For this week, we are revisiting the clinical recommendations for low back pain.
If you want to read the article I wrote earlier on acute low back pain, click here. If you want to hear the podcast episode on the topic, listen to episode 31: We need to have a spine.
This brief summary will provide you with some information on the current recommendations for chronic low back pain, which was published by the American College of Physicians (ACP) and the American Academy of Family Physicians (AAFP). Click here to read the guidelines in full.
As for chronic low back, the recommendations do not differ much from that for acute or sub-acute low back pain. The most useful things for a flare-up of chronic LBP center on nonpharmacological care are exercise, physical therapy, acupuncture, or massage. The problem is that a lot of evidence (aka, how many research studies and how sophisticated were they) was used to make these guidelines.
Another problem is the inconsistency of results. Here is the list of treatments that have been looked at… Exercise. Motor control exercise. Pilates. Tai chi. Yoga. Psychological therapies. Multidisciplinary rehabilitation. Acupuncture. Massage. Spinal manipulation. Ultrasound. TENS. Low-level laser. Lumbar support. Taping. Plus the following treatments, which did not have enough evidence to commit on, e-stim, interferential therapy, short-wave diathermy, traction, or superficial heat or cold.
Most of these treatments have been shown in some studies to help a little bit and other studies to make no difference. Cynics might say that the research is annoyingly inconsistent, which might be true in some regards. I think it has to do with the complexity, variety, and individualization of low back pain. In my years of treating LBP as a physical therapist, I have seen a wide variety of clients (age, sport, injury, etc) with an equally diverse presentation of low back pain (left side, right side, both sides, center, hurts with twisting, hurts with bending, etc).
I find it encouraging from the guidelines, studies found mindfulness-based stress reduction training was successful in reducing pain/improving function after 26 weeks and reducing pain after 52 weeks. This suggests that teaching our clients how to actively control their stress levels has a powerful effect on how they interact in their daily environments. This is powerful to know and something I think we can encourage everyone to do and it might help other issues too. Taking ownership over your body, what you feel, your daily activities, and how your body feels is never a bad thing!
The other thing I found encouraging was the power of multidisciplinary care. The guidelines found moderate-quality evidence that this collaborative approach resulted in moderate improvement in short-term pain (<12 weeks) and slightly improved long-term pain and disability. If you read the previous post/listened to episode 31, you should appreciate that moderate-quality evidence resulting in moderate improvement is pretty impressive. This is especially true because of how unique LBP is, as I described above!
These results really got me thinking because it’s difficult as a healthcare provider to avoid thinking you have all the answers. When I was younger, I thought when a physician or chiro sent a patient to me, “Okay. It’s my job to now fix this person.” But that’s wrong and I have worked to break that habit. It’s the client’s job to manage and figure out her body and limitations (see above) and it’s my job as a part of her team to help her achieve that goal. I think it’s important that you (the reader) seek out professionals who want to collaborate in a patient-centered environment. As always, we’ll discuss this further on the podcast. If you have any questions or comments, we’ve got you covered below.
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