Integrative and Lifestyle Medicine for Back Pain: A Brief Case Study

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Ziya “Z” Altug, PT, DPT, MS, OCS, is instructing his course, Integrative and Lifestyle Medicine Toolbox, scheduled for July 29. This remote course covers a toolbox approach for creating clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, expressive and art-based therapies, and nature-based therapies.

Ziya is a Board-Certified Orthopedic Clinical Specialist and a Doctor of Physical Therapy with 32 years of experience treating musculoskeletal conditions. He utilizes lifestyle and integrative medicine strategies in his clinical practice. Ziya is the author of Integrative Healing: Developing Wellness in the Mind and Body (Cedar Fort, Inc, 2018). He has been a longstanding member of the American Physical Therapy Association for the past 29 years and a member of the American College of Lifestyle Medicine since 2017. He is finishing the book Lifestyle Medicine Toolbox (Jessica Kingsley Publishers, London) for publication in early 2024.

Ziya's book Lifestyle Medicine Toolbox is available for pre-order on Amazon!

According to the ACSM’s Guidelines for Exercise Testing and Prescription (American College of Sports Medicine 2022) book from the American College of Sports Medicine, “exercise programs that incorporate individual tailoring, supervision, stretching, and strengthening, coupled with client preference and practitioner expertise, are associated with the best outcomes.”

The American College of Lifestyle Medicine defines lifestyle medicine as (American College of Lifestyle Medicine 2023), “Lifestyle medicine is the use of evidence-based lifestyle therapeutic approaches including:

    • a whole food, plant-based eating pattern
    • regular physical activity
    • restorative sleep
    • stress management
    • avoidance of risky substances
    • positive social connection
as a primary therapeutic modality, delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse chronic disease.”

Lifestyle medicine may play a role in managing chronic low back pain (Altug, 2021). For example, a retrospective longitudinal study by Roberts and colleagues (2022) found that “people who adopt optimal lifestyle behaviors and positive emotional factors are more likely to be resilient and maintain high levels of function despite suffering from low back pain.” Furthermore, a study by Williams and colleagues (2019) in the European Journal of Pain found that a healthy lifestyle intervention consisting of weight loss, physical activity, and diet may be cost-effective compared to usual care for managing chronic low back pain. Moreover, a cohort study by Bohman and colleagues (2014) found that healthy lifestyle behaviors appear to decrease the risk of back pain among women.

Case Study Patient Description:

The patient is a 50-year-old female referred to physical therapy by her family physician:

    • Primary Complaints: Gradual onset of back pain 2-8/10
    • Secondary Complaints: Shortness of breath with stairclimbing at home and fatigue with walking greater than 20 minutes
    • Past Medical History: Osteopenia, prediabetes, overweight
    • Pain History: Progressive back pain for the past 6 months with no known cause
    • Pain Aggravating Factors: Sitting greater than 30 minutes, walking greater than 15 minutes, bending to clean and refill the cat food dish
    • Pain Easing Factors: Resting in a reclining chair, self-massage to the back
    • Medications: Ibuprofen, as needed
    • Prior Therapy: None
    • Work History: Accountant for a large company. Performs mainly seated computer-related tasks. The patient has a one-hour commute to work in each direction.
    • Social History: She lives in a two-level home with her husband and two children. She volunteers at a community center on Saturdays.
    • Exercise History: No formal program
    • Lifestyle History: No smoking or alcohol use. The patient has difficulty sleeping greater than 5 hours secondary to work-related stress and long commute.


After a comprehensive assessment, a physical therapist treated the patient in the clinic and provided her with the following home program guidelines:

    • Exercise Program: Since the patient has a long commute, she did not have time to exercise after work. The patient was encouraged to initiate a short-bout outdoor walking program at work. She performed 10 minutes of walking in the morning upon arrival at work, 10 minutes of walking during lunch, and 10 minutes of walking as she returned to her car at the end of her workday. The therapist also instructed the patient in simple core stabilization exercises she could perform at her office.
    • Office Program: The patient was advised to stand and perform several stretches for one minute every 30 to 45 minutes. The patient also spoke to her supervisor and switched to remote work from her home twice weekly.
    • Sleep Hygiene Program: The patient was issued sleep hygiene guidelines to help improve sleep. She was instructed in a mindfulness meditation routine to be performed before bedtime.
    • Stress Management: Since the patient was saving four hours of commute time per week due to two days of remote work, she applied this time to work in her garden during the week and on the weekend. She found gardening and being in nature helped reduce her stress and improve her sleep.

