Back pain is an inevitable part of a physiotherapists day be it in the clinic or advice for a friend. Do you think your treatment recommendations are the most up-to-date?
Guidelines are important for understanding evidence based recommendations for care provision and treatment. The National Institute for Heath and Care Excellence has been providing guidance for clinicians since 1999 covering a wide variety of topics. They periodically update the guidance available when new evidence is available. Their guidance is based on systematic reviews and expert panels.
The latest guidance to be updated is low back pain. Assessment, non-invasive and invasive management has been put under the spotlight.
In terms of non-invasive treatment, which is most relevant to physiotherapy, the focus of intervention should be around self-management. This should be through education, exercise before all else. Treatment should not include traction, acupuncture, electrotherapy (TENS, PENS or Ultrasound) or manual therapy without exercise. For those with recurrent back pain CBT or a talking therapy can also be included alongside exercise.
The inclusion of a return to work programme should also be a part of treatment programmes aimed at complimenting the self help philosophy which should be the mainstay of management. This fits nicely with the move away from using the terminology of acute, sub-acute and chronic and the adjustment to thinking of low back pain in terms of risk of poor outcomes.
Overall the recommendation to move away from passive treatments is a step in the right directions for enabling those with long standing problems. It will be interesting to see if other guidance follows this message in the future.
Take a look at the guidelines for yourself and let us know what you think of them via social media!