Interventions for LBP: Difference between revisions
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== Exercise Therapy == | == Exercise Therapy == | ||
There is now relatively large consensus across the various guidelines that specific back exercises (as opposed to the advice to stay active, including for example walking, cycling) are not recommended for patients with acute low back pain<ref name="Koes" />. There are now also<br>more firm recommendations in favour of exercise therapy in patients with subacute and chronic low back pain<ref name="Koes" /> but there is no evidence that one form of exercise is superior to another<ref name="Koes" />. | There is now relatively large consensus across the various guidelines that specific back exercises (as opposed to the advice to stay active, including for example walking, cycling) are not recommended for patients with acute low back pain<ref name="Koes" />. There are now also<br>more firm recommendations in favour of exercise therapy in patients with subacute and chronic low back pain<ref name="Koes" /> but there is no evidence that one form of exercise is superior to another<ref name="Koes" />. | ||
NICE Guidelines<ref name="NICE" /> recommend offering a structured exercise programme tailored to the person. | NICE Guidelines<ref name="NICE" /> recommend offering a structured exercise programme tailored to the person. Exercise programmes may include aerobic activity, movement instruction, muscle strengthening, postural control and& stretching. They should comprise up to a maximum of eight sessions over a period of up to 12 weeks, a group supervised exercise programme in a group of up to 10 people or one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person. | ||
== Manual Therapy == | == Manual Therapy == | ||
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Education[edit | edit source]
Many guidelines suggest education and advice as a key intervention strategy[1][2][3][4]. The common message is that patients should be reassured that they do not have a serious disease, that they should stay as active as possible and progressively increase their activity levels.
The NICE Guidelines[1] summarise many of the available guidelines and state the following:
- Provide people with advice and information to promote self-management of their low back pain.
- Offer educational advice that includes information on the nature of non-specific low back pain and encourages the person to be physically active and continue with normal activities as far as possible.
- Include an educational component consistent with this guideline as part of other interventions, but do not offer stand-alone formal education programmes.
- Take into account the person's expectations and preferences when considering recommended treatments, but do not use their expectations and preferences to predict their response to treatments.
- Advise people with low back pain that staying physically active is likely to be beneficial.
- Advise people with low back pain to exercise.
The STarT Back Approach also has some advice for us when educating individuals with LBP:
Language and labels
- Use functional explanations for pain (sprained back, non-serious back pain). Example: “Many people have back pain from time to time but it is rare for this to be caused by a specific problem. Mostly all that is needed is to get your back moving again and things will settle down.
- ”Avoid “spondylitis, degeneration, crumbling” etc.
- Can be more specific sometimes, for example sciatica, if this leads to specific management.
- Avoid investigating in the first place unless it is specifically indicated. However if you do so be aware that the technical terms used in reports often alarm patients. Translate appropriately, examples: “normal for your age ”, “ the changes seen on your scan are like getting grey hair or wrinkles as you get older”
Dealing with distress
- Suspend pre-judgment
- Listen carefully / summarize points
- Plan to address points
- Care with language and labels
- Be honest and realistic
- Do not criticize the opinions of other clinicians who have seen the patient.
- Provide information
Activity promotion
- Activity promotion: beneficial, hurt doesn’t equal harm, minimise bed rest
- Pacing: short, frequent bouts of activity rather than overdoing things and then regretting it the next day, rests between activity, do less than maximal capabilities and increase as tolerated.
- Return to work as soon as possible, prolonged absence likely to lead to loss of employment. Use fit notes to support return to work and communicate suggestions to the employer. Help the patient negotiate an early return to work if at all possible.
Exercise Therapy[edit | edit source]
There is now relatively large consensus across the various guidelines that specific back exercises (as opposed to the advice to stay active, including for example walking, cycling) are not recommended for patients with acute low back pain[3]. There are now also
more firm recommendations in favour of exercise therapy in patients with subacute and chronic low back pain[3] but there is no evidence that one form of exercise is superior to another[3].
NICE Guidelines[1] recommend offering a structured exercise programme tailored to the person. Exercise programmes may include aerobic activity, movement instruction, muscle strengthening, postural control and& stretching. They should comprise up to a maximum of eight sessions over a period of up to 12 weeks, a group supervised exercise programme in a group of up to 10 people or one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.
Manual Therapy[edit | edit source]
Manual Therapy refers to spinal manipulation (a low-amplitude, high-velocity movement at the limit of joint range that takes the joint beyond the passive range of movement), spinal mobilisation (joint movement within the normal range of motion) and massage (manual manipulation or mobilisation of soft tissues).
The recommendations regarding spinal manipulation continue to show some variation. In some guidelines manipulation is recommended, or presented as a therapeutic option, usually for short-term benefit, but others do not recommend it[3]. The reason for these differences is probably that the underlying evidence is not strong enough to result in similar reccomendations regarding manipulation across all guidelines, leaving more room for interpretation. There may also be local and political reasons involved.
The NICE guidelines recomend Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks in early management of non-specific LBP[1].
Electrotherapy[edit | edit source]
Guidelines suggest that electrotherapy modalities (laser, interferrential, ultrasound, TENS) are not appropriate for non-specific low back pain[3][1]
Cognitive Behavioural Therapy[edit | edit source]
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Low back pain: Early management of persistent non-specific low back pain. NICE guidelines [CG88], May 2009
- ↑ Hill J, D Whitehurst, Lewis M, Bryan S, Dunn K, Foster N, Konstantinou, Main C, Mason E, Somerville S, Sowden G, Vohora K, Hay E. A randomised controlled trial and economic evaluation of stratified primary care management for low back pain compared with current best practice: The STarT Back trial.The Lancet, Volume 378, Issue 9802, Pages 1560 - 1571, 29 October 2011
- ↑ 3.0 3.1 3.2 3.3 3.4 3.5 Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075–94
- ↑ Anthony Delitto, Steven Z. George, Linda Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Joseph J. Godges. Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association. Journal of Orthopaedic and Sports Physical Therapy, 2012, 42(4)
