Patients are commonly referred to physical therapy for work-related mechanical low back pain (LBP). Technological advances (eg, diagnostic imaging) for identifying pathology of the spine have not decreased the time period in which symptoms resolve nor do they guide physical therapy treatment. Treatment of low back pain is often influenced by the bias of individual physical therapists, and care is often based on unproven techniques. The patient's distress and illness behavior, socioeconomic and job status, previous surgeries, and chronicity of LBP can influence the outcome of treatment, but there is little evidence to support the correlation between structural pathophysiology identified by diagnostic testing and the disability status of patients with LBP. Medical diagnosis (eg, herniated nucleus pulposis, spondylolisthesis) has not been helpful in directing successful rehabilitation of patients with LBP. Identifying the exact tissues responsible for the LBP, therefore, should not be the goal of clinical assessment. Several studies suggest that an assessment-based treatment scheme provides a better outcome than a nonspecific treatment approach. Selection of assessment-based treatments depends on both the patient's history and an elucidation of the movements and mechanical stresses that reproduce the patient's symptoms. Recent research has supported the concept of prescribing exercise by matching the therapy to the motions that cause or relieve symptoms. The goal of exercise prescription based on repeated motion testing of the spine is to use the findings of the exam and movement testing to create a specific program to restore function. This rational approach to exercise prescription should theoretically result in faster resolution of symptoms and shorter episodes of care than nonspecific exercise programs. The purpose of this article is to demonstrate the usefulness of a classification system, described by Delitto et al, for determining appropriate treatment in a patient with recent onset of LBP and to describe how the diagnostic process influenced treatment choices.
J Orthop Sports Phys Ther. 1999;29(9):534-539.
Key Words: assessment-based treatment, exercise