Clinical Guidelines Lowerback

Clinical Guidelines .
\GKRKNY \GKIRF
:B[GRC
QG\I\ CD KCBMC NGVKJG FTKRP

FTKRP .1
(KJGYB) EI QG\I\ CD CBM .2
KRGZM CD CBM .3
:K"T LGZT
SKKZ NBGP[ Z"E
EFN QGRPB Z"E
\KNBZ[KF FEGCTF \XGCYG
QG\I\ CD KCBMN \GKRKNYF \GKIRFF \CK\MN
2007
NBZ[KC \KBGVZF \GZE\SFF

\KBGVZ \GKRKEPN UDBF
OKRKKRTF QMG\
3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ZCE I\V
5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BGCP
6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FPEYF
6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (15) \GZEDF
7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FKDGNGKPEKVB
7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FJK[
QG\I\ CD KCBM \TKRP .1
10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . QG\I\ CD CBM \TKRPN \GXNPF

14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OGMKS
(KJGYB) EI QG\I\ CD CBMC NGVKJ .2
16 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . BGCP
20 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . EI QG\I\ CD CBMC NGVKJ
23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FEGCTG CD CBM :I IVSR
(KVKXVS) KNGDS K\NC KRGZM QG\I\ CD CBMC NGVKJ .3
26 . . . . . . . . . . . . (KVKXVS) KNGDS K\NC KRGZM CD CBMC NGVKJN \GKIRFF \KXP\
30 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FKVZDGKNCKC
ZCE I\V
OKPZGDFP EIB BKFG FIV[PF KBVGZ NXB F\GIKM[C FKKR[F FRGN\F FRKF QG\I\ CD KCBM
.KCZTPF ONGTC FEGCTFP \GZETFN Z\GKC OKIKM[F
NTP FKSGNMGBFP HGIB OK[KPIP FNTPNC \TDGV BKFG ,NKDF OT FNGT FTVG\F N[ F\GIKM[
.60 NKD
KBVGZ ,OKEVG\ZGB ,FIV[P KBVGZ GKEIK GZCI ,FTVG\F OT \KTGXYP FZGXC EEGP\FN \RP NT
\GKIRF \CK\MN OKJYZVGZKMG \GKIB OKJSKVZ\GKHKV ,OGYK[ KBVGZ ,OKDGNGJPGBZ ,CBM
.QG\I\ CD KCBM N[ FTKRPG NGVKJN
G\MKZT NTG ZPGIF HGMKZ NT ,WPBPF NT EFN QGRPB Z"EG SKKZ NBGP[ Z"EN \EIGKP FEG\
.\KVGSF
.QG\I\ CD KCBMC NGVKJN FNB \GKIRF N[ K[TP OG[KKG NGVKJC FINXF GRNGMN NIBP KRB
WKCGZMH EGE Z"E
NBZ[KC FIV[PF KBVGZ EGDKB Z"GK
3 A CD CBMC NGVKJG FTKRP

