout the duration of the study e.g., changes to medication and starting to work with new healthcare practitioners to treat their NSLBP.
This was a within group study design, which is a statistically powerful research intervention for smaller sample sizes. Participants completed the Bournemouth Back Pain questionnaire (BBPQ) for 6 weeks prior to the commencement of treatment to establish their level of back pain and effect on their QOL (See Appendix D). The BBPQ was chosen due to its focus on the effects of NSLBP on activities of daily living. The questionnaires were submitted every Monday over the six-week control and following six-week intervention period. They were also submitted at week 16 of the study.
Towards the end of the control phase, an online consultation was carried out with each member of the study group to begin building a therapeutic alliance. This was repeated once the intervention stage was completed.
Throughout the 6-week intervention phase, participants were emailed course content, every Monday morning with the lessons of the week. Each week followed a 5-pillar structure, which embodied the Jing method adapted for an online educational format, as outlined below:
Table 3: The 5-Pillar system for the self-treatment of persistent pain
| Educate: Education around pain science, personal considerations within the BPS model of understanding pain, the mind-body connection. 1 factsheet focusing on a different aspect of pain science. |
| Embody: Gentle mindfulness and down-regulation exercises to bring you back home into your body: including the use of heat, acupressure, breath awareness and self-massage. Part 1 of a 30 min pre-recorded video |
| Evolve: Evolution of your mind-body awareness and your bodies capacity to move with ease, using mindful mobilisations, self-MFR and accessible stretches. Part 2 of a 30 min pre-recorded video |
| Empower: Rebuilding confidence and strength in the mind and body with resistance band and body weight exercises. Part 3 of a 30 min pre-recorded video |
| Enable: Enable yourself to live your best life through lifestyle modifications and strategies. Enable those around you to discover pain-free living. 1 lifestyle focused worksheet. |
Participants were expected to have read all material and practiced the video once before attending a live group Q&A and coaching session in the middle of the week. Participants were then asked to revisit all content once again before the next week’s new lessons were sent out. They were also asked to report back as to how many times they had practiced the videos (See Appendix E).
(To view the full summary of the online treatment intervention please see the appendix F)
Results
Whole group mean showed a 1.9-point drop in inability to control pain by week 12 of the study. The mean continued to decrease to a 2.2 drop by week 16.
The first 2 weeks of the intervention sees a slight Increase in participant’s pain. However, there is a rapid and sustained decline in pain from around week 9 onwards, which continues declining all the way to week 16.
The participants sense of ability to control their LBP, mirrored the declining trend of their pain. Both, reporting on how much their social activities and work were affected by their NSLBP, followed a similar trend to the decline in pain in the intervention period.
All five of the above figures show a consistent improvement in results after the intervention finished at week 12, leading into week 16.
The anomaly in Figure 3 week 2, can most likely be attributed to this part of the data being gathered in the summer holidays, when many participants were off work and relaxing on Holiday.
Discussion
This study, evaluating the effect of the OLJM on adults experiencing NSLBP, proved highly effective in reducing patients LBP and improving their quality of life using a multi-modal online treatment program. It managed to achieve a distinct change as the intervention progressed, with a consistently improving trendline of the study’s combined data to show a decrease of 15.4 on the total score (see Figure 1). Bolton, (2004) Indicates that a 13-point total score on BBPQ is associated with a significant clinical improvement in LBP.
The study’s multi-modal intervention showed great potential for being an effective treatment strategy for persistent pain. The OLJM, further adapted into the 5-pillar educational approach, was a suitable tool for such a modality, with its focus on the BPS treatment of chronic pain. This supports the growing body of evidence which promotes the use of online programs and telehealth as a viable alternative for managing and treating chronic pain (Parkinson, Mackie and Parrott, 2021; Villatoro-Luque et al.,2023; Cui et al., 2023). This is building on the work of the likes of Jones-Morris, (2021) and Williams (2021) who had already demonstrated the efficacy of the hands on Jing Method for the treatment of NSLPB in their studies.
