Welcome back to SpineIQ’s Back Blog! Last week, we discussed the opportunities of using text messaging to collect patient reported outcome measures from your patients. This week, we are going to discuss the possibilities of using text messaging as treatment for your patients!


Text messaging is the most studied mobile health intervention. Studies have reported that patients feel text messaging is cost-effective, useful, and easy to understand.1,2 Additionally, text messaging has been successfully used in many health conditions including, diabetes and cardiovascular disease.3,4 The majority of patients experiencing low back pain report text messages about things to do for their pain report that the text messages are informative, motivational, and want to continue receiving them.5

Ideas for clinicians

Low back pain Clinical Practice Guidelines consistently recommend that patients are given self-management strategies to use for their low back pain.6 However, clinicians routinely report that encouraging self-management strategies can be time consuming and difficult.7 A potential strategy to mitigate this problem is using text messaging that can be automated in order to reduce clinician time burden in promoting self-management for low back pain. There are websites/programs such as eztexting that allow the user to plan and automate text messages to be sent out. A few studies have reported positive impact of adding text message delivered low back pain self-management to usual care for patients with low back pain.8 The table below are some ideas of potential information that can be delivered through text messaging that will help increase self-management by patients with low back pain.


Topic Example
Back pain facts Exercise is safe and healthy for your spine even if you experience some pain or discomfort
Back pain education Too much bed rest may be detrimental for your back pain so try moving in tolerable amounts and directions.
Multifactorial nature of back pain Back pain can increase due to many different factors such as stress or lack of sleep. More back pain does not mean damage is done.
Back pain motivation Doing things you enjoy even with back pain can be beneficial so try to continue doing enjoyable tasks such as spending time with friends and family.
Back pain fun facts Did you know that most back pain resolves within 6 weeks and people rarely need surgery or imaging?
Reminder to walk Walking can be beneficial for back pain. Your phone tracks how many steps you’ve taken recently. Try increasing it a little bit (~500-1000 steps) from your current average.
Home exercise program Exercise is one of the best ways to treat back pain. Remember to do your home exercise program.



While text messaging will never replace in person treatment for back pain. It has been shown to be a potential way to supplement current treatment plans and increase patient self-management. The ability to automate text messages allows this to be a high value, low burden addition to clinicians! Try it out and let us know what you think!



  1. Redfern J, Santo K, Coorey G, et al. Factors Influencing Engagement, Perceived Usefulness and Behavioral Mechanisms Associated with a Text Message Support Program. PloS One. 2016;11(10):e0163929. doi:10.1371/journal.pone.0163929
  2. Burn E, Nghiem S, Jan S, et al. Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events. Heart Br Card Soc. 2017;103(12):893-894. doi:10.1136/heartjnl-2016-310195
  3. Chow CK, Redfern J, Hillis GS, et al. Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease: A Randomized Clinical Trial. JAMA. 2015;314(12):1255-1263. doi:10.1001/jama.2015.10945
  4. Tailored mobile text messaging interventions targeting type 2 diabetes self-management: A systematic review and a meta-analysis – Cigdem Sahin, Karen L Courtney, PJ Naylor, Ryan E Rhodes, 2019. Accessed December 8, 2021. https://journals.sagepub.com/doi/full/10.1177/2055207619845279
  5. Fritsch CG, Ferreira PH, Prior JL, et al. TEXT4myBACK: A Text Message Intervention to Improve Function in People With Low Back Pain-Protocol of a Randomized Controlled Trial. Phys Ther. 2021;101(7):pzab100. doi:10.1093/ptj/pzab100
  6. Qaseem A, Wilt TJ, McLean RM, Forciea MA, Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530. doi:10.7326/M16-2367
  7. Kamper SJ, Logan G, Copsey B, et al. What is usual care for low back pain? A systematic review of health care provided to patients with low back pain in family practice and emergency departments. Pain. 2020;161(4):694-702. doi:10.1097/j.pain.0000000000001751
  8. Sandal LF, Bach K, Øverås CK, et al. Effectiveness of App-Delivered, Tailored Self-management Support for Adults With Lower Back Pain-Related Disability: A selfBACK Randomized Clinical Trial. JAMA Intern Med. 2021;181(10):1288-1296. doi:10.1001/jamainternmed.2021.4097