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Recommended Treatment for Lower Back Pain

Lower back pain is the leading cause of physical disability worldwide. In 2018, a leading medical journal The Lancet published a series of papers on the cause and treatment of lower back pain. These articles recommend nonpharmacological types of treatment such as exercise and Physiotherapy. We discuss these articles, their recommendations, and the best types of exercise for lower back pain.

Some key points include:

  • Exercise and education are the internationally recognised first-line treatments for persistent (> 12 weeks) lower back pain
  • Remaining active and education are internationally recognised first-line treatments for acute (< 6 weeks) lower back pain
  • Pharmacological treatments (including paracetamol) are not recommended in the primary management of acute or persistent lower back pain
  • Physiotherapists can help provide you with the tools to manage your condition and guide you though safe and effective exercise

Understanding Lower Back Pain

“Lower back pain is a symptom not a disease”

Only a small percentage of people with lower back pain have a specific nociceptive cause (pathological issue with body tissues) while the majority of causes are non-specific.

Non-specific lower back pain is more complicated. It consists of biological, psychological and social factors that result in a lessened ability to participate in everyday activities such as physical recreation and work. Unfortunately, this reduced participation tends to increase disability arising from the non-specific lower back pain.

Treatment of Lower Back Pain

If you suffer from specific lower back pain, a Physiotherapist will be able to identify and assist you in managing the factors that lead to your pain. Examples of specific low back pain are; fracture, nerve root compression, facet joint injury or malignancy.

Contemporary guidelines, produced by Danish, UK and US peak health bodies all recommend exercise, education, self-management, psychological therapies as the first line of treatment and manual therapy as adjunctive treatment for non-specific lower back pain.

The US national guideline recommends nonpharmacological care as the first treatment option and reserves pharmacological care for patients for whom nonpharmacological care has not worked.

The guidelines place less emphasis on pharmacological and surgical treatments and the routine use of imaging and investigations is not recommended.

What Type of Exercise for Non-Specific Lower Back Pain?

It is important that any exercise program incorporate your needs, preferences and capabilities. A Physiotherapist is an expert in assessing your physical capacity and matching that to an exercise modality that is right for you.

Graded activity is the process of gradually returning to the movements and activities that are now pain provoking.

Mobilisation of joints, dry needling and massage are manual therapies that are considered an adjunct therapy to persistent back pain and can be used as a short course of treatment but should not be the primary mode of management.

Guidelines also recommend consideration of psychological therapies, cognitive behavioural therapy, progressive relaxation, and mindfulness-based stress reduction.

Other electrophysical modalities such as interferential, TENS, ultrasound, traction and back supports are not recommended in the management of non-specific lower back pain.

If you are suffering from lower back pain, please do not hesitate to contact one of our Physiotherapists to provide you a better understanding of your condition and to help you with specific exercise management.



Foster, N.E., Anema, J.R., Cherkin, D., Chou, R., Cohen, S.P., Gross, D.P., Ferreira, P.H., Fritz, J.M., Koes, B.W., Peul, W. and Turner, J.A., 2018. Prevention and treatment of low back pain: evidence, challenges, and promising directions. The Lancet.

Hartvigsen, J., Hancock, M.J., Kongsted, A., Louw, Q., Ferreira, M.L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J. and Smeets, R.J., 2018. What low back pain is and why we need to pay attention. The Lancet.

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