Rehabilitation management of low back pain – it’s time to pull it all together!

Abstract

In the past, rehabilitation research initiatives for low back pain (LBP) have targeted outcome enhancement through personalized treatment approaches, namely through classification systems (CS). Although the use of CS has enhanced outcomes, common management practices have not changed, the prevalence of LBP is still high, and only selected patients meet the CS profile, namely those with a nociceptive context. Similarly, although practice guidelines propose some level of organization and occasionally a timeline of care provision, each mainly provides best practice for isolated treatment approaches. Moreover, there is no theoretical framework that has been proposed that guides the rehabilitation management process of mechanical LBP. In this commentary, we propose a model constituted of five domains (nociceptive drivers, nervous system dysfunction drivers, comorbidities drivers, cognitive–emotional drivers, and contextual drivers) grounded as mechanisms driving pain and/or disability in LBP. Each domain is linked to the International Classification of Functioning, Disability and Health, where once a patient is deemed suitable for rehabilitation, the clinician assesses elements of each domain in order to identify where the relative treatment efforts should be focused. This theoretical model is designed to provide a more comprehensive management overview, by appreciating the relative contribution of each domain driving pain and disability. Considering that the multiple domains driving pain and disability, and their interaction, requires a model that is comprehensive enough to identify and address each related issue, we consider that the proposed model has several positive implications for rehabilitation of this painful and highly prevalent musculoskeletal disorder.

Development of an Evidence-Based Practical Diagnostic Checklist and Corresponding Clinical Exam for Low Back Pain

“…3,4 Psychological, social, and environmental factors may be crucial to understanding and informing effective management approaches, which may require the expertise of mental health or other professionals. 50 One complementary approach to diagnosis is a classification system for spine-related concerns developed by the Global Spine Care Initiative. 51 This system classifies spine-related conditions by symptom characteristics, functional deficits, and severity.…”

The value of the rehabilitation treatment in the non-specific low back pain

“…In establishing the diagnosis, the critical element is to take a scrupulous medical history. It is important to pay attention to the patient's lifestyle, type of job, sports activity and circumstances that caused the first pain incident [9].…”

Ist die Trainierbarkeit von Rückenschmerzpatienten von der gestellten Diagnose abhängig?

“…Neben körperlichen Gründen, die unter den spezifischen Rückenschmerzen zusammengefasst werden, gibt es eine ganze Reihe von Gründen, die zu sogenannten unspezifischen Rückenschmerzen führen [3]. Dazu gehören die aus dem bio-psycho-sozialen-Modell bekannten Einflussfaktoren [9]. Als Diagnosen bietet sich eine Vielzahl an Möglichkeiten an, die in Verbindung mit Rückenschmerzen gebracht werden.…”