NICE guidelines put exercise at the heart of managing low back pain

New recommendations on the treatment of low back pain represent ‘an important moment for our profession’, according to the CSP’s chief executive Karen Middleton.


NICE is calling for a patient-centred approach to managing low back pain

The National Institute for Health and Care Excellence (NICE) has completely updated its guidelines for low back pain published in 2009.

The latest guidelines, produced after a consultation on draft recommendations earlier this year, call for a patient-centred approach to managing the condition. NICE recommends using a stratification tool, such as the STarT Back tool developed by Keele University, as part of the assessment to help inform shared decision-making about referring the patient for rehabilitation.

The guideline also recommends against the routine use of imaging as part of the assessment, unless the result is likely to change management – echoing the message delivered as part of the CSP’s back pain myth busters campaign.

There is a heavy emphasis on exercise programmes and self-management as key non-pharmacological interventions for treating low back pain. It suggests there is potential for adjunct therapies such as cognitive behavioural therapy and manual therapy.

An opportunity for physiotherapy

Ms Middleton said the guidance from NICE offered the opportunity for physiotherapy to take the lead on what is one of the most common causes of disability across the world.

But she said it was also a chance for CSP members to reflect upon their own practice to see what more they can be doing for patients.

‘This can be a challenging thing to do, but it is an integral part of the development of any profession,’ she said.

Acupuncture and electrotherapies are no longer recommended as a treatment for back pain, a change Prof Middleton acknowledged would leave some members unhappy.

‘We recognise those feelings but the process has now concluded and a decision has been reached.

‘Now we need to focus on ensuring that patients have access to high-quality physiotherapy services, and the recommendations give us the backing to making that happen across the country,’ she said.

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