The Role of Physiotherapy in Managing and Preventing Low Back Pain

Abstract

Low back pain (LBP) is a growing global health concern, with a significant increase in years lived with disability (YLDs) since 1990, particularly in low- and middle-income countries. Risk factors for LBP include smoking, obesity, sedentary occupations, and low socioeconomic status. Current clinical guidelines advocate for non-pharmacological and non-invasive approaches to managing LBP, emphasizing patient education, exercise therapy, and judicious use of diagnostic imaging, medications, and surgical interventions. Prevention strategies include public health initiatives addressing obesity and low physical activity levels. Exercise alone or combined with education effectively prevents LBP, with a pooled relative risk of 0.55 (95% CI: 0.41–0.74). For acute non-specific LBP, initial management includes reassurance, advice to stay active, and self-management strategies. Primary conservative physical treatments for chronic LBP include exercises, yoga, manual therapy, and interdisciplinary rehabilitation. Pilates, walking, and mobilization and manipulation therapies have shown promising outcomes in reducing pain and disability. The McKenzie Method of Mechanical Diagnosis and Therapy (MDT) has demonstrated superiority over other rehabilitation interventions in chronic LBP. Future strategies should focus on educating the public, modifying disability and compensation policies, addressing modifiable risk factors, optimizing healthcare pathways, and aligning practice with evidence by encouraging activity, functional improvement, and work participation.