Interventions for the management of acute and chronic low back pain: revision 2021

This is the 2021 update of the Academy of Orthopaedic Physical Therapy's low back pain guideline, published in JOSPT and written mainly for physical therapists. Unlike the broader 2012 guideline, it deliberately narrows its scope to treatments, leaving diagnosis and examination to other guidelines.

It grades the evidence for four groups of interventions (exercise, manual and other directed therapies, classification systems, and patient education) separately for acute pain, chronic pain, pain with leg symptoms, older adults, and care after surgery. It also covers approaches not reviewed in 2012, such as dry needling, cognitive functional therapy and pain neuroscience education.

Its strongest recommendations favor exercise training for chronic low back pain, thrust or nonthrust joint mobilization for both acute and chronic pain, and active treatments over education alone. Dry needling, massage and neural mobilization receive weaker support as add-ons for short-term benefit, and mechanical traction is not recommended for chronic pain with leg pain.