Traditional physiotherapy exercises typically have a very poor adherence rate. Shahidi et al., (2022) state that ‘the majority of individuals prescribed an in-clinic exercise-based rehabilitation program are non-adherent’ with self-reported time spent on home exercises varying widely from 15-70%. This study shows the potential for working online with, not only traditional physiotherapy exercises, but also more holistic interventions that reflect the BPS model of pain, such as: self-massage, acupressure, mind-body awareness exercises, pain science education and lifestyle interventions. It supports the notion that patients can learn to self-regulate their pain with therapeutic techniques that parallel those offered in a clinical massage setting (Villatoro-Luque et al., 2023b). This was also demonstrated in the studies into the OLJM by (Allen, 2021;Aherin, 2023). Importantly, it highlights the benefits of layering pain education, therapeutic alliance and a multi-modal treatment approach when managing patients NSLBP, as impressed upon by Lorimer Moseley and Butler (2015).
Pain re-education
This study, of which pain-science was a corner stone component, supports the work of Lotze, Moseley and Moseley, (2015) who emphasise the importance of ‘reconceptualizing’ pain in modern pain rehabilitation.
For content to be presented over a six-week online program, was not only part of the Jing Method, but also necessary to the overall study method; as participants took time to engage with the new concepts being presented to them and to begin to reframe their pain, as was argued by (Rujipong et al., 2021) . The benefit of an online intervention in the context of pain science is that it gives participants more time to digest the topics than would normally be available to them in a clinical setting, as supported by Barbari et al., (2020). This is reflected by the trends in the data, which saw a 63% drop in pain after 3 weeks of the study treatment intervention, which then consistently continued to drop from then on out. In fact, Cui et al., (2023) go so far as to say that not only do remote digital interventions show no significant differences in outcomes when compared to in-person physiotherapy; but that a significantly lower dropout rate was observed in the digital group compared to the conventional group. This study theorises that this could be due to the more flexible nature of online programmes, which are non-location specific, and which allow participants to engage with educational content at a time which suits them.
There was a clear relationship in the study between client’s understanding of pain science with their ability to manage their pain and reduce their LBP. The structure of the online approach was to build and layer education and therapeutic approaches, so that participants could embody and practice stages to have a cumulative benefit. An approached backed up by other studies (Adenis et al., 2023; Hernandez-Lucas et al., 2022).) This can best be seen in the drops in data at around week 9, when participants began gaining fresh insights into their unique pain presentation. This understanding was apparent in the shifting dialogues participants were having around their pain in the weekly live Q&A sessions. The data implies that this had a knock-on effect in their greater QOL with ability to participate in social activities and productivity at work. We can ascertain from these findings that understanding pain combined with movement and mindful therapeutic self-practices are much more effective than any one of these elements stand-alone (Hernandez-Lucas et al., 2022;Trivedi et al., 2022).
Interestingly even those 25% study participants who were experiencing life crisis such as grief and custody battles, still reported better understanding their triggers and connections between their LBP and stress by the end of the intervention. They felt better equipped to manage their LBP when life circumstances had settled down again, due to the education they had received on the study, despite pain levels remaining high in that moment due to stress. This outcome is not reflected in the BBPQ data and presents the challenges of evaluating the NSLBP outcomes where complex BPS factors are so heavily intertwined with their pain experience.
Could longer term pain outcomes and positive impact on QOL prove to be better when equipping patients with such multi-model tools and knowledge? Clients feedback on empowerment, despite not yet being fully out of pain, would Imply yes! This is supported by the data that shows continued decreasing trend in pain and improvement of QOL reported by all participants after the intervention had finished at week 16.
Therapeutic alliance
It is clear from this study that TA can still be built online, as supported by (Preston, 2021; Sheppard, 2018). Elements that contributed to building a strong online TA included: the opening and closing 1-2-1 consultations and the style of the videos, which participants reported finding personable, engaging, and accessible. With one participant commenting that ‘it was like you have been here in my front room with me every week’. This strong TA was present in clients final feedback forms whereby 64% of participants reported a 5 out 5 results in response to being asked if they felt supported throughout the online course (intervention) and 36 % a 4 out of 5.
Overall, there was a high level of engagement with the study’s content and a consistently reported adherence of twice a week to the home exercises across the group. This shows great potential for the 5-pillar system in a climate which sees low adherence to home exercises (Shahidi et al., 2022). Participant feedback attributed their engagement to the multi-modal layering of information and use of different medias for different learning styles. They reported finding the videos entertaining and the written content novel, engaging, yet easy to understand. Giving them whole new perspectives on their pain experience.
