Provider Guidelines for 3 Risk Types
Low Risk
Acute/subacute (less than 12 weeks)
Medium Risk
or Chronic (more than 12 weeks)
High Risk
Long Term / Permanent
Low Risk
The patients in the low risk category are very likely to improve. The aim is to support and enable self-management. The key factors are to address patient concerns and to provide information.
What to DO:
- Assessment to include medical issues but also patient worries, concerns and social impact
- Brief physical assessment as appropriate
- Medication review and advice
- Address specific patient issues from the assessment
- Provide oral and written information
- Explain outlook is good but can re-consult if necessary
- Recommend simple first line care: heat, massage, acupuncture, spinal manipulation
What to SAY:
- Provide reassurance on the benign nature of LBP, explain that it is unlikely that serious disease is present
- Explain that imaging is not required and will not change management
- Avoid language that promotes fear of pain and catastrophic thinking (e.g., injury, degeneration, wear and tear)
- Encourage activity and self-management over pharmacological treatment
Medium Risk
The main aims are to restore function (including work), minimize disability even if pain is unchanged and to support appropriate self-management.
What to DO:
- Similar to low risk, elicit concerns and adequate physical examination
- Tailored treatment according to physical findings and specific needs / worries of the individual patient
- Course of chiropractic or physical therapy, which for some patients may only be brief
- Specific chiropractic or physical therapy interventions when clear specific findings from physical assessment (i.e. manual therapy, specific exercises)
- Some patients will need onward referral to specialist services (i.e. secondary care spinal services, ortho, neurosurgery, pain clinic)
- Introduce cognitive behavioural approaches and mindfulness
What to SAY:
- Discuss treatment objectives that are specific and have an end time point; all specific treatment effects should ‘translate’ into functional improvements and reduced disability
- Explain that imaging is not required and will not change management
- Avoid language that promotes fear of pain and catastrophic thinking (e.g., injury, degeneration, wear and tear)
- Encourage activity and self-management, recommend against bed rest
- Recommend against the use of surgery, injections or denervation procedures
High Risk
The aims are to reduce pain and optimize function.
What to DO:
- Six individual (45-60 min) physical therapy appointments over three months using a combined physical & cognitive-behavioral approach
- Review medications regularly for evidence of benefit and discontinue if there has been no improvement
- Identification of potential obstacles to rehabilitation (e.g. Yellow & Red Flags)
- Identification of possible targets for intervention
What to SAY:
- Discuss treatment objectives that are specific and have an end time point; all specific treatment effects should ‘translate’ into functional improvements and reduced disability
- Encourage ongoing therapy to improve cognitive, emotional and behavioral responses to pain.
- Recommend against the use of surgery, injections or denervation procedures
