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LBP TREATMENT MYTHS What Really Works? – Blair & Chapman Chiropractic Robina

Home / Blair & Chapman Chiropractic Robina / LBP TREATMENT MYTHS What Really Works? – Blair & Chapman Chiropractic Robina

Myths abound in the community on the subject of low back pain. As a clinician it is sometimes difficult to be able with a degree of confidence to advise patients regarding appropriate treatment for different LBP presentations. We need to be knowledgeable about what may be helpful, what is not helpful and more so, what treatments may be potentially harmful. There lies a very fine clinical line between guiding a patient down a path that may afford long-term benefit for their low back pain as opposed to offering advice that may result in no real relief gain. At our Blair and Chapman Chiropractic clinic in Robina we always question, is there an evidence based guideline with which we can give this information to our patients with some degree of confidence? Thankfully the answer is yes, and in addition this guideline was updated in the Annals of Internal Medicine Vol. 147 No. 7, October 2007.

Treatment of Acute Low Back Pain
LBP of less than four weeks duration should be initially addressed with the use of NSAIDs, muscle relaxants and advice to remain active within pain tolerances. These recommendations have been made with a good level of evidence and a corresponding moderate net benefit. Fair level of evidence with moderate net benefit includes interventions such as opioids, benzodiazepines and herbal therapies (devils claw and white willow bark). Of no benefit, with good to fair evidentiary support is bed rest, exercise therapy and systemic corticosteroids.  Our Blair and Chapman Chiropractic clinic in Robina uses these guidelines.
Treatment of Chronic Low Back Pain
At the toaction and use of firm mattresses have no benefit and may at worst be harmfup of the recommendation list for low back pain over three months duration is exercise therapy, interdisciplinary rehabilitation, spinal manipulation, NSAIDS and interestingly, cognitive behavioural therapy. These recommendations generate a moderate net benefit based upon good evidence. Sitting at mid-range and of fair benefit the guidelines have listed interventions including; acupuncture, opioids, massage, yoga and back schools. Somewhat surprisingly the application of trl.
Our Blair and Chapman Chiropractic clinic in Robina uses these guidelines.
Contentious Ancillary Methods
The next bracket of potential therapies may be the most contentious thus far.  These are therapies whereby the level of evidence is very poor and further studies most certainly are still required.  Included in this bracket are biofeedback therapies, interferential therapy, low level laser, lumbar supports, shortwave diathermy, muscle relaxants, TENS and ultrasound.  Interferential, TENS and ultrasound are very commonly utilised forms of therapy; even though they have been presented in this unproven group it may well be that future studies cement their therapeutic merit.  At our Robina Chiropractic clinic we do not utilise methods that are considered unhelpful or potentially harmful.
Some Acute LBP
We can summarise the acute LBP group relatively easily.  Use NSAIDS, muscle relaxants and encourage the patient to remain relatively active.  It is ill-advised to recommend bed rest, exercise therapy or the usage of corticosteroids.  Most acute LBP episodes of non-specific aetiology resolve within a 10 day period but clinicians are still encouraged to be mindful of yellow and red flags.
Summary Chronic LBP

Chronic LBP of non-specific origin appears to be most receptive to a multidisciplinary, physical therapy based intervention.  This typically includes muscle lengthening, core strengthening, joint manipulation and functional capacity retraining.  In conjunction with this type of therapy NSAIDs may also be utilised, as can be cognitive behavioural therapy.  The knowledge base has yet to qualify the benefit of electrophysical therapy including ultrasound, TENS and interferential.

As a primary care general practitioner you should be confident that whenever you refer one of your patients to a physical therapist that they are evidence-based and are utilising sound guidelines with which they manage their clinical intervention.  Referring GP’s are well within their rights to question if their therapists are utilising guidelines and if so, is the version current.  At Blair and Chapman Chiropractic Robina  we are only too happy to hear these questions as this evidence based model is the cornerstone of our clinic decision making.  Sadly in the field of chiropractic, physiotherapy and osteopathy there are still pockets of therapists that do not use evidence-based treatment but times are changing and hopefully in the future all therapists will strive to achieve gold standard levels of practice.

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