That said, attendance to the live group Q&A live sessions were consistently low throughout the whole intervention, with most participants reporting challenges around attendance, whereby time commitment afterwork was often touted as a stressor and an obstacle. This highlights the major issue when asking the public to take a more active role in managing their own healthcare, as self-care often drops to bottom of the list of priorities in busy lives. It also highlights the challenges when working with disassociated members of the public, who have very different work-life patterns and needs. Perhaps, fortnightly live sessions instead of weekly, would place less pressure on future course participants timetables and give them further flexibility around lesson consolidation.
Some of these problematic factors might be mitigated by working with group specific representations of the population e.g., office workers from the same company, NHS workers, teachers etc. whereby commonality of themes may run throughout their LBP presentations and peer support may prove easier in group work. Having a designated time agreed to practice the videos and attend the live sessions in work hours would potentially relieve these problems if used in a corporate wellbeing scenario.
Healthcare cost saving
That the online program didn’t need to rely on 1-2-1 in person treatments to have a positive therapeutic effect, promises potential healthcare cost savings for patients, the NHS and employers alike. Cost saving for NHS and improvement in productivity in workforces are attractive carrots to be dangled in a climate that see’s the government providing over £12m of funding ‘to unlock the potential of digital technologies to support the delivery of care’ (NHS England, 2024). The government recognises the efficiency and effectiveness of digital interventions to relieve pressure on the system, with increased workforce productivity and accessibility to care being touted as some of the many benefits (NHS England, 2024). No wonder there is such a drive for innovation, at a time that currently sees 12 million workdays lost every year to back pain in the UK, accounting for one of the most common reasons for absence from work, (Unison, 2025).
Improvements in the study method
Some participants reported that the video software used was glitchy when trying to rewind videos to specific points. More advanced software designed specifically for online courses would help to get rid of this issue and promote the ability for participants to revise specific parts of the content as needed. With such upgraded software weekly lessons could be tracked with times viewed and patient progress.
Ceulemans et al. (2024) highlight how BPS rehabilitation for chronic low back pain needs ‘conceptualization on how to personalize’ such interventions to integrate them into clinical practice. For example, one client admitted to not being able to get up and down off the floor, meaning they couldn’t do large sections of the videos. This ability, therefore, needs to be included in inclusion criteria for this online program. Whilst the online videos tried to offer as many variables for personalisation as possible, scope for a secondary program for those with more extreme mobility and fitness restrictions, could be developed, as discussed by George and Zeppieri, (2009).
Limitations with the Study
The small sample size of the group, with only 12 participants completing the study, presented a limitation of the study. It would be useful to run the study with various groups and to track the longer-term outcomes of QOL over the course of the preceding year. Positive outcomes for NSLBP have considerably lower markers than for acute LBP (Otero-Ketterer et al., 2022). This indicates that whilst this study’s data saw, what some might perceive as, subtle shifts in participant’s QOL, the results are still significant (Bolton and Breen, 1999).
The complexity of persistent LBP and its entanglement with BPS factors make relying on questionnaires such as the BBPQ complicated. Aherin, (2023) recognised this is her study “[T] here are inherent limitations to using self-report measures” such as an individual’s inability to recognise or report a true state of stress (Epel et al., 2018, p. 5).
Conclusion
The effectiveness of this study into the OLJM for the treatment of NSLBP, which showed a + 50% decrease in perceived pain using the BBPQ, will comfortably add to the growing body of research regarding online therapeutic interventions. Research around the longer-term benefits of online therapeutic interventions is still in its infancy. But with the new government looking towards technology to help solve some of the demands put on NHS and workforces through chronic conditions such as NSLBP, it seems there’s a real demand for investigating online strategies further.
Whilst there is no denying that 1-2-1 patient-therapist interactions still seem to yield the greatest TA and positive outcomes, it is clear from this study that strong outcomes can still be achieved online. Online group health coaching interventions do appear to offer alternatives to an already overburdened NHS. However, how to personalise therapeutic practices in a varied group dynamic with different BPS markers, still poses a challenge for future online health developers to overcome.
The ability of pain science to deeply support a multi-modal treatment approach, shows great potential for improving the QOL in those experiencing NSLBP. Perhaps an either-or approach, therefore, is limiting by nature? Rather, online interventions could be used as an adjunct to support and develop the work started by clinicians in the treatment rooms. Using online multi-modal programs, rooted in self enquiry, and understanding, to help reduce return healthcare visits and time spent off work, through continued patient empowerment.
