Current Trends for Physical Therapy Management of Low Back Pain Based on Newest Clinical Practice Guideline

As research develops it guides our treatment for best practice and effective interventions to provide patients. These recommendations are compiled into Clinical Practice Guidelines which are meant to provide evidence-based guidelines for treating different diagnoses. When discussing low back pain, these guidelines are separated into subgroups of acute low back pain and chronic low back pain (back pain for >3 months). The following will discuss the best practice for both of these.  

Acute Low Back Pain

Physical Therapists may use treatment-based classifications (based on findings of the evaluation) for determining appropriate interventions to decrease pain and disability with acute low back pain. Treatment should include manual therapy with use of thrust and non-thrust mobilizations to decrease pain and disability and/or massage and soft -tissue mobilization for short-term pain relief. In combination with manual techniques, treatment sessions can also include exercise training interventions, with specific trunk muscle activation. Education will be provided on the biopsychosocial contributors to pain and self-management techniques, such as remaining active, pacing strategies and back-protection techniques. Modalities, including heat, ice, ultrasound and TENs, do not have strong evidence for use in treatment of acute low back pain. 

Chronic Low Back Pain

Treatment for chronic low back pain will focus on a combination of manual techniques and exercise. Thrust and non thrust mobilizations are effective in decreasing pain and disability while massage and soft-tissue mobilization are effective in decreasing pain in the short-term. Neural mobilizations may be used in patients with leg pain for short-term relief from pain. There should be a high focus on exercise with a combination of specific trunk muscle activation and movement control training along with general and aerobic exercise. In regards to modalities, dry needling in conjunction with other interventions has been found effective in short-term pain relief. Physical therapists should deliver pain neuroscience education alongside other physical therapy interventions, such as exercise or manual therapy, to patients with chronic low back pain. It is recommended that traction should not be used in chronic low back pain with leg pain due to lack of benefit when added to other interventions.

Reference:

1. George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304