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The Nice Guidelines for low back pain can be downloaded using the link below.

it is there are 25 pages of info of which the relevant recommnedation is printed here;

Key priorities for implementation

Information, education and patient preferences

· Provide people with advice and information to promote self-management of their low back pain.

· Offer one of the following treatment options, taking into account patient preference: an exercise programme (see section 1.3.3), a course of manual therapy (see section 1.4.1) or a course of acupuncture (see section 1.6.1). Consider offering another of these options if the chosen treatment does not result in satisfactory improvement.

Physical activity and exercise

· Consider offering a structured exercise programme tailored to the person:

- This should comprise up to a maximum of eight sessions over a period of up to 12 weeks.

- Offer a group supervised exercise programme, in a group of up to 10 people.

- A one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.

Manual therapy[1]

· Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks.

Invasive procedures

· Consider offering a course of acupuncture needling comprising up to a maximum of 10 sessions over a period of up to 12 weeks.

· Do not offer injections of therapeutic substances into the back for
non-specific low back pain.

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 (see section 1.2.5) and

- have high disability and/or significant psychological distress.

Assessment and imaging

· Do not offer X-ray of the lumbar spine for the management of non-specific low back pain.

· Only offer an MRI scan for non-specific low back pain within the context of a referral for an opinion on spinal fusion (see section 1.9).

Referral for surgery

· Consider referral for an opinion on spinal fusion for people who:

- have completed an optimal package of care, including a combined physical and psychological treatment programme (see section 1.7) and

- still have severe non-specific low back pain for which they would consider surgery.

[1] The manual therapies reviewed were spinal manipulation, spinal mobilisation and massage (see section 1.4 for further details). Collectively these are all manual therapy. Mobilisation and massage are performed by a wide variety of practitioners. Manipulation can be performed by chiropractors and osteopaths, as well as by doctors and physiotherapists who have undergone specialist postgraduate training in manipulation.

The last bit about manual therapy is the part relevant to our works, we also approach via the Psychosocial method and give exercises for the condition.

NICE clinical guideline 88

Low back pain

Ordering information

You can download the following documents from www.nice.org.uk/CG88

· The NICE guideline (this document) – all the recommendations.

· A quick reference guide – a summary of the recommendations for healthcare professionals.

· ‘Understanding NICE guidance’ – a summary for patients and carers.

· The full guideline – all the recommendations, details of how they were developed, and reviews of the evidence they were based on.

For printed copies of the quick reference guide or ‘Understanding NICE guidance’, phone NICE publications on 0845 003 7783 or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it and quote:

· N1865 (quick reference guide)

· N1866 (‘Understanding NICE guidance’).

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales.

This guidance represents the view of NICE, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, and informed by the summary of product characteristics of any drugs they are considering.

Implementation of this guidance is the responsibility of local commissioners and/or providers. Commissioners and providers are reminded that it is their responsibility to implement the guidance, in their local context, in light of their duties to avoid unlawful discrimination and to have regard to promoting equality of opportunity. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

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