| Note on research and authorship The goal of rehabilitation for low back pain is to decrease pain and to promote an active lifestyle and regular participation in an exercise program, helping the individual regain mobility and strength to that particular region of the spine (Malmivaara).
Therapy to reduce symptoms followed by spinal exercises may be all that is required for mild cases. However, more involved rehabilitation is required for severe symptoms. Passive intervention should be time limited, with emphasis on active exercise. Rehabilitation will be based upon the duration of time from the onset of symptoms.
Acute Phase (up to 7 days): Recovery may be improved by a few sessions of manipulation, followed by instruction on comfortable postures and positions that are safe for the spinal structures. The individual should be encouraged to resume activities that can be tolerated (Bigos).
Sub Acute Phase (2 to 12 weeks): Instruction should be given on an exercise program that will help maintain the individual's well being. Physical therapy will include modalities such as moist heat and electrical stimulation to control pain in order to promote physical activity. The individual may also benefit from spinal injections for pain control. During this phase, the work place should undergo an ergonomic evaluation so that changes may be implemented to help the employee return to work. Toward the later stages of this phase, if the individual shows a lack of or slow progress, a psychologist should evaluate the individual to determine whether or not there are signs of psychological distress secondary to the injury (Kendall). There is evidence that a multidisciplinary treatment approach can be effective in treating these individuals and returning them to a full level of activity (Loisel).
Chronic Phase (more than 12 weeks): Exercise instruction must continue, the program combining coordination, aerobic conditioning, and flexibility. The individual should continue to be educated on functional exercises and proper body mechanics. A short course on cognitive pain management may be beneficial. If not already performed, an ergonomic evaluation with modifications may enable the individual to maintain or return to work and reduce the risk of re-injury. Vocational services should be available for individuals who cannot return to their previous job title or do not have a job to which to return (van Tulder). |
| FREQUENCY OF REHABILITATION VISITS | | Nonsurgical | |
| Physical Therapist | | Up to 12 visits within 6 weeks | | | | | | | | Physical Therapist | | Daily up to 6 weeks ‡ | | | | | | | | Occupational Therapist | | Daily up to 6 weeks ‡ | | | | | | | | Chiropractor | | Up to 3 visits within first week of onset | | | | | | | | Psychologist | | Up to 2 visits within 6 weeks of onset | | | | | | | | Psychologist | | Up to 12 visits within 6 weeks ‡ | | | | | | | | Ergonomist | | Up to 2 visits within 8 weeks | | | | | | | | Vocational Counselor | | Up to 3 visits within 6 weeks ‡ | |
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| ‡ As part of multidisciplinary intervention (work condition). |
| The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice. |
Source: Medical Disability Advisor