References
Adenis, N. and Gosselin K. and Stetsenko N. and Thevenona A. (2023) ‘Clarification of the “pain neuroscience education” concept in the management of patients with persistent low back pain: A scoping review’, Journal of Back and Musculoskeletal Rehabilitation. Available at: https://doi.org/10.3233/BMR-220370.
Aherin B. R. (2023) The Effects of the Online Jing MethodTM of Advanced Clinical Massage on Mental Health in Adults. BTEC L6 Research Project. Jing Institute of Massage and Complementary Medicine.
Allen D. L. (2021) The Moderating Effects of Online Self-Care Massage on Academic Burnout in a University Student Population. BTEC L6 Research Project. Jing Institute of Massage and Complementary Medicine.
Barbari, V. and Storari L. and Ciuro A. and Testa M.(2020) ‘Effectiveness of communicative and educative strategies in chronic low back pain patients: A systematic review’, Patient Education and Counseling, 103(5), pp. 908–929. Available at: https://doi.org/10.1016/J.PEC.2019.11.031.
Bardin, L.D.K.P.M.C.G. (2017) ‘Diagnostic triage for low back pain: a practical approach for primary care’, The Medical journal of Australia, 206(6), pp. 268–273.
Bolton J. E. (2004) ‘Sensitivity and specificity of outcome measures in patients with neck pain: detecting clinically significant improvement’, Spine, 29(21).
Bolton, J.E. and Breen, A.C. (1999) ‘The Bournemouth questionnaire: A short-form comprehensive outcome measure. I. Psychometric properties in back pain patients’, Journal of Manipulative and Physiological Therapeutics, 22(8), pp. 503–510. Available at: https://doi.org/10.1016/S0161-4754(99)70001-1.
Borell-Carrió, F., Suchman, A.L. and Epstein, R.M. (2004) ‘The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry’, Annals of Family Medicine. Available at: https://doi.org/10.1370/afm.245.
Williams C. (2021) A double-blind randomised trial to assess the efficacy of Jing Advanced Clinical Massage and Earthing as interventions in the treatment of chronic low back pain. BTEC L6 Research Project. Jing Institute of Massage and Complementary Medicine.
Ceulemans, D. and Moens M. and Reneman M. and Callens J. and Smedt A. and Godderis L. and Goudman L. and Lavreysen O. and Putman K. and VAN DE VELDE D. (2024) ‘M BIOPSYCHOSOCIAL REHABILITATION IN THE WORKING POPULATION WITH CHRONIC LOW BACK PAIN: A CONCEPT ANALYSIS’, Journal of Rehabilitation Medicine. Available at: https://doi.org/10.2340/jrm.v56.13454.
Chen, S. and Chen M. andWu X. and Lin S. and Tao C. and Cao H. and Shao Z. and Xiao G. (2022) ‘Global, regional and national burden of low back pain 1990–2019: A systematic analysis of the Global Burden of Disease study 2019’, Journal of Orthopaedic Translation. Available at: https://doi.org/10.1016/j.jot.2021.07.005.
Crawford, C. Boyd C. and Paat C. and Price A. and Xenakis L. and Yang E. and Zhang W. (2016) ‘INTEGRATVIVE MEDICINE SECTION The Impact of Massage Therapy on Function in Pain Populations-A Systematic Review and Meta-Analysis of Randomized Controlled Trials: Part I, Patients Experiencing Pain in the General Population’, Pain Medicine, 17, pp. 1353–1375. Available at: https://doi.org/10.1093/pm/pnw099.
Cuenca-Martínez, F., Cortés-Amador, S. and Victoria Espí-López, G. (2018) ‘Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review’. Available at: https://doi.org/10.1298/ptr.E9937.
Cui, D. (2023) ‘Randomized-controlled trial assessing a digital care program versus conventional physiotherapy for chronic low back pain’, npj Digital Medicine, 6(1). Available at: https://doi.org/10.1038/s41746-023-00870-3.
Daren, D. and Forward, P. (2008) Synopsis of Causation Low Back Pain.
Eaves, E.R. Sherman K. and Ritenbaugh C. and Hsu C. and Nichter M. and Turner J. and Cherkin D. (2015) ‘A qualitative study of changes in expectations over time among patients with chronic low back pain seeking four CAM therapies’, BMC Complementary and Alternative Medicine, 15(1). Available at: https://doi.org/10.1186/s12906-015-0531-9.
