Jump to content

Interventions for LBP

Original Editor - Rachael Lowe

Top Contributors - Admin, Nupur Smit Shah, Kim Jackson, Muhammad Arslan, Simisola Ajeyalemi, Alexandra Stead, 127.0.0.1, WikiSysop, Vidya Acharya, Claire Knott, Lucinda hampton, Jess Bell and Saud Alghamdi  

Introduction

Low back pain (LBP) is a common musculoskeletal condition characterised by pain or discomfort in the area between the lower rib margins and the inferior gluteal folds [1][2]. It may be associated with a range of conditions, including non-specific low back pain, lumbar spondylosis, degenerative disc disease, intervertebral disc disorders, spondylolisthesis, facet joint-related pain and sacroiliac joint disorders.[3][4] However, in most cases, a specific structural cause cannot be identified, and the condition is classified as non-specific low back pain.[5]

The management of LBP should be based on the individual's clinical presentation, functional limitations, contributing physical factors and psychosocial factors.[6] Treatment aims to reduce pain and disability, improve physical function, promote self-management and support participation in normal activities and quality of life.[7]

Physiotherapy management may include patient education and reassurance, advice to remain physically active, exercise therapy, strengthening and endurance exercises, movement and motor control exercises, aerobic activity, manual therapy and, where appropriate, psychological and behavioural approaches.[8] Interventions should be individualised according to the patient's needs, preferences, clinical presentation and prognosis. Psychosocial factors, including fear of movement, pain-related beliefs, anxiety, depression and low self-efficacy, should also be considered as part of a biopsychosocial approach to the management of LBP.[9]

Education

Most clinical guidelines recommend education and advice as key components of low back pain management.[10][11][12][13][14][15] The common message is that patients should be reassured that they do not have a serious disease, that they should stay as active as possible, progressively increase their activity levels and return to work as soon as possible.[16] This is particularly relevant for patients with acute back pain who are low risk of disability.[17][18]

NICE Guidelines on Education for LBP

The NICE Guidelines on education and advice for LBP:[10]

  • Provide people with advice and information to promote self-management of their low back pain.
  • Offer educational advice that includes information on the nature of non-specific low back pain and encourages the person to be physically active and continue with normal activities as far as possible.
  • Include an educational component consistent with this guideline as part of other interventions, but do not offer stand-alone formal education programmes.
  • Take into account the person's expectations and preferences when considering recommended treatments, but do not use their expectations and preferences to predict their response to treatments.
  • Advise people with low back pain that staying physically active is likely to be beneficial.
  • Advise people with low back pain to exercise.

The STarT Back Approach also has some advice for us when educating individuals with LBP:[19]

Language and labels

It is important to be mindful of the language and labels that are used in conjunction with providing education for LBP and below are some useful tips:[20]

  • Use simple, functional explanations that emphasise that most low back pain is not caused by serious structural damage.
  • Avoid potentially alarming terms such as “degeneration”, “crumbling” or “spondylitis” when they are not clinically necessary.
  • Use specific diagnostic terms, such as sciatica, when they provide useful information for management.
  • Avoid unnecessary investigations when there is no clinical indication.
  • When imaging or investigations are clinically indicated, explain technical findings in clear, reassuring language and place age-related changes into context. For example, explain that some changes seen on imaging are common with normal ageing, similar to wrinkles or grey hair.
  • Avoid language that may increase fear, anxiety or beliefs that normal movement will cause further damage.

Dealing with distress

When supporting people experiencing distress related to low back pain, clinicians should use a supportive, empathetic and non-judgemental approach.[21] Emphasises should be made on:

  • Suspend pre-judgment
  • Listen carefully / summarise points
  • Plan to address points
  • Care with language and labels
  • Be honest and realistic
  • Do not criticise the opinions of other clinicians who have seen the patient.
  • Provide information

Activity promotion

People with low back pain should be encouraged to remain active, gradually resume normal activities and avoid prolonged inactivity.[22] Key strategies include:

  • Activity promotion: beneficial, hurt doesn’t equal harm, minimise bed rest.[23]
  • Pacing: short, frequent bouts of activity rather than overdoing things and then regretting it the next day, rests between activity, do less than maximal capabilities and increase as tolerated.[24]
  • Return to work as soon as possible, prolonged absence likely to lead to loss of employment.[25] Use fit notes to support return to work and communicate suggestions to the employer.[26] Help the patient negotiate an early return to work if at all possible.[27]

