The RCGP - Clinical and Special Projects, Clinical Guidelines, Acute Low Back Pain. Contents, Index page


Chapter 3

Principal Recommendations
Linked to Evidence

Diagnostic Triage
Use of X-Rays
Drug Therapy
Bed Rest
Advice on Staying Active
Back Exercises





Recommendations Evidence


Consider manipulative treatment for patients who need additional help with pain relief or who are failing to return to normal activities.
In acute and sub-acute back pain, manipulation provides better short-term improvement in pain and activity levels and higher patient satisfaction than the treatments to which it has been compared.
However, there is no firm evidence that it is possible to select which patients will respond or what kind of manipulation is most effective.
The optimum timing for this intervention is unclear
The risks of manipulation for low back pain are very low, provided patients are selected and assessed properly and it is carried out by a trained therapist or practitioner.
Manipulation should not be used in patients with severe or progressive neurological deficit in view of the rare but serious risk of neurological complication.


Back Pain Contents