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Is a Back Pain App Worth Paying For?

I built a back pain app, so I have a stake in this answer. Read the page with that in mind and check the numbers yourself.

YouTube is free, and the exercises in any decent back program fit on one printed page (mine does). What a paid app can add is the part between sessions: remembering what you did, reading how your back answered the next morning, and deciding whether the next session should be easier, the same, or harder. Whether that is worth money depends on whether that part is where you have fallen off before.

What a clinician does that an app cannot

A physical therapist or doctor takes a history, examines you, screens for problems that need medical care, and adjusts the plan to what they find. Software cannot examine you. If you have never been assessed, or you are unsure what your symptoms mean, spend the money there first.

What clinic visits cost varies widely with where you live, your insurance, your deductible, and how many visits you need, so check your own numbers. For an app, count the full price after any trial, including renewals.

Where home programs fall apart

The trouble usually starts after discharge, when the plan that worked under supervision becomes a printout on the fridge. Beinart and colleagues' 2013 review of home exercise in chronic low back pain opens by noting that up to 70% of patients do not do their prescribed home exercise. Supervision, taking part in an exercise program, and behavior change support with motivational strategies were among the factors linked with better adherence.

When I drifted off home programs, I still believed in the exercises. What wore me down was deciding the dose every day with nobody to ask. That decision is the part an app can take over.

The evidence for apps is thin

Evidence that exercise helps chronic low back pain in general (Searle and colleagues pooled 39 trials in 2015) does not show that any particular app works. Machado and colleagues reviewed back pain apps in 2016. Most chose treatments that guidelines endorse, but content quality was low and none had been rigorously tested for effects on patients. Newer apps exist, so look for studies of the specific product. Low Back Pain Coach has not been tested in a trial, and the exercise research behind it is general.

What Low Back Pain Coach costs

It is a free download with one free guided first session. After that it is $9.99 a month or $59.99 a year, each with a 7-day free trial for eligible new subscribers (US prices). Subscriptions renew until you cancel in App Store or Google Play settings. For that you get sessions set from your recent workouts and next-morning pain logs, a voice that counts holds and reps, a pain log with graphs, flare-up mode, and a PDF report for your clinician. Your pain and training data stay on the phone unless you choose to sign in to sync or turn on a backup.

A notebook and a kitchen timer can run the same program for nothing. The 4-week log example shows how.

When I would skip the purchase

• Something on the red flags list applies. Get care first: emergency care now for the emergency signs, a clinician today for the others.
• You have not been assessed. See a clinician first.
• A clinician who examined you gave you a plan that conflicts with the app. Talk to them first.
• You want hands-on care or a standing appointment. An app does not notice a skipped week the way a person does.
• Your last self-run program lasted three months or more. A notebook will probably do.

Test it during the trial

Plan two sessions in the trial week. Check whether the instructions are clear, whether logging takes seconds or minutes, and what the app does when your pain goes up. Read what health data it collects and how to delete it. Note the renewal date and set a reminder. If you have not opened the app by day five, cancel.

The app