Exercise Therapy

There is now relatively large consensus across the various guidelines that specific back exercises (as opposed to the advice to stay active, including for example walking, cycling) are not recommended for patients with acute low back pain.[11] There are now also more firm recommendations in favour of exercise therapy in patients with subacute and chronic low back pain but there is no evidence that one form of exercise is superior to another.[28] [11]

NICE Guidelines recommend offering a structured exercise programme tailored to the person. Exercise programmes may include aerobic activity, movement instruction, muscle strengthening, postural control and stretching.[29] They should comprise up to a maximum of eight sessions over a period of up to 12 weeks, a group supervised exercise programme in a group of up to 10 people or one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.[30]

Exercise-based approaches for low back pain

Clinical practice guidelines recommend several exercise-based approaches for people with low back pain, depending on the individual's clinical presentation and functional limitations:[12]

  • Trunk coordination, strengthening and endurance exercises may be considered for people with subacute or chronic low back pain with movement coordination impairments, including those who have undergone lumbar microdiscectomy.
  • Repeated movements or exercises that promote centralisation may be considered for people with acute low back pain and referred lower-extremity pain. Repeated exercises in a direction determined by the individual's response may also be used to improve mobility and reduce symptoms in people with acute, subacute or chronic low back pain with mobility deficits.
  • Flexion exercises, combined with interventions such as manual therapy, strengthening exercises, nerve mobilisation and progressive walking, may be considered for older adults with chronic low back pain and radiating pain.
  • Lower-quarter nerve mobilisation may be considered to reduce pain and disability in people with subacute or chronic low back pain with radiating pain.
  • Moderate- to high-intensity exercise may be considered for people with chronic low back pain without widespread pain.
  • Progressive, low-intensity fitness and endurance activities may be incorporated into pain management and health promotion strategies for people with chronic low back pain and widespread pain.

Manual Therapy

Manual therapy refers to hands-on techniques used to assess and treat musculoskeletal disorders of the spine.[31] In the management of low back pain, manual therapy primarily includes spinal manipulation and spinal mobilisation.[32] Spinal manipulation involves a high-velocity, low-amplitude thrust applied to a spinal joint, while spinal mobilisation involves controlled passive movements of the spinal joints within or towards the available range of motion.[33][34]

The recommendations regarding spinal manipulation continue to show some variation and systematic reviews have demonstrated marginal treatment effects across heterogeneous groups of patients with low back pain.[35][36]Recommendations for spinal manipulation vary between clinical guidelines, with some supporting its use for short-term symptom relief while others do not recommend it and this variation may reflect differences in the interpretation and strength of the available evidence.[11] There may also be local and political reasons involved. Recent research has demonstrated that spinal manipulative therapy is effective for subgroups of patients and as a component of a comprehensive treatment plan, rather than in isolation.[12] Clinical prediction rules can be used to identify patients that will benefit form thrust manipulation.[37][38][39][40]

The NICE guidelines recommend offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks in early management of non-specific LBP.[10]

Clinicians should consider utilising thrust manipulative procedures to reduce pain and disability in patients with mobility deficits and acute low back and back-related buttock or thigh pain.[12] Thrust manipulative and mobilisation procedures can also be used to improve spine and hip mobility and reduce pain and disability in patients with subacute and chronic low back and back-related lower extremity pain.[8]

Maitland Mobilisation

Maitland's mobilisations involves graded passive oscillatory movements applied to spinal joints to reduce pain and improve joint mobility and function.[41] The technique is based on both biomechanical and neurophysiological mechanisms and may be used as part of a broader physiotherapy programme for people with low back pain.[42]

Maitland mobilisation techniques commonly used in the management of low back pain include:[43][44][45]

