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Treatment Based Classification System

Despite all the advancements in medical imaging over the past few decades, the United States has failed to see improvement in its treatment of low back pain. The cost and burden of low back pain are at an all-time high and show no signs of improving.

X-rays and MRIs are great for ruling out “red flags” (which we will discuss more in this report), however, they are not great for identifying what tissue is specifically responsible for low back pain. For more information on this, please see the “Information about Medical Imaging and Associated Harms” section of this report.

For this reason, once “red flags” are ruled out, it is more important to identify those more likely to respond favorably to specific treatments than it is trying to play the guessing game of naming the tissue structure responsible for your low back pain.

The primary patient classifications used are as follows:

  • Spinal manipulation and exercise
  • Directional preference
  • Motor control/strengthening

These categories are by no means perfect, but have been shown to result in better patient outcomes than not using a classification approach. Like everything we will do in physical therapy, we will continuously monitor your progress towards your goals and make adjustments when needed.

We will discuss the each of these categories in greater detail in this report.


  1. Alrwaily, M., Timko, M., Schneider, M., Stevans, J., Bise, C., Hariharan, K. and Delitto, A., 2016. Treatment-Based Classification System for Low Back Pain: Revision and Update. Physical Therapy, 96(7), pp.1057-1066.
  2. Fritz, J., Cleland, J. and Childs, J., 2007. Subgrouping Patients With Low Back Pain: Evolution of a Classification Approach to Physical Therapy. Journal of Orthopaedic & Sports Physical Therapy, 37(6), pp.290-302.
  3. Fritz, J., Delitto, A. and Erhard, R., 2003. Comparison of Classification-Based Physical Therapy With Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain. Spine, 28(13), pp.1363-1371.

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