Fairweather, R. and Mari, M. (2015) Massage Fusion. 3rd edn. Edited by Serena Wolfaard. Handspring Publishing Limited.
Furlan, A.D. Giraldo M. and Baskwell A. and Irvin E. and Imamura M. (2015) (12). Available at: https://doi.org/10.1002/14651858.CD001929.PUB3.
George, S.Z. and Zeppieri, G. (2009) ‘Physical therapy utilization of graded exposure for patients with low back pain’, Journal of Orthopaedic and Sports Physical Therapy, 39(7), pp. 496–505. Available at: https://doi.org/10.2519/JOSPT.2009.2983.
Hartvigsen, J. Hancock M. andKonsted A. and Louw Q. and Ferreira M. and Genevay S. Hoy D. and Karpinen J. Pranksky G. et al, (2018) ‘What low back pain is and why we need to pay attention’, The Lancet, 391(10137), pp. 2356–2367. Available at: https://doi.org/10.1016/S0140-6736(18)30480-X.
Hernandez-Lucas, P. and Leirós-Rodríguez R. and Lopez-Barreiro J. and García-Soidán J. and Leiros-Rodrıguez R. (2022) ‘Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis’. Available at: https://doi.org/10.1080/07853890.2022.2140453
Jones-Morris , L. (2021) Effect of the Jing method of advanced clinical massage on non-specific low back pain and anxiety in community midwives. BTEC L6 Research Project. Jing Institute of Massage and Complementary Medicine.
Kenny, T.and Tidy, C. (2016) ‘Nonspecific Lower Back Pain in Adults’. NHS, [Online], Available at: https://assets.practice365.co.uk/wpcontent/uploads/sites/419/2021/05/Lower_back_pain_pil.pdf (accessed 4 November 2025)
Lebert, R. Noy M. and Purves E. Tibbett J. (2022) ‘Massage Therapy: A Person-Centred Approach to Chronic Pain’, International Journal of Therapeutic Massage and Bodywork: Research, Education, and Practice, 15(3). Available at: https://doi.org/10.3822/ijtmb.v15i3.713.
Lotze, M., Moseley, G Lorimer and Moseley, G L (2015) ‘Theoretical Considerations for Chronic Pain Rehabilitation’. Available at:
https://academic.oup.com/ptj/article/95/9/1316/2686518 (Accessed: 8 May 2024).
Lowe, W. (2023) Massage in Pain Management, Massage Magazine. Available at: https://www.massagemag.com/massage-in-pain-management-142109/ (Accessed: 16 May 2024).
Moseley, G. Lorimer and Butler, D.S. (2015) ‘Critical Review Fifteen Years of Explaining Pain: The Past, Present, and Future’, American Pain Society: The Journal of Pain, 16(9). Available at: https://doi.org/10.1016/j.jpain.2015.05.005.
NHS (2021) Management of Low back pain and Sciatica in primary care. [Online]. Available at:https://www.derbyshiremedicinesmanagement.nhs.uk/assets/Clinical_Guidelines/Formulary_by_BNF_chapter_prescribing_guidelines/BNF_chapter_10/Low_back_pain_and_sciatica.pdf (Accessed: 8 May 2024).
NHS England (2024) Digital productivity fund. [Online]. Available at: https://transform.england.nhs.uk/key-tools-and-info/digital-productivity/digital-productivity-fund/ (Accessed: 9 December 2024).
Otero-Ketterer, E. Peñacoba-Puente C. and Ferreira Pinheiro-Araujo C. and Valera-Calero J. and Ortega-Santiago R. (2022) ‘Biopsychosocial Factors for Chronicity in Individuals with Non-Specific Low Back Pain: An Umbrella Review’, International journal of environmental research and public health, 19(16). Available at: https://doi.org/10.3390/IJERPH191610145.
Parkinson, J., Mackie, R. and Parrott, R. (2021) ‘Physio Near Me: Are virtual outpatient musculoskeletal (MSK) physiotherapy appointments an effective way to assess and manage patients?’, Physiotherapy, 113. Available at: https://doi.org/10.1016/j.physio.2021.10.146.
Preston K. (2021) A Positive way forward for Massage Therapists: An Exploration of Literature that suggests a Therapeutic Alliance can be built Online in the Rehabilitation of Low back pain sufferers. BTEC L6 Research Project. Jing Institute of Massage and Complementary Medicine.
