Other treatment options for simple low back pain of more than 6 weeks duration

• physical activity and exercise
  • 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

Reference:

• 1. NICE (May 2009).Low back pain - Early management of persistent non-specific low back pain