In addition to the formal home program, the physical therapist encouraged the patient to consider creating a small home gym and take a cooking class at a local community college on the weekend to further establish sustainable, healthful habits.


After three months of following her home program instructions, the patient’s back pain decreased to 0-2/10 with activities of daily living, her body weight was reduced by 10 pounds, and she no longer had shortness of breath with stairclimbing and fatigue with walking. This case shows that simple and cost-effective clinical recommendations using the lifestyle medicine approach may effectively help treat back pain.


  1. Altug Z. Lifestyle medicine for chronic lower back pain: an evidence-based approach. Am J Lifestyle Med. 2021;15(4):425-433.
  2. American College of Lifestyle Medicine. Available at: Accessed May 2023.
  3. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription, 11th ed. Philadelphia, PA: Wolters Kluwer; 2022.
  4. Bohman T, Alfredsson L, Jensen I, Hallqvist J, Vingård E, Skillgate E. Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study. BMJ Open. 2014;4(12):e005713. 
  5. Roberts KE, Beckenkamp PR, Ferreira ML, et al. Positive lifestyle behaviours and emotional health factors are associated with low back pain resilience. Eur Spine J. 2022;31(12):3616-3626.
  6. Williams A, van Dongen JM, Kamper SJ, et al. Economic evaluation of a healthy lifestyle intervention for chronic low back pain: A randomized controlled trial. Eur J Pain. 2019;23(3):621-634.

Further Readings:

  1. Arippa F, Nguyen A, Pau M, Harris-Adamson C. Postural strategies among office workers during a prolonged sitting bout. Appl Ergon. 2022;102:103723.
  2. Jakicic JM, Kraus WE, Powell KE, et al. Association between bout duration of physical activity and health: a systematic review. Med Sci Sports Exerc. 2019;51(6):1213-1219.
  3. Madjd A, Taylor MA, Delavari A, Malekzadeh R, Macdonald IA, Farshchi HR. Effect of a long bout versus short bouts of walking on weight loss during a weight-loss diet: a randomized trial. Obesity (Silver Spring). 2019;27(4):551-558.
  4. Menardo E, Di Marco D, Ramos S, et al. Nature and mindfulness to cope with work-related stress: a narrative review.Int J Environ Res Public Health. 2022;19(10):5948.
  5. Rusch HL, Rosario M, Levison LM, et al. The effect of mindfulness meditation on sleep quality: a systematic review and meta-analysis of randomized controlled trials. Ann N Y Acad Sci. 2019;1445(1):5-16.

 Integrative and Lifestyle Medicine Toolbox

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Price: $125.00          Experience Level: Beginner          Contact Hours: 4.5 hours

Course Dates:  July 29, 2023

Description:  Brief lectures will focus on the research and resources and labs will cover a toolbox approach for creating clinically relevant pain, anxiety, depression, and stress management strategies using lifestyle medicine, integrative medicine, expressive and art-based therapies, and the impact of nature on health. Participants will be able to practice Tai Chi/Qigong, expressive and art-based therapies including Music, Dance, and Drama Therapy, nature and aromatic therapies, self-hypnosis, and self-massage.

This course was written and developed by Ziya “Z” Altug, PT, DPT, MS, OCS, a board-certified doctor of physical therapy with 32 years of experience in treating musculoskeletal conditions. Ziya utilizes lifestyle and integrative medicine strategies in his clinical practice. He is the author of the book Lifestyle Medicine Toolbox from Jessica Kingsley Publishers (London: United Kingdom, 2024). Ziya Altug is a member of the American Physical Therapy Association and the American College of Lifestyle Medicine. He has taken workshops in yoga, Pilates, tai chi, qigong, meditation, Feldenkrais Method, and the Alexander Technique.

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