Physical Therapists Publish Clinical Practice Guidelines for Low Back Pain
Physical therapists are commonly involved in the treatment of patients with chronic low back pain. Like all health care professionals, therapists must base treatment on evidence that the treatment is beneficial to the patient.

The evidence we have so far suggests that not all low back pain should be treated the same. Sometimes manipulation is the best approach whereas in other cases, exercises are advised. And even within those categories of treatment, there are subgroups to choose from. For example, exercise could include stretching for flexibility or strengthening to improve stability.

How does the therapist know what treatment to provide for each individual patient? And do therapists in different towns across the United States select the same treatment program for the same problem? The answer to those questions can be found in the recently published document: Low Back Pain. Clinical Practice Guidelines (CPGs) Linked to the International Classification of Functioning, Disability, and Health (ICF) from the Orthopaedic Section of the American Physical Therapy Association (APTA).

This publication is a must-read for all physical therapists who are working with patients who have low back pain. As the name implies, the 57-page document is a guide to assist therapists in knowing how to approach each patient with low back pain.

Risk factors, clinical course, diagnosis, examination, and outcomes are all discussed in detail. Information provided and recommendations made are all based on current evidence available. The approach taken is toward returning patients to their previous level of function. This is a shift from the past when everything was viewed as disability and dysfunction rather than ability and function.

The authors provide a detailed accounting of how these recommendations were determined. After an in-depth discussion of each section, they offer a summary of the recommendations that make up the clinical guidelines. Here's a brief review of some of those recommendations:

  • Risk factors for low back pain - most likely there are many risk factors, not just one or even two and probably not strongly linked with low back pain anyway.
  • Clinical course - the focus should be on preventing low back pain and recurrences (repeat episodes) of low back pain.
  • Diagnosis/Classification - When it comes to the wide range of symptoms and clinical presentation possible with low back pain, it is a challenge for health care professionals to know what to call the diagnosis. There are currently two separate classification systems used (International Statistical Classification of Diseases or ICD and International Classification of Functioning, Disability, and Health (ICF). The authors explain the use of both and provide a quick summary of the clinical findings associated with each diagnostic group.
  • Differential Diagnosis - it is the therapist's responsibility to look for and recognize back pain caused by a more serious medical problem such as infection, fracture, or tumor. Such cases must be referred to a medical doctor. Guidelines for recognizing problems outside the scope of a physical therapist's practice are provided in this section.
  • Examination, Interventions, and Outcomes - These sections speak to the type of evaluation physical therapists should perform with low back pain patients, treatment for each type of problem, and results of that treatment. Evidence is reviewed for treatment choices include manual therapy; exercises for trunk coordination, strengthening, and endurance; nerve mobilization; traction; education and counseling; and fitness activities.

    In conclusion, this long-awaited clinical practice guideline for low back pain treated by the physical therapist if finally available. It was written by eight physical therapists best-known for their research, knowledge, and understanding of low back pain. An even larger group of names well-known to physical therapists are listed as reviewers. As more research is done and evidence becomes available, these guidelines will be updated. Contact information is provided for the authors if anyone wants further information.
    Anthony Delitto, PT, PhD, et al. 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. April 2012. Vol. 42. No. 4. Pp. A1-A57.