Is physical therapy more beneficial than usual care in improving acute axial back pain? Although this is not a common problem seen in neurosurgery or spine surgery clinics it is definitely a commonly asked question by our primary care colleagues. Fritz et al.1randomized patients with acute axial back pain (<16 days) into an early physical therapy (n=108) or usual treatment group (n=112). The early PT group started PT within 3 days of enrolling in the study. Both groups improved over time with an improvement of over 30 points on the Oswestry Disability Index, with a statistically significant but not clinically significant earlier improvement in the early physical therapy group compared to the usual treatment group. This paper provides level 1 evidence that patients with acute axial low back pain do not necessarily need or benefit from early physical therapy. The question of which subgroup of patients may benefit from physical therapy remains unanswered.