  • Central posteroanterior (CPA) mobilisation: Passive PA oscillations applied centrally over the lumbar spinous processes.
  • Unilateral posteroanterior (UPA) mobilisation: PA oscillations applied to one side of the lumbar spinous process or articular pillar to influence segmental movement.
  • Transverse mobilisation: Oscillatory pressure applied to the transverse process to produce segmental rotation or lateral movement.
  • Lumbar rotation mobilisation: Passive oscillatory mobilisation performed with the lumbar spine positioned in rotation.
  • Lumbar flexion and extension mobilisation: Passive mobilisation techniques used to improve restricted lumbar movement in the relevant direction.
  • Maitland grades I–II: Low-amplitude oscillations performed within the available range, primarily used for pain modulation.
  • Maitland grades III–IV: Larger-amplitude oscillations performed towards or at the end of the available range, primarily used to address joint stiffness and improve range of motion.
  • Grade V manipulation: A high-velocity, low-amplitude thrust performed at the end of the available range. This should only be performed by appropriately trained clinicians when clinically indicated and after appropriate screening for contraindications.

Mulligan Concept

The Mulligan Concept is a manual therapy approach that combines a therapist-applied sustained accessory glide with active movement performed by the patient.[46][47] The technique is commonly referred to as mobilisation with movement (MWM) and is intended to improve movement and reduce pain during functional activities.[48]

For low back pain, Mulligan techniques may include:

  • Lumbar mobilisation with movement (MWM): A sustained manual glide is applied to the lumbar spine while the patient actively performs a previously painful or restricted movement.[47]
  • Sustained Natural Apophyseal Glides (SNAGs): A sustained facet joint mobilisation is applied while the patient actively moves the lumbar spine, such as during flexion, extension or rotation.[49]
  • Self-SNAGs: The patient uses a belt or strap to reproduce an appropriate sustained glide while performing the active movement independently.[50][51]

Mulligan techniques should be applied in a pain-free or substantially pain-reduced manner.[52] The direction and force of the mobilisation should be individualised according to the patient's response.[53] They are generally used as part of a broader rehabilitation programme that includes exercise, education and self-management.[54]

McKenzie Method

The McKenzie Method, also known as Mechanical Diagnosis and Therapy (MDT), is a structured approach to the assessment and management of musculoskeletal disorders, including low back pain.[55] It uses repeated movement testing to identify the patient's directional preference and response to movement.[56]

Exercises commonly used in the McKenzie Method for low back pain include:[57][58][59]

  • Prone lying: Maintaining a prone position to assess and, where appropriate, improve tolerance to lumbar extension.
  • Prone on elbows: Supporting the upper body on the elbows to introduce gentle lumbar extension.
  • Press-ups: Performing repeated lumbar extension from a prone position while keeping the pelvis in contact with the treatment surface.
  • Standing lumbar extension: Repeatedly extending the lumbar spine in standing, commonly used when extension is the patient's directional preference.
  • Repeated lumbar flexion: Repeated flexion movements performed in lying or standing when flexion is identified as the patient's directional preference.
  • Flexion in lying: Bringing the knees towards the chest to produce lumbar flexion.
  • Self-management exercises: Patients are taught to perform the appropriate repeated movements or sustained positions independently and incorporate them into daily activities.

The exercises are selected according to the individual's symptoms and response to repeated movement testing.[60] A directional preference may be identified when repeated movement in a particular direction reduces or centralises symptoms.[61] The McKenzie approach may therefore be particularly useful for selected patients with a clear directional preference, rather than being considered a universal exercise programme for all people with low back pain.

Traction

Traction, whether used alone or in combination with other treatments is not recommended.[10] The evidence suggests that traction has little or no impact on pain intensity, functional status, global improvement and return to work among people with LBP. [62]

Although there is some preliminary evidence which suggests that subgroup of patients with signs of nerve root compression may benefit from intermittent lumbar traction in the prone position.[63] Findings from higher quality studies advises against the use of lumbar traction for the management of low back pain. [8]

Electrotherapy

Evidence for the effectiveness of most electrotherapy modalities in the management of low back pain is limited.[64] [65] Guidelines suggest that electrotherapy modalities (laser therapy, interferential therapy, therapeutic ultrasound, transcutaneous electrical nerve stimulation) are not appropriate for non-specific low back pain.[11] Passive treatment modalities (for example bed rest, massage, ultrasound, electrotherapy, laser and traction) should be avoided as mono-therapy and not routinely be used, because they may increase the risk of illness behaviour and chronicity.[66]

Cognitive Behavioural Therapy

Behavioural education, also known as cognitive behavioural therapy, encompasses many aspects of patient education and counselling for patients with low back pain, including:[67]

  • Activity pacing
  • Attention diversion
  • Cognitive restructuring
  • Goal setting
  • Graded exposure
  • Motivational enhancement therapy
  • Maintenance strategies
  • Problem-solving strategies

There is moderate-quality evidence that operant therapy and behavioural therapy are more effective than waiting-list or usual care for short-term pain relief in patients with chronic low back pain, but no specific type of behavioural therapy is superior to another.[68] In the intermediate to long term, there is no established difference between behavioural therapy and group exercise for management of pain or depressive symptoms in patients with chronic low back pain.