BGCP
GNB \GKIRF .(KJGYB) EI QG\I\ CD CBMC NGVKJN \GKRKNY \GKIRF GPSZGV OKR[ Z[TM KRVN
FXGV\NG OKKJRGGNZF OKEGDKBF N[ CIZR KGCKDN GMH \KNNM \GBKZC K\GZ[ \ZDSPC GPSZGV[
.\PEGYF \ZDSPF N[ \ZMKR FCIZF ZYKTC LB ,QGMET OKGGFP OMKRVN[ \GKIRFF .\CIZR
(K"ZF) NBZ[KC \KBGVZF \GZE\SFF \GSIC FSRM\F \GKIRFF \B F[CKD Z[B FEGCTF \XGCY
\GKIMGRF \GKIRFF .B[GRC \KVGZKB FEGCT \XGCY N[ KEGIKK UYKFC FEGCT NT FMP\SFG
NMN \GKBZF \PZ \B DZEN GREVYF ,QM GPM .CD CBM \TKRPCG KRGZM QG\I\ CD CBMC OD \GYSGT
UGS ET FEKVYC FYZSR GRMP\SF FKNT \GZVSF .Z\GKC \KRMETF \GZVSC F\GCDNG FXNPF
KGBZF QP .2005 KRGK UGS ET \GZVSF \B GRYZS WZBC GR\EGCTCG \KVGZKBF FXGCYC 2003
\B UY[N \GMK[PP QF[ BEGGN KEM [GN[=OKK\R[N \IB N[ \GZKE\C GNBM[ \GKIRF QMETN
\GTGXYP NNGM OGI\C OKNVJPF NMN \GRGGMP \GKIRFF .Z\GKC KRMETF KTEPF TEKPF
GH \KTGXYP=CZ F[KD \VY[P FEGCTF \XGCY .\KPEYB LMN GMPSGF[ KBR\CG OKKBGVZ=BZBV
JSKVZ\GKHKVF ,\GIBN ETG KRG[BZF BVGZF LZE I\RPF QP OKNVJPF IGGJ \B \NNGM BKFG
.ZGJYZVGZKMFG
\MZTFN OD ,L[PFC ,GMHKG \KNBZ[KF \GBKZCF \MZTPC GTPJGK FNB \GKIRF[ OKGGYP GRB
.OKNVGJPF NT Q\TV[F
,QGKRMJF ,JZGVVZ ["T FBGVZN FJNGYVF ,KBGVZ LGRKIN FYNIPF NFRP ,SKKZ NBGP[ Z"E
FVKI
,\KZCTF FJKSZCKRGBFG FSEF ,FBGVZN S"FKC ,FIV[PF \BGVZN DGIF Z"GK ,EFN QGRPB Z"E
OKN[GZK
QG\I\ CD KCBMN \GKNBZ[KF \GKRKNYF \GKIRFF \CK\MN K"ZF N[ FEGCTF \XGCY KHMZ
\GEG\ KPN[
\GKIRF [GCKDN KNBZ[KF OGZGVF SRM\F F\GSIC Z[B ,NBZ[KC \KBGVZF \GZE\SFN \GEG\
.K"ZF NGP FEGCTF \B OB\ Z[B YIXK LGZC Z"EN FEG\ .2004 ZCPJVS ,FVKI ,NPZM QEC
.FCZF FEGCTN ,FZGP\ BNN ,O\GSKKD\F NT FEGCTF \XGCY KZCI NMN FEG\
KZPBP \B GRKMF[ QPTR EZG Z"EG ZIS KNJ Z"E ,CN K[K Z"E N[ O\PGZ\N FMZTFG \GEG\
NT TYZ ZPBP \B C\M[ OZKN EGZPR Z"E N[ G\PGZ\NG .OKSZEPG \GBSM ,OKRZHP NT TYZF
.FTKRPN FYKJYZVGZKM
.\ZCGIF \FDFC ZHT[ QGJSRKKV QGZFB Z"EN \EIGKP FEG\

FPEYF
(\KNNMF FKVZDGKNCKCN \GSIKK\P \GBCGPF)
\GRPKFP \GKZYIP \GKBZ NT \SSGCPF ,FEKIB F[KD \GG\FN BKF \GKRKNY \GKIRF N[ Q\ZJP
,(1) C"FZB QFKRKC ,QG\I\ CD CBMC NGVKJN \GKIRF GPSZV \GCZ \GXZB .(evidence-based)
.(6) ERNGFG (5) \VZX ,(4) FKNDRB ,(3) ERNKH GKR ,(2) FKNZJSGB
European) (7) \KBVGZKBF FETGF \GXNPF NT \GSSGCP ,QBM \GBCGPF \GKNBZ[KF \GKIRFF
\GKIRF BGZYN Q\KR .\V\G[P \KBVGZKB FSZKD F[CKDG FRE[ (Commission, COST Action B13
\IB NMC \GKRKEP \TKCYN SKSC \G[P[P \GKIRFF .www.backpaineurope.org =C GNB
.\KBVGZKBF FETGC \GZCIF (NBZ[K NNGM) \GRKEPFP
FRKF (QBM \GBCGPF \GXNPFN \PZG\ F\EGCTP FCZF QM[) QGKXN FKGBZF \VSGR FEGCT \ZDSP
,CDF \XGCY FMG\CG ,(http://www.update-software.com/cochrane) The Cochrane Collaboration
\GRG[ \GKGCZT\FC \GYSGTF ,(systematic reviews) \GK\JK[ \GZKYS 25 =M FPSZV FM ET Z[B
\GDXGPF \GKIRFN \GKJRGGNZF \GZKYSF .(KVKXVS) KNGDS BN QG\I\ CD CBMC NGVKJNG FTKRPN
K\C ,(9) \GNKTVN FRGMR FMZEF ,(8) OKECGTN \KNBKXGS=GMKSV=GKCF NGVKJF \[KDC \GYSGT QBM
(13) CD \GZGDI ,(12) KCKJYB NGDZ\ ,(11) K\GDFR\F NGVKJ ,(10) (back schools) CD \GKTCN ZVS
.(14) FEGCT KBR\G
Randomized Clinical ) OKZYGCP OKKRKNY OKZYIP LPS NT \GXNPF SSCN FVETF FR[K ,NNMM
.(Trials, RCTs
(15) \GZEDF
\GTNXF GY QKC[ ZGHKBC OKPYGPPF \GIGR ZSGI GB CBMM ZEDGP (\"DM) QG\I\ CD CBM .
.OKKNDZN FRZYF KNC GB OT ,OKRC[KF KNVYN \GRG\I\F
ZEDGP ,Z\GKC IKM[F BGF[ ,(non-specific low back pain) (KVKXVS) KNGDS BN QG\I\ CD CBM .
GB \KCXT FRZYF ,ZC[ ,NGEKD ,OGFKH GPM \ZEDGPG FTGEK FKDGNG\VN LKKG[P GRKB[ FHMM
.(cauda equina syndrome) SGS CRH \RGPS\
,\GTGC[ 6=P \GIV L[PRF CBMM ZEDGP (KJGYB) EI \"DM .

