a structured exercise programme tailored to the person is a therapeutic option:
comprises up to a maximum of eight sessions over a period of up to 12 weeks
one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person
exercise programmes may include the following elements:
aerobic activity
movement instruction
muscle strengthening
postural control
stretching
manual therapy is a therapeutic option
different manual therapies:
a low-amplitude, high-velocity movement at the limit of joint range that takes the joint beyond the passive range of movement
spinal mobilisation (joint movement within the normal range of motion
massage (manual manipulation or mobilisation of soft tissues)
duration and frequency of therapy
up to a maximum of nine sessions over a period of up to 12 weeks
invasive procedures
acupuncture is a therapeutic option
up to a maximum of 10 sessions over a period of up to 12 weeks
combined physical and psychological treatment programme
Consider referral for a combined physical and psychological treatment programme, comprising around 100 hours over a maximum of 8 weeks, for people who: have received at least one less intensive treatment (exercise program, manual therapy or acupuncture course) and have high disability and/or significant psychological distress
referral for surgery
refer consideration spinal fusion who have completed an optimal package of care, including a combined physical and psychological treatment programme and still have severe non-specific low back pain for which they would consider surgery.
NICE note that:
injections of therapeutic substances into the back for non-specific low back pain should not be offered as a treatment option for non-specific back pain
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