The NICE guidelines suggest referral for a combined physical and psychological treatment programme that includes a cognitive behavioural approach and exercise, comprising around 100 hours over a maximum of 8 weeks, for people who have received at least one less intensive treatment and have high disability and/or significant psychological distress.[10]

Conclusion

Overall, contemporary management of low back pain supports a patient-centred, biopsychosocial approach in which treatment is selected according to the individual's clinical presentation, functional limitations, psychosocial context, preferences and treatment response rather than the presumed structural source of pain alone.[69]

Education, reassurance, maintenance of normal activity and appropriately prescribed exercise should form the foundation of management, particularly given the limited value of passive treatments when used in isolation.[9] Exercise therapy appears beneficial for subacute and chronic low back pain, although current evidence does not demonstrate consistent superiority of one exercise modality over another.[70] Manual therapy, including mobilisation and manipulation, may provide additional short-term benefits for appropriately selected patients and is best integrated with active rehabilitation rather than delivered as a stand-alone intervention.[32] Similarly, approaches such as Mechanical Diagnosis and Therapy may be useful where a clear directional preference or centralisation response is identified, while Mulligan and Maitland techniques can be considered according to the individual's movement and symptom presentation.[71] In contrast, routine use of traction and electrotherapy is not supported for non-specific low back pain.[66][15][72][73]

Psychological and behavioural interventions may have an important complementary role for individuals experiencing persistent symptoms, substantial disability or psychological distress.[74] Taken together, the evidence indicates that effective physiotherapy management is less dependent on a single therapeutic technique and more dependent on appropriate clinical reasoning, targeted intervention selection, progressive activity and supported self-management.[75] Future research should therefore focus on identifying clinically meaningful subgroups and treatment characteristics that can guide more precise, personalised and sustainable management of low back pain.

