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Utilizing Clinical Practice Guidelines for Treatment of Low Back Pain: Summary
• Moderate evidence/B: ○ Thrust and nonthrust joint manipulation to reduce pain and disability with chronic LBP + LE pain ○ Soft tissue mobilization to reduce pain and disability: ■ In conjunction with other treatments ■ Neural mobilization to reduce pain and disability for chronic LBP with leg pain ○ Dry needling to reduce pain and disability: ■ In conjunction with other treatments • Poor evidence/D: ○ Should not use traction with chronic LBP + leg pain due to lack of evidence of efficacy Key Points for Manual Therapy • Acute LBP: • Weak evidence/C: ○ Thrust/nonthrust joint mobilizations and soft tissue mobilization: Ssome evidence in reducing LBP ○ No evidence to support the use of other directed therapies • Chronic LBP: ○ Most studies support short-term effectiveness of interventions in this category ○ Traction not supported as being beneficial in treating chronic LBP + leg pain 3. Classification Systems • Mechanical diagnosis and therapy : Based on changes in low back pain (and/or lower extremity) symptoms in response to direction-specific repeated lumbar spine movements or sustained postures. Findings are used to classify clients into different syndromes (i.e., derangement, dysfunction, or postural) that guide the treatment approach
• Treatment-based classification : To guide initial treatment approach (manipulation, stabilization, specific exercise, or traction) based on specific initial assessment findings, including client history, clinical presentation, and physical examination • Movement system impairment: Based on impaired trunk movements and postures associated with LBP symptoms observed during a standardized examination. Test results are used to classify clients based on observed lumbar movement or alignment impairments (rotation, extension, flexion, rotation with extension, or rotation with flexion), with subgroup assignment guiding the initial treatment approach to match specific signs and symptoms • Cognitive functional therapy : Uses an integrated behavioral approach for individualizing the management of LBP. Pathoanatomical, physical, psychological, social, lifestyle, and health-related risk factors are assessed, with nonmodifiable barriers and a modifiable target for change identified to guide treatment based on three components (“making sense of pain,” “exposure with control,” and “lifestyle change”). Formerly called O’Sullivan’s classification system • Prognostic risk stratification : Identifies clients at different levels of risk for persistent pain (low, medium, high) using a multidimensional screening tool, with each risk category associated with different treatment pathways, for example, the STarT Back Tool • Pathoanatomic-based classification : Based on pathoanatomic-based findings from examination that could cause low back pain. Subgroups are defined by symptom location and response to examination procedures and used to guide the treatment approach
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