Rujipong, P. Kantaruksa K. Chaloumsuk N. and Yothayai C. (2021) ‘Pain Self-Management Strategies of Chronic Back Pain Sufferers in Thailand: A Qualitative Study (A Doctoral Project)’, The Open Nursing Journal, 15(1). Available at:https://doi.org/10.2174/1874434602115010085.
Shahidi, B. Padwal J. and Lee E. and Xu R. Northway S. and Taitano L. and Wu T. and Raiszadeh K. (2022) ‘Factors impacting adherence to an exercise-based physical therapy program for individuals with low back pain’, PLoS ONE, 17(10 October). Available at: https://doi.org/10.1371/journal.pone.0276326.
Sheppard, D. (2018) Examining the effects of therapeutic alliance on pain outcomes when using different communication styles to teach and support participants through a core rehabilitation programme. BTEC L6 Research Project. Jing Institute of Massage and Complementary Medicine.
Shipton, E.A. (2018) ‘Physical Therapy Approaches in the Treatment of Low Back Pain’, Pain and Therapy. Available at: https://doi.org/10.1007/s40122-018-0105-x.
De Souza, L. and Oliver Frank, A. (2011) ‘Patients’ experiences of the impact of chronic back pain on family life and work’, Disability and Rehabilitation, 33(4), pp. 310–318. Available at: https://doi.org/10.3109/09638288.2010.490865.
Tom, A. and Rajkumar E. and John R. George A. (2022) ‘Determinants of quality of life in individuals with chronic low back pain: a systematic review’, Health Psychology and Behavioral Medicine, 10(1), pp. 124–144. Available at: https://doi.org/10.1080/21642850.2021.2022487.
Trivedi, H., Avrit T. and Chan L. and Burchette D. and Rathore R. (2022) ‘The Benefits of Integrative Medicine in the Management of Chronic Pain: A Review’, Cureus [Preprint]. Available at: https://doi.org/10.7759/cureus.29963.
Tsao, J.C.I. (2007) ‘Effectiveness of massage therapy for chronic, non-malignant pain: A review’, Evidence-based Complementary and Alternative Medicine. Available at: https://doi.org/10.1093/ecam/nel109.
Turci, A.M. Nogueira C. and Cristina H. and Carrer N. and Chaves C. (2023) ‘Self-administered stretching exercises are as effective as motor control exercises for people with chronic non-specific low back pain: a randomised trial’, Journal of Physiotherapy, 69, pp. 93–99. Available at: https://doi.org/10.1016/j.jphys.2023.02.016.
Unison (2025). [Online} Available at: https://www.unison.org.uk/get-help/knowledge/health-and-safety/back-pain/ (accessed 7th October 2025)
Varallo, G. Giusti E. and Scarpina F. and Cattivelli F. and Capodaglio P. and Castelnuovo G. (2021) ‘The association of kinesiophobia and pain catastrophizing with pain-related disability and pain intensity in obesity and chronic lower-back pain’, Brain Sciences, 11(1). Available at: https://doi.org/10.3390/brainsci11010011.
Villatoro-Luque, F.J. Rodríguez-Almagro D. and Aibar-Almazán A. and Fernández-Carnero S.and Pecos-Martín D. Ibáñez-Vera A. and Castro-Martín E. and Achalandabaso-Ochoa A. (2023) ‘Telerehabilitation for the treatment in chronic low back pain: A randomized controlled trial’, https://doi.org/10.1177/1357633X231195091 [Preprint]. Available at: https://doi.org/10.1177/1357633X231195091.
Wade, D.T. and Halligan, P.W. (2017) ‘The biopsychosocial model of illness: A model whose time has come’, Clinical Rehabilitation, 31(8), pp. 995–1004. Available at: https://doi.org/10.1177/0269215517709890.
WHO (2023) Low Back Pain. [Online]. Available at: https://www.who.int/news-room/fact-sheets/detail/low-back-pain (Accessed: 10 June 2024).
Yang, H. and Wang X. and Wang X. and Yang J. and Zhang W. and Ding Y. and Sang T. and Chen W. and Wang W. (2023) ‘Effect of mindfulness-based mind-body therapies in patients with non-specific low back pain—A network meta-analysis of randomized controlled trials’, Frontiers in Aging Neuroscience, 15. Available at: https://doi.org/10.3389/FNAGI.2023.1148048/FULL.
