Confused About Which Evidence-Based Treatment To Use For Your Patients With Low Back Pain?

Written by Kyle Kiesel Wednesday, March 18, 2020 SFMA

Manipulation? TA draw-ins? Repeated movements? SI Correction? Rest? Walking? Stretching? Pain Education? Regional Interdependence?   

Feeling a bit confused on where to start with your patients who have low back pain(LBP)?

International Practice guidelines support manipulation and exercise but fall short to help you decide on what, when, and who. So what type of exercise?  For which type of patient and who and how should you manipulate?

Techniques such as pain science education, dry needling, and breathing re-training are popular, but should we apply these for every patient with LBP?  How do you decide?

Our new online and associated live course will answer these questions.  This course covers the current best evidence to exam and treat patients with LBP from a rehabilitation perspective. It is perfect for any rehabilitation professional who treats patients with LBP.  The course utilizes a category system to confirm you have chosen the best treatment approach for the patient in front of you. So rather than a one size fits all approach, this course will teach you how to quickly categorize your patient into one of 4 research-based categories, match the best evidence treatment to your patient today, and progress through a logical impairment and movement-based progression individualized to your patient.   

Watch your confusion disappear and your outcomes improve as you classify, treat, progress and discharge your patient’s with LBP following this model. 

Categorizing your patients into one of these four categories will allow you to determine for the focus of the initial treatment:  spinal manipulations and mobilizations, repeated flexion or extension exercises, stabilization and motor control exercises, or pain science education.

Once the category is identified and the initial treatment performed, the next step is to identify major movement impairment risk factors. To accomplish this, we utilize the Selective Functional Movement Assessment.

The SFMA is an individualized movement-based process that identifies the most prominent mobility and motor control impairments in your patient.  The SFMA Problems List is addressed in priority while keeping in mind your patients LBP category. 

This process allows you to treat your patient’s LBP from an evidence-based perspective while addressing major risk factors for musculoskeletal (MSK) health.  These can be done simultaneously. 

Lastly, we need to consider discharge testing to set our patients up for success.  Using evidence-based screening and testing tools, you will capture your patients current MSK status to ensure your home exercise and fitness prescription is targeted at major risk factors to maximize your patient’s MSK health and overall long-term wellness.

Get started today with a Clinical Overview: Approach into the Classification and Management of Patients with Low Back Pain Online

Selected References:
1. Alrwaily M, Timko M, Schneider M, et al. Treatment-Based Classification System for Low Back Pain: Revision and Update. Phys Ther. 2016;96(7):1057-1066. 
2. Browder DA, Childs JD, Cleland JA, Fritz JM. Effectiveness of an extension-oriented treatment approach in a subgroup of subjects with low back pain: a randomized clinical trial. Phys Ther. 2007;87(12):1608-1618; discussion 1577-1609. 
3. Cleland JA, Fritz JM, Kulig K, et al. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. Spine (Phila Pa 1976). 2009;34(25):2720- 2729. 
4. Ford, J. J. et al. Individualised physiotherapy as an adjunct to guideline-based advice for low back disorders in primary care: a randomised controlled trial. Br. J. Sports Med. 50, 237–245 (2016).
5. Fritz JM, Cleland JA, Childs JD. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290- 302. 
6. Kiesel KB, Uhl TL, Underwood FB, Rodd DW, Nitz AJ. Measurement of lumbar multifidus muscle contraction with rehabilitative ultrasound imaging. Man Ther. 2007;12(2):161- 166. 
7.  Oliveira, C.B., Maher, C.G., Pinto, R.Z. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27, 2791–2803 (2018).
8. Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A clinical prediction rule to identify patients with low back pain who are likely to experience short-term success following lumbar stabilization exercises: a randomized controlled validation study. J Orthop Sports Phys Ther. 2014;44(1):6-B13. 
9. Russo M., Deckers K., Eldabe S., Kiesel KB., Gilligan C., Vieceli J., Crosby P. 2018. Muscle
  Control and Non-specific Chronic Low Back Pain. Neuromodulation 2018; 21: 1–9.
10. Smart, K. M., Blake, C., Staines, A. & Doody, C. Clinical indicators of ‘nociceptive’,‘peripheral neuropathic’and ‘central’mechanisms of musculoskeletal pain. A Delphi survey of expert clinicians. Man. Ther. 15, 80–87 (2010)

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