In this, the third post of the “Low Back Pain and You” series, we will discuss evidence-based interventions provided by Physical Therapists.  Hopefully, you will see why we should be the first person you see for your back pain and learn what to expect from you Physical Therapist.

Classification and Clinical Prediction Rules (CPR)

As we’ve discussed before, not all back pain is created equal.  So, why do many practitioners continue to treat every case of LBP with the same advice and the same medication?

Fortunately, Physical Therapists have developed a classification system that matches patients with appropriate and effective treatments.  The treatment-based classification system (Delitto et al, 1995) consists of categories based on the response of the patient to active motion.  These groups include active exercise with directional preference, traction, mobilization/manipulation, and stabilization.  In clinical studies, the TBC system has been shown to result in better outcomes than therapy based on clinical practice guidelines. (Fritz et al, 2003) 

More recently, Physical Therapists have developed clinical prediction rules to further identify patients who are most likely to benefit from certain treatments.  There are two clinical prediction rules related to low back pain.  These include the lumbar stabilization CPR (Hicks et al, 2005)and the manipulation CPR (Flynn et al, 2002).  Studies show significant improvements in patients who meet the clinical prediction rules and are treated with matched interventions.

Patients most likely to benefit from spinal stabilization exercises (74-97%  improvement in probability of success if patient fits 3 or more of the following):

  • Younger than 40 years old
  • Straight leg raise > 90 degrees
  • Positive prone instability test
  • Aberrant movement patterns
  • FABQ physical activity subscale < 9

Patients most likely to benefit from spinal manipulation ( presence of 4/5 resulted in an increased likelihood of success to 95%)

  • Duration of symptoms < 16 days
  • FABQ work subscale < 19
  • No symptoms below the knee
  • At least one hip with internal rotation motion > 35 degrees
  • At least one hypomobile lumbar segment

What does all this mean to you as a patient?  If your therapist is treating all back pain the same – find a new therapist.  Modalities such as hot packs, electrical stimulation, and ultrasound have been shown to provide little or no benefit in the treatment of low back pain.  Ask your Physical Therapist if they use classification systems or clinical prediction rules. 

To find a quality Physical Therapist in your area, click HERE

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