.\GTGC[ 12=N 6 QKC L[PRF CBMM ZEDGP (KJGYB=CS) EKEI \"DM .
.Z\GK GB \GTGC[ 12 L[PRF CBMM ZEDGP KRGZM \"DM .
CBM N[ \GZCD\F BNG ,OKPGJVPKS BNN FVGY\ ZIBN F[EI FEGHKVBM ZEDGP ZHGI \"DM .
.OKKY
CD CBMC NGVKJG FTKRP A 6

FKDGNGKPEKVB
FNGT \GIKM[F Z[BM ,\G[TG\PF \GXZBC 70%=P FNGED OKKIF LNFPC \"DM \TVGF \GIKM[
.(19) 35=55 KBNKDC FBK[N FTKDP[ ET (18) ,(17) ,(16) ZVSF \KC KBNKD LNFPC
OKNCGSFP 85% =MC ,USGRC .\GPKEC OKBXPPFG FKDGNG\VF ,\GRGN\F QKC FPB\F FBXPR BN
ZMGP KRGZM GB ZHGI \"DM .\KCXT FTZVF GB \KNGDS FKDGNG\VN CBMF \B LKK[N Q\KR BN \"DMP
OKZETRF GNBC OF ,\"DM \GCYTC FEGCTP \GZETKFF KPK \KXIPM .FEGCT KPK QECGBN OZGDM
\GKBGVZF \GBXGFFP 80% ,LMP FBXG\M .OKZETRFP 15% YZ OKGGFPF [EGIP Z\GK
.(20) OKZHGIFG OKKRGZMF OKZYPF { 15% O\GBC \GTY[GP \GK\ZCIFG
OEGY UY\F .\"DM N[ \PEGY FKZGJSKF GRKF [EI \"DM UY\FN Z\GKC YHIF QGMKSF OZGD
OKPZGD OKNNGM GFGH[ OKVSGR QGMKS KPZGD .(21) QGMKSF \B NKVMP OK[EGI 12 N[ IGGJC
OKPZGDG ,(19) OKZHGI NG\KVG UGVKM ,FPZF GPM OKZHGI OKKRVGD OKSPGTC OKZG[YF OKKRMPGKC
.(22) ,(19) KNGI \GDFR\FG QGBMKE ,FEZI ,\GK[VR \GYGXP GPM OKNBKXGSGMKSV
FJK[
OKRG[ OKPGI\P OKBRKNY N[ FEGCT \XGCY F[DVR ,\"DMC NGVKJN \GKIRFF \B Z[BN KEM
FPMSFN TKDFN KEM OKHMGZP OKKPGKN ,NBZ[KC \KBGVZF \GZE\SFF \GSIC ,2004 ZCPJVSC
.\GXNPFF KCDN \V\G[P
OGZGVF KV\\[P
EKYV\ O[
FIV[P BVGZ ,OGZGVF Z"GK SKKZ .[ Z"E
FIV[P BVGZ ,U\G[ { Z"GK EFN .B Z"E
OGEKYN F\GPTFG ,FVKI \JKSZCKRGB ,FKVZ\GKHKVN DGIF \DKXR JFC=DKZ[ .F 'CD
NBZ[KC FKVZ\GKHKVF
KPGBN IGJKC ,\K\YGST\ FBGVZ KYSNGYS .P Z"E
NBZ[KC FKVZ\GKHKVF OGEKYN F\GPTF DKXR NBNXC .D ZP
\GBKZCF EZ[P ,\K[BZF \KJSKVZ\GKHKVF DZV .B 'CD
FVKI ,QGKX KRC KBGVZ HMZP ,FKDGNGJPGBZ ZRHGZ .K Z"E
\KNJNYSGNGYSGP FBGVZN FEGDBF ,OGYK[ ZGP .K Z"E
QGKRMJF ,JZGVVZ ["T FBGVZN FJNGYVF ,CBMN FIPGP ,KPKRV BVGZ QGSVNGG .S Z"E
\KNJNYSGNGYSGP FBGVZN FEGDBF ,FIV[P .Z KERGG .B Z"E
CBMN \KNBZ[KF FEGDBFG CBMC NGVKJN KEGTKSF OGZGVF ,\GIB KBP[ .B 'ZE
CD \KDZGZKMN 'IK ,FYGZGS ,EVG\ZGB QG[[ .B Z"E
N"FX ,EVG\ZGB QGJSRKKV .B Z"E
FRRTZ ,QKKJ[RKGN \KC ,OGYK[G \KNYKHKV FBGVZ ZDZJ .K Z"E
OKN[GZK ,FSEF KBJKSZCKRGBF I"KC ,FYKJYZVGZKM OZKN .R Z"E

