Getting over back pain could be partly a case of mind over matter, researchers say.
All the patients had lower back pain
A team from Manchester who looked at patients with chronic lower back pain found patients benefited from a combination of exercise and psychological support.
Many had believed their lives had been curtailed because of their condition.
But giving them psychological support and advice enabled patients to overcome their back pain.
The researchers suggest psychological support could reduce the number of people being put onto waiting lists for scans and conventional therapy.
Many patients mistakenly believe that by exercising they are making their back worse
One woman in her 40s had been off work for two years and had a fear of carrying files.
Doctors taught her the fear was irrational and showed her how to lift files. She has now been able to go back to work.
Breaking avoidance cycle
Steve Woby of Manchester Metropolitan University studied the treatment of patients with back pain by North Manchester General Hospital.
He spent two years evaluating the hospital's programme which has been running since 1999, and which has treated more than 250 people.
The hospital's eight-week scheme encourages people to exercise, and also addresses their concerns about their back pain.
Patients are exposed to actions they may have a fear of, to break their pattern of avoidance and inactivity which can lead to further back problems
Dr Woby found psychological factors such as depression, fear and low-confidence were more important in prolonging patients' conditions than their physical incapacity.
He said: "Many conventional physiotherapy treatments, such as manipulation, won't address the psychological factors that influence back pain.
"But by studying the changes that occurred on certain psychological factors - depression, fear of movement and low confidence - we could accurately predict in three out of four cases which patients would overcome their incapacity.
"Until now, if someone is off work with back pain for three months, their chances of returning have been considered virtually nil."
Dr Woby added: "Many patients mistakenly believe that by exercising they are making their back worse.
"We teach that there is good pain and bad pain.
"By changing our beliefs we are giving them back control of their bodies and breaking the cycle of inactivity and depression, which often makes their back pain worse."
'Lack of confidence'
Vincent Cullen, spokesman for the General Osteopathic Council, said: "For some patients, psychological factors may assume a greater part to play in the cause of their back pain and these would be addressed by the osteopath who would attempt to 'enable' the patient.
"This 'enabling' may take the form of teaching the patient to deal with such factors as lack of confidence, fear of movement and avoidance of certain activities by self-help measures or, when necessary, by referring them to an appropriate healthcare practitioner where there is a serious psychological disorder."