References

  1. ↑ Krismer M, Van Tulder M. Low back pain (non-specific). Best practice & research clinical rheumatology. 2007 Feb 1;21(1):77-91.
  2. ↑ Hoy D, March L, Brooks P, Woolf A, Blyth F, Vos T, Buchbinder R. Measuring the global burden of low back pain. Best practice & research Clinical rheumatology. 2010 Apr 1;24(2):155-65.
  3. ↑ Farley, T., Stokke, J., Goyal, K., & DeMicco, R. (2024). Chronic Low Back Pain: History, Symptoms, Pain Mechanisms, and Treatment. Life, 14(7), 812.
  4. ↑ Malik KM, Nelson AM, Chiang TH, Imani F, Khademi SH. The specifics of non-specific low back pain: re-evaluating the current paradigm to improve patient outcomes. Anesthesiology and pain medicine. 2022 Nov 1;12(4):e131499.
  5. ↑ Petersen T, Laslett M, Juhl C. Clinical classification in low back pain: best-evidence diagnostic rules based on systematic reviews. BMC musculoskeletal disorders. 2017 May 12;18(1):188.
  6. ↑ Feuerstein M, Beattie P. Biobehavioral factors affecting pain and disability in low back pain: mechanisms and assessment. Physical therapy. 1995 Apr 1;75(4):267-80.
  7. ↑ van Hooff ML, van der Merwe JD, O’Dowd J, Pavlov PW, Spruit M, de Kleuver M, van Limbeek J. Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management. European Spine Journal. 2010 Sep;19(9):1517-26.
  8. ↑ 8.0 8.1 8.2 George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, Gilliam JR, Hendren S, Norman KS, Beattie PF, Bishop MD. Interventions for the management of acute and chronic low back pain: revision 2021: clinical practice guidelines linked to the international classification of functioning, disability and health from the academy of orthopaedic physical therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy. 2021 Nov;51(11):CPG1-60.
  9. ↑ 9.0 9.1 Foster NE, Anema JR, Cherkin D, Chou R, Cohen SP, Gross DP, Ferreira PH, Fritz JM, Koes BW, Peul W, Turner JA. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet. 2018 Jun 9;391(10137):2368-83.
  10. ↑ 10.0 10.1 10.2 10.3 10.4 Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748.
  11. ↑ 11.0 11.1 11.2 11.3 11.4 Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. Eur Spine J 2010;19:2075–94
  12. ↑ 12.0 12.1 12.2 12.3 Anthony Delitto, Steven Z. George, Linda Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Joseph J. Godges. 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. Journal of Orthopaedic and Sports Physical Therapy, 2012, 42(4)
  13. ↑ Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J 2018; 27: 60-75.
  14. ↑ Van Wambeke P, Desomer A, Ailliet L, et al. Summary: Low back pain and radicular pain: assessment and management. KCE report 287Cs. Brussels: Belgian Health Care Knowledge Centre (KCE), 2017.
  15. ↑ 15.0 15.1 Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017; 166: 514-530.
  16. ↑ World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: World Health Organization; 2023.
  17. ↑ Stevans JM, Delitto A, Khoja SS, Patterson CG, Smith CN, Schneider MJ, Freburger JK, Greco CM, Freel JA, Sowa GA, Wasan AD. Risk factors associated with transition from acute to chronic low back pain in US patients seeking primary care. JAMA network open. 2021 Feb 16;4(2):e2037371.
  18. ↑ Kovacs FM, Abraira V, Zamora J, Fernández C, Spanish Back Pain Research Network. The transition from acute to subacute and chronic low back pain: a study based on determinants of quality of life and prediction of chronic disability. Spine. 2005 Aug 1;30(15):1786-92.
  19. ↑ Sowden G, Hill JC, Morso L, Louw Q, Foster NE. Advancing practice for back pain through stratified care (STarT Back). Brazilian journal of physical therapy. 2018 Jul 1;22(4):255-64.
  20. ↑ Linskens FG, van der Scheer ES, Stortenbeker I, Das E, Staal JB, van Lankveld W. Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: a randomised controlled trial in healthy respondents. Patient Educ Couns. 2023;110:107649.
  21. ↑ Evers S, Hsu C, Sherman KJ, Balderson B, Hawkes R, Brewer G, et al. Patient perspectives on communication with primary care physicians about chronic low back pain. Perm J. 2017;21:16-177.
