Classification and treatment of subacute low back pain. Putting the bio-psycho-social model together

摘要

The paper by Ford et al published in a recent issue1 is the fourth of a series describing a classification of low back disorders as well as treatment protocols specific to each subgroup, with the further objective of designing randomized controlled trials. In most health systems, physiotherapists are on the frontline in the treatment of low back disorders and the background of these treatments has varied. In the 1960s and 1970s, biomechanical explanations were prevalent. Discogenic and zygapophyseal dysfunction were described and a number of 'methods' were derived from biomechanical hypotheses which represented the main beliefs of therapists. These methods including manual therapy and specific exercises are very commonly used, despite the fact that there is little evidence of their effects.2 The authors underline that this may be due to the heterogeneity of the populations, patients with different biomechanical patterns being included in the same protocols.