Welcome back to SpineIQ’s BackBlog! This week, we would like to highlight a new clinical practice guideline published by the Academy of Orthopaedic Physical Therapy in the Journal of Sports Physical Therapy. This is an update of the 2012 version of the guideline. It is important to continuously update and revise clinical practice guidelines because the evidence suggests that guideline concordant care is more effective, cost-effective, and leads to more patient satisfaction compared to guideline nonconcordant care. This clinical practice guideline focused specifically on evidence of interventions provided by physical therapists in randomized controlled trials. However, these recommendations are important for every clinician as nonpharmacologic interventions should be first-line care for low back pain. These recommendations are based on level 1 or 2 randomized controlled trial evidence. Additionally, they are graded as should use (A grade), may use (B grade), and can use (C grade).
Acute low back pain
- Clinicians should use thrust or non-thrust joint mobilization
- Clinicians may use treatment-based classifications
- Clinicians may use active education (e.g., one-on-one education on biopsychosocial factors)
- Clinicians can use exercise
- Clinicians can use massage or soft tissue mobilization
- Clinicians can use mechanical diagnosis and therapy
Acute low back pain with leg pain
- Clinicians may use exercise
Chronic low back pain
- Clinicians should use exercise
- Clinicians should use thrust or non-thrust joint mobilization
- Clinicians should use pain neuroscience education in conjunction with other treatments
- Clinicians may use soft tissue mobilization or massage in conjunction with other treatments
- Clinicians may use mechanical diagnosis and therapy, prognostic risk stratification, or pathoanatomic-based classification
- Clinicians may use standard education (e.g., advice about staying active)
- Clinicians can consider dry needling in conjunction with other treatments
- Clinicians can use treatment-based classification, cognitive functional therapy, or movement system impairment
Chronic low back pain with leg pain
- Clinicians may use exercise
- Clinicians may use thrust or non-thrust joint mobilizations
- Clinicians may use neural mobilization in conjunction with other treatments
- Clinicians should not use mechanical traction
Chronic low back pain in older adults
- Clinicians should use exercise
Postoperative low back pain
- Clinicians may use general education (e.g., advice to stay active)
- Clinicians can use exercise
Conclusion
Low back pain is the leading cause of disability and non-pharmacological interventions should be first line use for patients with acute, chronic, and postoperative low back pain. This clinical practice guideline provides clinicians a clear synthesis of the current evidence surrounding care for low back pain and allows clinicians to use multiple different tools from their toolbox to address the patient in front of them. It is important to note that clinical practice guidelines are meant to do just that – provide guidance. They are not meant to be prescriptive nor used as the standard of care. Clinicians should always use any guideline in conjunction with their clinical experience and patient preference to decide what interventions are best for each patient through a shared decision-making process.