  22. ↑ Roren A, Daste C, Coleman M, Rannou F, Freyssenet D, Moro C, Lefèvre-Colau MM, Nguyen C. Physical activity and low back pain: A critical narrative review. Annals of physical and rehabilitation medicine. 2023 Mar 1;66(2):101650.
  23. ↑ Sanchis-Gimeno JA, Valenzuela-Fuenzalida JJ, Zuld AB, Orellana-Donoso M, Granite G. Low Back Pain as a Nursing Education Priority. International Medical Education. 2026 Jul 31;5(3):72.
  24. ↑ Antcliff D, Keenan AM, Keeley P, Woby S, McGowan L. “Pacing does help you get your life back”: The acceptability of a newly developed activity pacing framework for chronic pain/fatigue. Musculoskeletal care. 2022 Mar;20(1):99-110.
  25. ↑ Russo F, Papalia GF, Diaz Balzani LA, Stelitano G, Zampogna B, Fontana L, Vadalà G, Iavicoli S, Papalia R, Denaro V. Prognostic factors for return to work in patients affected by chronic low back pain: a systematic review. Musculoskeletal Surgery. 2024 Dec;108(4):403-15.
  26. ↑ Bernaers L, Willems TM, Rusu D, Demoulin C, Van de Velde D, Braeckman L. Bridging the Gap Between Rehabilitation and Return to Work: A Qualitative Evaluation of a Workplace Intervention for Low Back Pain. Journal of Occupational Rehabilitation. 2026 Jun;36(2):534-48.
  27. ↑ Kreuger DC, Donker‑Cools BH, Oomens S, Luymes C, Anema JR, Schaafsma FG. The return-to-work journey: experiences with communication and collaboration among employees and employers during long-term sick leave and return-to-work. Disability and rehabilitation. 2025 Jul 31;47(16):4168-75.
  28. ↑ Almeida M, Saragiotto B, Richards B, Maher C. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. Med J Aust 2018; 208 (6): 272-275
  29. ↑ de Campos TF. Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59]. Journal of physiotherapy. 2017 Apr 1;63(2):120.
  30. ↑ Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC musculoskeletal disorders. 2024 May 1;25(1):344.
  31. ↑ Kerry R, Young KJ, Evans DW, Lee E, Georgopoulos V, Meakins A, McCarthy C, Cook C, Ridehalgh C, Vogel S, Banton A. A modern way to teach and practice manual therapy. Chiropractic & Manual Therapies. 2024 May 21;32(1):17.
  32. ↑ 32.0 32.1 Grenier JP, Rothmund M. A critical review of the role of manual therapy in the treatment of individuals with low back pain. Journal of Manual & Manipulative Therapy. 2024 Sep 2;32(5):464-77.
  33. ↑ Bronfort G, Haas M, Evans R, Kawchuk G, Dagenais S. Evidence-informed management of chronic low back pain with spinal manipulation and mobilization. The Spine Journal. 2008 Jan 1;8(1):213-25.
  34. ↑ Leininger B, Bronfort G, Evans R, Reiter T. Spinal manipulation or mobilization for radiculopathy: a systematic review. Physical Medicine and Rehabilitation Clinics. 2011 Feb 1;22(1):105-25.
  35. ↑ Assendelft WJ, Morton SC, Emily IY, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low‐back pain. Cochrane Database of Systematic Reviews. 2004(1).
  36. ↑ Assendelft WJ, Morton SC, Yu EI, Suttorp MJ, Shekelle PG. Spinal manipulative therapy for low back pain: a meta-analysis of effectiveness relative to other therapies. Annals of internal medicine. 2003 Jun 3;138(11):871-81.
  37. ↑ Flynn T, Fritz J, Whitman J, et al. A clinical prediction rule for classifying patients with low back pain who demonstrate short-term improvement with spinal manipulation. Spine (Phila Pa 1976).
  38. ↑ Childs JD, Fritz JM, Flynn TW, et al. A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study. Ann Intern Med. 2004;141:920-928.
  39. ↑ Cleland JA, Fritz JM, Kulig K, et al. Comparison of the effectiveness of three manual physical therapy techniques in a subgroup of patients with low back pain who satisfy a clinical prediction rule: a randomized clinical trial. Spine (Phila Pa 1976).
  40. ↑ Hancock MJ, Maher CG, Latimer J, Herbert RD, McAuley JH. Independent evaluation of a clinical prediction rule for spinal manipulative therapy: a randomised controlled trial. Eur Spine J. 2008;17:936-943.
  41. ↑ Ibrahim A, Elkeblawy M, Howeidy M, Elkeblawy M, Grase M, Aneis Y. Effect of Maitland mobilization on lumbar proprioception, pain, and disability in patients with chronic nonspecific low back pain. Physiotherapy Quarterly. 2023 Mar 27;31(4):87-92.
