Wednesday, January 30, 2008

A Great Debate

I recently listened to a spirited debate on the PT Journal Podcast regarding two approaches to classification and manipulation for LBP. I strongly encourage you to download the file or subscribe to the podcast and listen for yourself. The debaters Timothy Flynn, PT PhD, OCS, FAAOMPT, and Christopher Maher, PT, PhD brought out some very salient points regarding the assessment and treatment of mechanical low back pain.

To be honest, I had to listen to the debate multiple times to pick out some of the really strong take-home messages that emerged from the discussion. While the debate was focused on the assessment and management of LBP, it had me thinking more rigorously about how these themes could apply to other aspect to our practice. In no particular order of importance:

  • The widespread use of the term "nonspecific" low back pain is inadequate and misleading. It would be analogous to our medical colleagues using the words "nonspecific" abdominal pain and contributes to further confusion regarding accurate diagnosis and management.

  • There is a need to develop standardized clinical practice patterns and a unified language with respect to the dosage and modes of manual therapy we deliver to our patients.

  • There is still considerable variation between highly trained individuals regarding the classification, assessment, and management of mechanical low-back pain.

You can download the link by right-clicking here and saving to your hard drive.

I hope you will download this debate and continue to reevaluate your methodology with respect to evaluation and management of not only low back pain, but other complex conditions as well. Our aim as orthopedic therapists should be to continually elevate our standards of practice. Take care and talk to you soon!


  1. Thanks for contributing to the PT bloggers club. :)

    I think you hit on a couple of good points from the debate - but I'd like you to expand on your view of using the term nonspecific low back pain.

    Are you proposing we used treatment-based classification systems or revert to diagnosing specific pain generators for patients with LBP?

  2. Great questions. I can tell you my practice patterns have evolved considerably over the last six years and now are a composite of both biopsychosocial and diagnostic approaches.

    Functional outcome literature seem to favor more of a biopsychosocial approach while there seems to be strong evidence supporting a specific diagnostic approach to impairment-level problems.

    I have found considerably better outcomes using a combined approach vs applying only one or the other approach. I do feel there is insufficient evidence to support the wholesale adoption of one approach or the other. At the same time, there is compelling evidence to support components of both.

    As the literature and my clinical experience continues to evolve, I plan to continually reevaluate my practice.

    My short term plan is to implement some stronger elements of standardization in my practice patterns with respect to all my interventions. Thank you for the comment and good luck.