Interventions for Management of Acute and Chronic Low Back Pain: Revised Guidelines
Low back pain (LBP) remains a musculoskeletal condition with an adverse societal impact. Globally, LBP is highly prevalent and a leading cause of disability
Academy of Orthopaedic Physical Therapy (AOPT) has updated it's 2012 guidelines on Interventions for management of Acute and chronic low back pain and the same has been published in the Journal of Orthopaedic & Sports Physical Therapy.
The overall objective of this update was to provide recommendations on interventions delivered by physical therapists or studied in care settings that included physical therapy providers. It also focused on synthesizing new evidence, with the purpose of making recommendations for specific nonpharmacologic treatments.
Summary of Recommendations
Exercise for Acute Low Back Pain
Physical therapists can use exercise training interventions, including specific trunk muscle activation, for patients with acute low back pain (LBP).
Exercise for Acute Low Back Pain With Leg Pain
Physical therapists may use exercise training interventions, including trunk muscle strengthening and endurance and specific trunk muscle activation, to reduce pain and disability for patients with acute LBP with leg pain.
Exercise for Chronic Low Back Pain
Physical therapists should use exercise training interventions, including trunk muscle strengthening and endurance, multimodal exercise interventions, specific trunk muscle activation exercise, aerobic exercise, aquatic exercise, and general exercise, for patients with chronic LBP.
Physical therapists may provide movement control exercise or trunk mobility exercise for patients with chronic LBP.
Exercise for Chronic Low Back Pain With Leg Pain
Physical therapists may use exercise training interventions, including specific trunk muscle activation and movement control, for patients with chronic LBP with leg pain.
Exercise for Chronic Low Back Pain With Movement Control Impairment
Physical therapists should use specific trunk muscle activation and movement control exercise for patients with chronic LBP and movement control impairment.
Exercise for Chronic Low Back Pain
Physical therapists should use exercise training interventions, including trunk muscle strengthening and endurance, multimodal exercise interventions, specific trunk muscle activation exercise, aerobic exercise, aquatic exercise, and general exercise, for patients with chronic LBP.
Physical therapists may provide movement control exercise or trunk mobility exercise for patients with chronic LBP.
Exercise for Chronic Low Back Pain With Leg Pain
Physical therapists may use exercise training interventions, including specific trunk muscle activation and movement control, for patients with chronic LBP with leg pain.
Exercise for Chronic Low Back Pain With Movement Control Impairment
Physical therapists should use specific trunk muscle activation and movement control exercise for patients with chronic LBP and movement control impairment.
Exercise for Chronic Low Back Pain in Older Adults
Physical therapists should use general exercise training to reduce pain and disability in older adults with chronic LBP.
Exercise for Postoperative Low Back Pain
Physical therapists can use general exercise training for patients with LBP following lumbar spine surgery.
Manual and Other Directed Therapies for Acute Low Back Pain
Physical therapists should use thrust or nonthrust joint mobilization to reduce pain and disability in patients with acute LBP.
Physical therapists may use massage or soft tissue mobilization for short-term pain relief in patients with acute LBP.
Manual and Other Directed Therapies for Chronic Low Back Pain
Physical therapists should use thrust or nonthrust joint mobilization to reduce pain and disability in patients with chronic LBP.
Physical therapists may use thrust or nonthrust joint mobilization to reduce pain and disability in patients with chronic LBP with leg pain.
Physical therapists may use soft tissue mobilization or massage in conjunction with other treatments to reduce pain and disability in the short term for patients with chronic LBP.
Physical therapists can consider the use of dry needling in conjunction with other treatments to reduce pain and disability in the short term for patients with chronic LBP.
Physical therapists may use neural mobilization in conjunction with other treatments for short-term improvements in pain and disability in patients with chronic LBP with leg pain.
Physical therapists should not use mechanical traction for patients with chronic LBP with leg pain, based on the lack of benefit when added to other interventions.
Classification Systems for Acute Low Back Pain
Physical therapists may use treatment-based classification (TBC) to reduce pain and disability in patients with acute LBP. This recommendation is unchanged from the 2012 clinical practice guideline.
Physical therapists can use Mechanical Diagnosis and Therapy (MDT) to reduce pain and disability in patients with acute LBP.
Classification Systems for Chronic Low Back Pain
Physical therapists may use MDT, prognostic risk stratification, or pathoanatomic-based classification to reduce pain and disability in patients with chronic LBP.
Physical therapists can use TBC, cognitive functional therapy, or movement system impairment to reduce pain and disability in patients with chronic LBP.
Education for Acute Low Back Pain
Physical therapists may use active education strategies rather than passive strategies (ie, providing access to educational materials only). Active education strategies include one-on-one education on the biopsychosocial contributors to pain and self-management techniques, such as remaining active, pacing strategies, and back-protection techniques. Physical therapists may also incorporate counseling on the favorable natural history of acute LBP as part of the education strategy.
Education for Chronic Low Back Pain
Physical therapists may use standard education strategies for patients with chronic LBP, but not as a stand-alone treatment. Standard education strategies include advice related to exercise and advice about staying active.
Physical therapists should deliver pain neuroscience education alongside other physical therapy interventions, such as exercise or manual therapy, to patients with chronic LBP.
Physical therapists should use active treatments (ie, yoga, stretching, Pilates, and strength training) instead of stand-alone educational interventions for patients with chronic LBP.
Education for Postoperative Low Back Pain
Physical therapists may use general education (ie, postsurgical precautions, exercise, and resuming physical activity) for patients with LBP following lumbar spine surgery. This recommendation applies to those undergoing discectomy or decompression surgery. No specific recommendation is provided for education for patients undergoing other surgical procedures (eg, spinal fusion) due to lack of evidence.
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