Shades of Gray in Treatment Guidelines for Low Back Pain
Guidelines for the treatment of low back pain (LBP) were released in 1994. But when helping their patient with LBP, do physical therapists follow these guidelines? These authors surveyed physical therapists in Ontario, Canada, to find out.

The survey was answered by 274 physical therapists who regularly saw patients with LBP. The survey presented three case studies of people with LBP who referred themselves for physical therapy. Therapists listed how they would assess each patient's condition and what treatments they would choose.

The authors found that the therapists generally followed the guidelines. Education and exercise were the most commonly used treatments, and few of the therapists recommended long bed rest. However, the therapists still preferred to use treatments such as ultrasound and biofeedback, which have not been proven to be very effective in treating low back pain. Also, very few of the therapists used spinal manipulation, which is recommended in the guidelines for treating acute low back pain. Yet the authors found that few of the therapists had been trained in joint manipulation. They suggest that physical therapy practice could improve by expanding its training in spine manipulation.

The survey also asked the therapists' opinions about the guidelines. A majority of them thought the guidelines could be useful in managing LBP. But less than half found the current guidelines useful. Is this because these therapists are set in their ways, or is it because they believe their treatments work--despite a lack of solid evidence? Is LBP too difficult to treat by following a single set of guidelines? Since physical therapists have such a paramount role in helping people with back pain, this article serves as a good starting point to help highlight the guidelines for effectively treating low back pain.
Linda C. Li, BSc (PT), MSc, et al. Physical Therapy Management of Low Back Pain: An Exploratory Survey of Therapist Approaches. In Physical Therapy. April 2001. Vol. 81. No. 4. Pp. 1018-1028.