A Physios’ Best Weapon Against Chronic Low Back Pain

3 min read. Posted in Low back
Written by Physio Network info

Ever wondered just how important it is to follow evidence-based practice when it comes to low back pain?

Well, a recent study helps us answer this question.

Here’s the study title – Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

The study found that each ‘non-guideline concordant intervention’ received within the first 21 days of acute low back pain significantly increased the likelihood of developing chronic pain.

See just how much in the graph below.


As you can see from the graph, using three non-guideline-based interventions can double your patient’s risk of developing chronic low back pain!

A perhaps even scarier finding from this paper is that ‘nearly half of patients (48%) received at least 1 discordant intervention within 3 weeks of the initial visit’. So it’s clear that as a profession we can definitely do better.


What are guideline concordant / evidence-based interventions?

Want to know what concordant/evidence-based interventions look like? Look no further than this great paper by Lin et al (2019):

‘What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review’

Here are their 11 recommendations:

1. Care should be patient centred. This includes care that responds to the individual context of the patient, employs effective communication and uses shared decision-making processes

2. Practitioners should screen patients to identify those with a high likelihood of serious pathology/red flag conditions

3. Psychosocial factors should be assessed

4. Radiological imaging is discouraged unless:

  • serious pathology is suspected
  • there has been an unsatisfactory response to conservative care or unexplained progression of signs and symptoms, or
  • imaging is likely to change management

5. Assessment should include physical examination. Physical examination could include neurological screening tests, mobility and/or muscle strength

6. Patient progress should be evaluated, including the use of validated outcome measures

7. All patients should be provided with education/information about their condition and management options

8. Patients should receive management that addresses physical activity and/or exercise

9. If used, manual therapy should be applied only in conjunction with other treatments

10. Unless specifically contraindicated (eg, ‘red flag’ condition[s]), offer evidence-informed non-surgical care prior to surgery

11. Facilitate continuation or resumption of work


Anything not on this list (or contrary to this list) could qualify as non-guideline concordant, thereby increasing the risk of low back pain becoming chronic. So make sure you use the above recommendations to guide your practice.

We hope this blog helps you appreciate the importance of following evidence-based interventions. It’s one of the most powerful things you can do as a physio to help prevent low back pain from becoming chronic, and it really does improve your patients outcomes.

This is one of the reasons why we started Physio Network – to make it as easy as possible for you to keep up to date with the abundance of new evidence published every month.

If you need some help with this, be sure to check out our Research Reviews.

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If you have a question, suggestion or a link to some related research, share below!

  • Abdulrahman Albukhari

    So , if Physio choose dry needling as first intervention, this not based on evidence based practice?? Correct .
    Thanks for helpful blog .

    Abdulrahman Albukhari | 20 September 2021 | Likes

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