Instituto Henriqueta Teixeira

Instituto Henriqueta Teixeira



Clinical Prediction for Success of Interventions for Managing Low Back Pain

Jeffrey Hebert, DC [a], Shane Koppenhaver, MPT [a], Julie Fritz, PhD, PT, ATC [a], Eric Parent, PhD, PT [b]

[a] The University of Utah, College of Health, 520 Wakara Way, Salt Lake City, UT 84108, USA
[b] Department of Physical Therapy, The University of Alberta, Faculty of Rehabilitation Medicine, Edmonton, Canada


Low back pain (LBP) is highly prevalent in athletic and nonathletic populations, and is a common cause of pain and disability. It is difficult to identify the pathoanatomical cause for most cases of LBP, leading many to consider LBP as a single ‘‘nonspecific’’ disorder. Most studies evaluating the treatment effectiveness of interventions for LBP have been based on this presumption and have generally demonstrated small to no treatment effects. Most providers think of LBP as a more heterogeneous disorder, and the inability to more specifically match patients to interventions likely to be beneficial is one possible explanation for the lack of research evidence proving the effectiveness of treatments and the suboptimal outcomes of clinical care. Treatmentbased classification, one approach to subgrouping patients with ‘‘nonspecific’’ LBP, focuses on identifying clusters of findings from the history and clinical examination that predict a more favorable outcome with a specific treatment approach. By matching patients with the appropriate specific exercise, stabilization exercise, spinal manipulation, or traction treatment, providers may expect a high probability of a successful clinical outcome.

LBP imposes an enormous burden in the United States, both to individuals and to society. LBP is the most common type of pain reported by adults [1], and is among the most frequent complaints seen in physicians’ offices [2]. Moreover, 60% of LBP sufferers experience some form of functional limitation or disability as a result of their pain [3]. Pain and disability attributable to LBP are accompanied by an estimated $100 billion to $200 billion in health care expenditures and lost wages annually in the United States [4], equivalent to over 1% of the entire gross domestic product. Despite many recent advances in imaging and surgical technology, LBP prevalence and its related economic and societal burden have remained largely unchanged in the past decade [1,4].

Athletes may be especially susceptible to LBP and low back injuries. The prevalence of LBP appears particularly high for participants in sports that place high demands on the spine, such as wrestling, gymnastics, and golf [5]. Among the general population, LBP symptoms only weakly correlate with abnormal imaging findings and the great majority of cases of LBP cannot be attributed to specific pathoanatomical causes [6]. Athletes may be more likely than nonathletes to have an identifiable pathoanatomical cause of LBP symptoms [7,8]. Higher rates of spondylolysis, spondylolisthesis, and disc degeneration have been reported in athletes than in the general population [9,10]. Despite an increased incidence of certain pathoanatomical findings, it remains difficult to identify a specific cause in the majority of cases of LBP in athletes. The inability to identify a cause can make it difficult for clinicians to determine which treatment strategy is most likely to be effective. To assist clinicians in predicting which intervention is likely to be most effective, this article reviews the evidence for various interventions commonly used in the treatment of LBP.

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