Physical therapies (NICE)

At six weeks, if the pain has failed to settle, the patient should be offered a course of either:

  • acupuncture (10 sessions over 12weeks)
  • continuing with the course of manual therapies, including spinal manipulation (9 sessions over 12 weeks). Manual therapy is a collective term that includes spinal manipulation, spinal mobilisation and massage
  • a course of group based exercise in a class of up to 10 people (8 sessions over a period of up to 12 weeks) with encouragement to return to activity and achieving the aim of restored function. This may include aerobic activity, movement instruction, muscle strengthening, postural control and stretching
  • a one-to-one supervised exercise programme may be offered if a group programme is not suitable for a particular person.

These sessions should also focus on teaching the patient the principles of cognitive behavioural approach and taking into account identified yellow flags.

Do not offer/refer for:

  • SSRIs for treating pain
  • injection of therapeutic substances into the back
  • laser therapy
  • interferential therapy
  • therapeutic ultrasound
  • TENS
  • lumbar supports
  • traction

Do not refer for:

  • radio frequency facet joint denervation
  • IDET(intradiscal electrothermal therapy)
  • PIRFT(percutaneous intradiscal radio frequency thermo-coagulation treatment)



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