Physiotherapy well placed to provide specific back pain management, not just advice
Physiotherapy advice regarding management of LBP has long been recognised as effective (Indahl 1995) and recommended in clinical guidelines. Recent guidelines for LBP risk in manual handling settings (Petit 2015) identified at least moderate evidence for the following recommendations:
- Deliver reassuring and consistent information concerning LBP prognosis (moderate)
- Perform a clinical examination looking for medical signs of severity related to LBP (strong)
- Encourage continuation or resumption of physical activity (strong)
- For persistent/recurrent back pain, assess prognostic factors likely to influence progression to chronic LBP, prolonged disability and delayed return to work (strong)
- For prolonged/repeated sick leave from work, evaluate the pain, functional disability and their impact and main risk factors for prolonged work disability (strong)
Following the recent STOPS back pain trials, individualised physiotherapy combined with advice has been shown to be even more effective than advice alone. More specifically, management of pathoanatomical (eg: disc, facet joint and sciatica), psychosocial (eg: fear avoidance, anxiety and depression) and neurophysiological (eg: central sensitisation) barriers identified at assessment provides further benefit to the patient.
The above recommendations suggest that whilst educating the patient regarding prognosis and providing encouragement to remain active is important, also considering the risk factors for poor outcome will further assist.
Following the STOPS trials, a further study was performed analysing factors predictive of outcome (Ford et al. – submitted for publication), and the final model included a number of clinical factors such as deep lumbar stabiliser activity, leg symptoms and clinically determined inflammation. This supports the completion of a thorough clinical examination rather than a basic assessment followed by standardised treatment.
With a solid research background, Advance Healthcare Physios are well placed to undertake the necessary detailed assessment and specific management of back problems.