  42. ↑ GILL G, JAGGA V, PAL S. Effectiveness of Maitland Mobilisation on Pain and Function in Individuals with Mechanical Low Back Pain: A Systematic Review. Journal of Clinical & Diagnostic Research. 2024 Oct 1;18(10).
  43. ↑ Outeda LR, Cousiño LA, Carrera ID, Caeiro EM. Effect of the maitland concept techniques on low back pain: a systematic review. Coluna/Columna. 2022 Jul 25;21(2):e258429.
  44. ↑ Chesterton P, Payton S, McLaren S. Acute effects of centrally-and unilaterally-applied posterior-anterior mobilizations of the lumbar spine on lumbar range of motion, hamstring extensibility and muscle activation. Journal of Back and Musculoskeletal Rehabilitation. 2018 Nov;31(6):1013-23.
  45. ↑ Alarab A, Salhab I, Darawy D, Aker MA, Al Naji R, Hroub N. Maitland mobilization versus core stability exercises in management chronic nonspecific LBP. Biomed Pharmacol J. 2024;17(2):1115-1124.
  46. ↑ Hidalgo B, Pitance L, Hall T, Detrembleur C, Nielens H. Short-term effects of Mulligan mobilization with movement on pain, disability, and kinematic spinal movements in patients with nonspecific low back pain: a randomized placebo-controlled trial. Journal of manipulative and physiological therapeutics. 2015 Jul 1;38(6):365-74.
  47. ↑ 47.0 47.1 Pourahmadi MR, Mohsenifar H, Dariush M, Aftabi A, Amiri A. Effectiveness of mobilization with movement (Mulligan concept techniques) on low back pain: a systematic review. Clinical rehabilitation. 2018 Oct;32(10):1289-98.
  48. ↑ Pozas OM, Cuenca-Zaldívar JN, González-Alvarez ME, Sarzo FJ, Beltran-Alacreu H, Carnero JF, Romero EA. Effectiveness of mobilization with movement on conditioned pain modulation, mechanical hyperalgesia, and pain intensity in adults with chronic low back pain: A randomized controlled trial. Musculoskeletal Science and Practice. 2025 Feb 1;75:103220.
  49. ↑ Hussien HM, Abdel-Raoof NA, Kattabei OM, Ahmed HH. Effect of mulligan concept lumbar SNAG on chronic nonspecific low back pain. Journal of chiropractic medicine. 2017 Jun 1;16(2):94-102.
  50. ↑ Kikuchi Y, Akasaka K, Otsudo T, Hattori H, Hasebe Y, Hamada Y, Hall T. The effects of lumbar self-sustained natural apophyseal glides on lumbar spine range of motion and hip muscle flexibility in asymptomatic college students: a crossover study. Journal of Clinical and Translational Research. 2024 Apr 25;10(2):172-9.
  51. ↑ Shager K, Murugiah M, Kei TS, Ranganathan H, Ahmad MA. Effects of Mulligan sustained natural apophyseal glide mobilizations on pain, mobility, and lumbar-related disability in chronic non-specific low back pain: A systematic review and meta-analysis. Medicine. 2026 Jun 26;105(26):e49456.
  52. ↑ Yakut H, Yakut Y, Doral MN. Immediate, short and long-term clinical results of combined Mulligan mobilization with movement techniques in non-specific chronic low back pain: a randomized placebo-controlled trial. Advances in Rehabilitation. 2022 May;36(2):1-4.
  53. ↑ Cankaya MS, Pala OO. Outcomes of Mulligan concept applications in obese individuals with chronic mechanical low back pain: a randomized controlled trial. Life. 2024 Jun 13;14(6):754.
  54. ↑ Fiaad MN, Elsayed WH, Takla MK, El Zawahry AM. Mulligan mobilization vs. spinal manipulation effect on low back pain. Journal of Advanced Pharmacy Education & Research| Jan-Mar. 2020;10(1):70-5.
  55. ↑ Lam OT, Strenger DM, Chan-Fee M, Pham PT, Preuss RA, Robbins SM. Effectiveness of the McKenzie method of mechanical diagnosis and therapy for treating low back pain: literature review with meta-analysis. Journal of orthopaedic & sports physical therapy. 2018 Jun;48(6):476-90.
  56. ↑ Halliday MH, Garcia AN, Amorim AB, Machado GC, Hayden JA, Pappas E, Ferreira PH, Hancock MJ. Treatment effect sizes of mechanical diagnosis and therapy for pain and disability in patients with low back pain: a systematic review. journal of orthopaedic & sports physical therapy. 2019 Apr;49(4):219-29.
  57. ↑ Machado LA, Maher CG, Herbert RD, Clare H, McAuley JH. The effectiveness of the McKenzie method in addition to first-line care for acute low back pain: a randomized controlled trial. BMC medicine. 2010 Jan 26;8(1):10.
  58. ↑ Skikić EM, Trebinjac S. The effects of McKenzie exercises for patients with low back pain, our experience. Biomolecules and Biomedicine. 2003 Nov 20;3(4):70-5.
