N.I.C.E Guidelines on Lower Back Pain

In May 2009 the National Institute of Clinical Excellence (N.I.C.E.) published its clinical guidelines for the treatment on non-specific lower back pain (CG88).1 For most chiropractors, osteopaths, acupuncturists and many physio-therapists, this was a land mark document and the result of at least 10 years accumulated research into this area.  It concluded that spinal manipulation, acupuncture and managed exercises were the best form of treatment for lower back pain.  N.I.C.E. recommend that for cases of lower back pain lasting six weeks or more, a course of treatments from a qualified practitioner as described above is the most effective way of resolving the problem.

So how do you choose which one to go and see?  The "free" route is to see your GP who can refer you to a physiotherapist.  My recommendation is to ask your friends and acquaintances who have had similar experiences.  If you get recommended the same person a few times, then give them a call. Once you've committed to making that call, try and get seen as soon as possible, ideally within a few days.

It's important that you "click" with the practitioner in the first one to two treatment sessions.  You need to feel confident that this individual is going to be able to help you.  They should examine you, provide an explanation as to what the problem is, and give you an idea of the treatment program required.  There are a few conditions that need to be ruled out. They are; fractures, inflammatory disease, infections, malignancies and ankylosis spondylitis. All qualified practitioners would be able to identify these and referred appropriately.

The guidelines recommend between 8 to 10 sessions over a 12 week period, depending on the type of treatment required.  I have always taken the view that it's a combination of manual therapy (including spinal manipulation), acupuncture and exercises that work best.  To me these are just different "tools" to be used by the "mechanic". The skill is in fitting the treatment to the problem and the individual.

When I first started as a Chiropractor I would often be asked "Does it work then?"  It's a question I haven't heard in some time.  Chiropractic works for much more that just low back pain and the evidence basis is ever increasing.  For lower back pain, the jury is well and truly in!

1.     http://guidance.nice.org.uk/CG88

Julien Barker

Principal Chiropractor

South Street Chiropractic