Cognitive Functional Therapy

Cognitive functional therapy for low back pain is presented as a multidimensional approach that goes beyond biomechanics alone. It begins with a simple distinction between two broad patient patterns: one dominated by tension, guarding, and fear-avoidance, and another with low tone and poor spinal control. From there, the focus shifts to identifying the main drivers of pain, including lifestyle, movement habits, beliefs, emotions, social factors, general health, and sensitivity. A central idea is that many people with chronic back pain move in a stiff, guarded way that increases compression and pain. Treatment emphasizes pain education, careful communication, and practical experiences that show patients they can move safely and with less pain. Relaxation, breathing, reducing muscle overactivity, and gradually exposing patients to feared movements such as bending, sitting, standing up, lifting, and weight bearing are key strategies. The approach also highlights the importance of avoiding stigma, building trust, and supporting self-efficacy. Manual contact may still be used, but mainly to guide safer movement rather than to provide passive treatment.