The current trend in management of low back pain leaning away from an anatomical origin of symptoms, yet structuralism in the diagnosis and treatment of low back pain is still highly prevalent.  In particular, it is still popular in the vision of physicians, especially physiatrists and surgeons.  They can’t inject and slice psychosocial causes of symptoms can they?

A recent study from Cid et al in Pain Practice was published with goal to identify common causes of low back pain from a panel of experts.  Basically this is professional opinions on what anatomical structures, based on subjective and objective data, are the cause of low back pain.

I cropped out the tables from the study for you.  Take a look below.

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Cid J et al. A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach. Pain Practice. 2013: 1-10.
Cid J et al. A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach. Pain Practice. 2013: 1-10.
Cid J et al. A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach. Pain Practice. 2013: 1-10.

 

Cid J et al. A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach. Pain Practice. 2013: 1-10.
Cid J et al. A Modified Delphi Survey on the Signs and Symptoms of Low Back Pain: Indicators for an Interventional Management Approach. Pain Practice. 2013: 1-10.

 

Despite controversy, I find this information valuable. With ~85% of LBP of mechanical origin “unknown”, this does assist in providing a clinical diagnosis.  If anything, it helps with speaking the language with physicians.  Now only if we (as physical therapists) can use this information to guide treatment, then we are making moves.

Do you agree with the results in tables above?  What would you add to this conversation?

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2 comments

  1. If and when I ascribe an anatomical source of low back pain it is with the intention of directing treatment. I find it most valuable when dealing with patients who do not respond to PT and those who would likely respond to some other intervention. For example, if I have a patient who is not responding to PT, has symptoms consistent with SIJ pain, and I am able to reproduce their exact pain with sacroiliac joint provocation testing I would refer them on to physiatry for consideration of a guided SIJ injection. (And, if the injection is successful, see if the combination of PT and an injection proves helpful.)

    Another instance when it is valuable is an illustration to explain a treatment program. For example, someone who centralizes on examination can be given the disc model to explain why moving in one particular direction (or combination of directions) can lead to an improvement.

    The literature really needs to get away from “consensus indicators” and move towards comparison of a clinical examination to a reference standard, and from there determining which treatments are effective for particular sub groups.

    1. Hey Paul,
      Thanks for commenting!

      I HIGHLY agree with what you’re saying. The INTENT of a diagnosis is to provide the optimal treatment. Right now in PT, we do not have the optimal treatment per say (such as, is HVLAT, directional preference, exercise, muscle energy techniques, etc) BETTER compared head to head.

      I like your last statement too and basically sums up my thinking process. It is what I teach my interns (as they want to diagnose so much!)…by a week into the clinical, they know what I mean.

      H

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