Management of Chronic Lower Back Pain

MANAGEMENT OF
CHRONIC LOWER
BACK PAIN

INTRODUCTION
Background :
• Both male and female equally suffer from low back
pain accounting to 80% of adults.
• People with chronic low back pain tend to develop
chronic pain that may last for 12 weeks or more.
• Acute low back may cause spondylosis in older people
and is mechanical in nature or it may be associated
with underlying causes such infections and
inflammatory disease of the joints.
• Risk factors include age, genetics, physical activity,
weight gain and overload of backpack in children.
• Chronic low back pain can be managed by
conventional methods and recent best practice methods
(Ninds.nih.gov, 2020).
Fig 1: low back pain in the
lumbar region

Literature Review
• Searle et al., (2015) determined exercise
interventions are better for treating low back pain
compared to other interventions.
• Wells et al., (2014) conducted a survey of
Australian physical therapist to examine if Pilates
exercise was effective in treating chronic low back
pain.
• Glazov et al., (2016) determined that laser
acupuncture was beneficial for patients with
chronic low back pain.
Fig 2: exercise intervention for low
back pain
Fig 3: laser acupuncture

Literature review
• Upon assessing the efficacy of osteopathic
manipulation, Franke, Franke & Fryer, (2014)
found that it was helpful in managing low back
pain.
• de Luca et al., (2017) reviewed manual therapy
was safe and the effective while reducing chronic
low back pain and disability in older person
whereas Kamper et al., (2015) assessed and
confirmed that the long term effect of
multidisciplinary biopsychosocial rehabilitation
reduced pain and disability more effectively than
primary care.
Fig 4: Manual therapy
Fig 5: osteopathic manipulative
treatment

RESEARCH QUESTIONS
 The research is based on the fact that lack of treatment for acute low back pain can be
followed by chronic low back pain which will require an effective management practice.
 Conventional methods such as physical therapy is effective when used with other
interventions such as anti-inflammatory drugs but the best practice used in recent times
is exercise.
The research question is-
Is exercise intervention more effective than physiotherapy in managing lower back pain
patients of Australian?
Hypothesis
H1: Exercise intervention is better than physiotherapy for treating patients with chronic
lower back pain.
H0: Physiotherapy is better than exercise intervention for treating patients with chronic
lower back pain.

METHODS
Study design:
• This research will be conducted as randomized controlled trial (Kamper et al., 2015)
and will be quantitative in nature.
• The control population will receive physiotherapy as standard practice of
intervention and test population will receive exercise as intervention.
• Quantitative design will be an experimental research to determine the cause-effect
relationship.
• This experimental research will determine whether exercise intervention is the best
practice for reducing chronic low back pain.
Study population:
Research participants will be selected on the basis of purposive sampling. Here 100
participants with chronic lower back pain between the age 30-75 will be selected from
4 different primary health care regions of Australia.

Inclusion and exclusion criteria
Inclusion criteria Exclusion criteria
Patients suffering from specific chronic low back
pain
Patients suffering from acute and non-specific
lower back pain
Patients including adults and olderly between the
age 30-75 years
Patients below 30 years and above 75 years
Patients suffering from lower back pain for atleast
1 year
Patients suffering from lower back pain for less
than 1 year
Proficiency in English Non-proficiency in English

Statistical plan
Research instrument- survey conducted using a questionnaire
based on Quebec Back Pain Disability Scale (QBPDS)
(Tac.vic.gov.au, 2020)
Data collection method-
• Data through QBPDS questionnaire will be collected from all
patients prior to the intervention.
• The control intervention that is physiotherapy will be provided
to 50 random patients and the rest of the 50 patients will
receive the test intervention that is exercise.
• Patient outcome will be assessed through QBPDS after two
months of the interventions.
Data analysis-Responses from both the control and the test
interventions will be analysed by statistical analysis, using the
SPSS 21.0 version software where significant P-value will be less
than 0.05.
Fig 6: QBPDS questionnaire

Strengths
• Interventions are compared to find
superiority
• Randomization reduces allocation
and selection bias
• Statistical significance easily
interpreted and adequately
powered sample size avoids type 1
and type 2 error.
• Quantitative data collection is
precise and dependable (Choy,
2014).
Limitations
• Multiple sites needed for
validity is difficult to manage
• Intervention may proceed by
the time the trial is published
• Randomization of patients
require the equal establishment
of both the interventions in
clinical community.
• Large scale research requires
large sample size

Conclusion:
• Patients who are physically inactive or overweight and are suffering
from chronic lower back pain, different types of exercise ranging from
high to moderate aerobic exercises is expected to reduce chronic low
back pain and increase stability.
• Strengthening exercise for older people can reduce pain intensity and
improve disability.
• Exercise during early pregnancy can provide strength to abdomen, back
and pelvis for increasing weight bearing ability.
• Exercises reduces the cost of undergoing physiotherapy.

References:
Choy, L. T. (2014). The strengths and weaknesses of research methodology: Comparison and complimentary between
qualitative and quantitative approaches. IOSR Journal of Humanities and Social Science, 19(4), 99-104.
de Luca, K. E., Fang, S. H., Ong, J., Shin, K. S., Woods, S., & Tuchin, P. J. (2017). The effectiveness and safety of manual
therapy on pain and disability in older persons with chronic low Back pain: a systematic review. Journal of
manipulative and physiological therapeutics, 40(7), 527-534.
Franke, Franke & Fryer, (2014) assessed the effectiveness of osteopathic manipulative treatment in managing low back
pain. It was found out that this intervention was useful in both acute and chronic low back pain with a 3 months
session.
Glazov, G., Yelland, M., & Emery, J. (2016). Low-level laser therapy for chronic non-specific low back pain: a meta-
analysis of randomised controlled trials. Acupuncture in Medicine, 34(5), 328-341.

References
Kamper, S. J., Apeldoorn, A. T., Chiarotto, A., Smeets, R. J. E. M., Ostelo, R. W. J. G., Guzman, J., & Van Tulder, M. W.
(2015). Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and
meta-analysis. Bmj, 350.
Ninds.nih.gov. (2020). Low Back Pain Fact Sheet | National Institute of Neurological Disorders and Stroke. Ninds.nih.gov.
Retrieved 22 February 2020, from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-
Back-Pain-Fact-Sheet.
Searle et al., (2015) determined that exercise interventions are better compared to other treatments for low back pain.
Tac.vic.gov.au. (2020). Tac.vic.gov.au. Retrieved 22 February 2020, from
https://www.tac.vic.gov.au/files-to-move/media/upload/quebec_scale.pdf.
Wells, C., Kolt, G. S., Marshall, P., & Bialocerkowski, A. (2014). The definition and application of Pilates exercise to treat

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