Designed and created by Guideline Central in participation with the Academy of Orthopaedic Physical Therapy
Interventions for the Management of Acute and Chronic Low Back Pain
Patient Guideline Summary
Publication Date: October 31, 2021
Last Updated: March 3, 2023
This patient summary means to discuss key recommendations from the American Physical Therapy Association (APTA) for interventions for the management of acute and chronic low back pain. It is limited to adults 18 years of age and older and should not be used as a reference for children.
- We will use the abbreviation LBP throughout this summary to refer to low back pain.
- LBP is usually caused by trauma or overuse. Back surgery may require subsequent physical therapy for optimum results.
- Symptoms include pain in the low back sometimes extending into a leg and impaired movement.
- This patient summary focuses on physical therapy methods for treating LBP, both acute and chronic.
- Treatment can improve strength and function as well as reduce pain.
- A treatment plan contains multiple elements over time as you improve.
- Exercise training interventions include specific trunk muscle activation, strengthening, and endurance
- Movement control
- Trunk mobility exercise
- Aerobic exercise
- Aquatic exercise
- General exercise
- Thrust or non-thrust joint mobilization
- Massage or soft tissue mobilization
- Dry needling
- Neural mobilization
- Strength training
- Active education strategies:
- Advice related to exercise
- Advice about staying active
- Pacing strategies
- Neuroscience education regarding pain
- Passive strategies (i.e., access to educational materials).
- For those undergoing discectomy or de-compression surgery:
- Post-surgical precautions
- Resuming physical activity
- Physical therapy combines treatment with education, each program directed to the unique needs of the individual patient.
- There are several treatment protocols developed and standardized for LBP:
- Treatment-based classification (TBC)
- Multidimensional clinical framework
- Cognitive functional therapy (CFT)
- Movement system impairment MSI
- Mechanical Diagnosis and Therapy (MDT)
- Prognostic risk stratification
- Pathoanatomic-based classification
- Mechanical traction for patients with chronic LBP with leg pain is not recommended.
- APTA: American Physical Therapy Association
- CFT: Cognitive Functional Therapy
- LBP: Low Back Pain
- MDT: Mechanical Diagnosis And Therapy
- MSI: Movement System Impairment
- TBC: Treatment-based Classification
George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021. J Orthop Sports Phys Ther. 2021 Nov;51(11):CPG1-CPG60. doi: 10.2519/jospt.2021.0304. PMID: 34719942.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.