  59. ↑ García-López H, Morales-Quintana Á, Obrero-Gaitán E, Romero-Del Rey R, Cortés-Pérez I. Effectiveness of the McKenzie-based exercises in improving pain, disability, and cervical range of motion in patients with chronic non-specific neck pain: A systematic review with meta-analysis. Physiotherapy Theory and Practice. 2026 Apr 4:1-5.
  60. ↑ Yarznbowicz R, Tao M, Owens A, Wlodarski M, Dolutan J. Pain pattern classification and directional preference are associated with clinical outcomes for patients with low back pain. Journal of Manual & Manipulative Therapy. 2018 Jan 1;26(1):18-24.
  61. ↑ May S, Aina A. Centralization and directional preference: a systematic review. Manual therapy. 2012 Dec 1;17(6):497-506.
  62. ↑ Wegner I, Widyahening IS, Van Tulder MW, Blomberg SE, De Vet HC, Brønfort G, et al. Traction for low-back pain with or without sciatica. Cochrane Library [Internet]. 2013 Aug 19.
  63. ↑ Vanti C, Panizzolo A, Turone L, Guccione AA, Violante FS, Pillastrini P, Bertozzi L. Effectiveness of mechanical traction for lumbar radiculopathy: a systematic review and meta-analysis. Physical therapy. 2021 Mar 1;101(3):pzaa231.
  64. ↑ Thiese MS, Hughes M, Biggs J. Electrical stimulation for chronic non-specific low back pain in a working-age population: a 12-week double blinded randomized controlled trial. BMC musculoskeletal disorders. 2013 Mar 28;14(1):117.
  65. ↑ GE Bekkering, HJM Hendriks, BW Koes, RAB Oostendorp, RWJG Ostelo, JMC Thomassen, MW van Tulder. Dutch Physiotherapy Guidelines for Low Back Pain. Physiotherapy, February 2003, Volume 89, Issue 2, Pages 82–96
  66. ↑ 66.0 66.1 van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, Koes B, Laerum E, Malmivaara A; COST B13 Working Group on Guidelines for the Management of Acute Low Back Pain in Primary Care. Chapter 3. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006 Mar;15 Suppl 2:S169-91.
  67. ↑ Vitoula K, Venneri A, Varrassi G, Paladini A, Sykioti P, Adewusi J, Zis P. Behavioral therapy approaches for the management of low back pain: an up-to-date systematic review. Pain and therapy. 2018 Jun;7(1):1-2.
  68. ↑ Richmond H, Hall AM, Copsey B, Hansen Z, Williamson E, Hoxey-Thomas N, Cooper Z, Lamb SE. The effectiveness of cognitive behavioural treatment for non-specific low back pain: a systematic review and meta-analysis. PloS one. 2015 Aug 5;10(8):e0134192.
  69. ↑ Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for a new approach?. Disability and rehabilitation. 2022 Jun 19;44(13):3270-84.
  70. ↑ Hayden JA, Van Tulder MW, Malmivaara AV, Koes BW. Meta-analysis: exercise therapy for nonspecific low back pain. Annals of internal medicine. 2005 May 3;142(9):765-75.
  71. ↑ Tuttle N, Hazle C. An empirical, pragmatic approach applying reflection in interaction approach to manual therapy treatments. Physiotherapy Theory and Practice. 2021 Jul 3;37(7):775-86.
  72. ↑ Alrwaily M, Almutiri M, Schneider M. Assessment of variability in traction interventions for patients with low back pain: a systematic review. Chiropractic & manual therapies. 2018 Sep 17;26(1):35.
  73. ↑ Rajfur J, Pasternok M, Rajfur K, Walewicz K, Fras B, Bolach B, Dymarek R, Rosinczuk J, Halski T, Taradaj J. Efficacy of selected electrical therapies on chronic low back pain: a comparative clinical pilot study. Medical science monitor: international medical journal of experimental and clinical research. 2017 Jan 7;23:85.
  74. ↑ Petrucci G, Papalia GF, Russo F, Vadalà G, Piredda M, De Marinis MG, Papalia R, Denaro V. Psychological approaches for the integrative care of chronic low back pain: a systematic review and metanalysis. International Journal of Environmental Research and Public Health. 2021 Dec 22;19(1):60.
  75. ↑ Nicol V, Verdaguer C, Daste C, Bisseriex H, Lapeyre É, Lefèvre-Colau MM, Rannou F, Rören A, Facione J, Nguyen C. Chronic low back pain: a narrative review of recent international guidelines for diagnosis and conservative treatment. Journal of clinical medicine. 2023 Feb 20;12(4):1685.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Interventions_for_LBP&oldid=381918"