Is your client's back pain "rapidly reversible"? Improving low back care at its foundation

Prof Case Manag. 2008 Mar-Apr;13(2):87-96. doi: 10.1097/01.PCAMA.0000314179.09285.5a.


Purpose/objectives: To convey a valuable and greatly misunderstood paradigm for evaluating and treating low back pain (LBP) and its extensive scientific evidence.

Primary practice setting(s): Low back pain is a highly prevalent and very expensive health dilemma. But by using a paradigm called Mechanical Diagnosis and Therapy (a.k.a. McKenzie methods), it is now possible to identify a very large LBP subgroup whose pain is rapidly reversible, meaning that it can often be eliminated quickly, with return to full function using a single, patient-specific direction of simple, yet precise, end-range low back exercises and some posture modifications. This interesting subgroup includes patients with both acute and chronic LBP as well as both LBP-only and sciatica with neural deficits.

Findings/conclusions: This special form of clinical assessment can detect which patients are in this large, rapidly reversible subgroup and which ones are not. Of the numerous studies targeting Mechanical Diagnosis and Therapy (MDT), three have focused on patients whose persisting pain had led to recommendations of disc surgery where 50% were then found to still have a rapidly reversible disc problem with high rates of nonsurgical rapid recovery. If patients are never assessed in this way, this reversibility remains undiscovered and these patients commonly undergo potentially unnecessary surgery.

Implications for case management practice: Armed with knowledge of this subgroup, how to identify it, the considerable supportive scientific evidence and strongly beneficial implications of utilizing this MDT paradigm, case managers are positioned to have an immensely positive impact on the care of LBP. Tremendous cost savings and greatly improved clinical outcomes are available by utilizing this form of evidence-based MDT care.

Publication types

  • Review

MeSH terms

  • Biomechanical Phenomena
  • Case Management
  • Evidence-Based Medicine
  • Exercise Therapy
  • Humans
  • Low Back Pain / diagnosis*
  • Low Back Pain / etiology
  • Low Back Pain / rehabilitation
  • Medical History Taking / methods*
  • Outcome Assessment, Health Care
  • Pain Measurement / methods*
  • Patient Selection
  • Patient-Centered Care
  • Physical Examination / methods*
  • Posture
  • Range of Motion, Articular
  • Recovery of Function*
  • Total Quality Management / organization & administration*
  • Unnecessary Procedures