TEKP UGSKB
FK\GXNPF \B FSSKC \BH FXGCY .COST B13 =F \XGCY \GXNPF G[PK[ TEKPN KZYKT ZGYP
:OKBCF TEKPF KZDBPC GPSZV\F Z[B (systematic reviews) \GK\JK[ \GZKYS NT NM OEGY
ZVSP LZGXN OKKRGZJYNB OKRG\R KESPC USGR [GPK[G ,COCHRANE, MEDLINE, EMBASE
.KVKXVS OGI\C OKB[GR
.2003 ZCPXE ET 1966=P FVGY\F \B FSKM \KBVGZKBF FXGCYF N[ \GZVSC [GVKIF
OKKBGVZ OKRG\KTC \GPSZV\P \GKIRF[ QGGKM .MEDLINE =C TXGC \GKRKNY \GKIRF ZIB [GVKI
\GKIRF" "CD CBM" OKIRGPC GR[P\[F) JRZJRKBC [GVKIF \B GRCIZF ,\GYGIZ OK\KTN YZ
GPM .(OKRMZXG \KPGBN \GBKZCN OKZG[YF OKKTGXYP OKEGDKB N[ OKZ\BC GR[VKIG "\GKRKNY
.OGI\C OKIPGP OT K[KB Z[Y K"T \GXNPFG \GKIRF GFGH QM
\GPKKY \GKIRF QKC FBGG[F F\[TR L[PFC .\GK\JK[ \GZKYSP GBXGF \GXNPF ,QG[BZ CN[C
OKZPBP ZIB [GVKIC TEKP KZDBP O\GBC \GZVS \ZKYS F\[TR ,K[KN[ CN[C .\GXNPFFG
.OGI\ G\GBC FRGZIBF \K\JK[F FZKYSC [GVKIF \VGY\ UGS ZIBN GPSZV\F Z[B OKKZGYP
OKIPGP ZVSP N[ \ZGYKCN GZCTGF \GKVGSF \GXNPFF .FXGCYF KEK NT GRGEKR \GXNPFF UGSCN
.OK[EI TEKP \GZGYP \VSGF LZGXN OGI\C OKKPNGT
(Levels of evidence) \GKBZF \PZ DGZKE

.FXNPF/FKKIRF NMC \GMPG\F \GKBZF \PZN OB\FC GDZGE \GXNPFFG \GKIRFF NNM
:QPYNEM FDZGE \GKBZF \PZ
\GMKBC OKZYGCP OKKRKNY OKZYIP N[ \K\JK[ FZKYS LG\P OKKCYT OKBXPP :A FPZ .
.(Radomized Controlled Trials ± RCTs) FFGCD
\GMKBC OKZYGCP OKKRKNY OKZYIP N[ \K\JK[ FZKYS LG\P OKKCYT OKBXPP :B FPZ .
(OKZYGCP OKK\BGG[F OKZYIP) OKKNPGERZ ORKB[ OKZYGCP OKZYIP GB FMGPR
.Comparative Clinical Trials, CCTs
LG\P OKKCYT ORKB[ OKBXPP GB (FMGPR GB FFGCD \GMKBC) ZYGCP KRKNY ZYIP :C FPZ .
.OKZYGCP OKK\BGG[F OKZYIP GB OKZYGCP OKKRKNY OKZYIP N[ \K\JK[ FZKYS
.ECNC OKIPGP \TE BNB CCTs GB RCTs LG\P \GKBZ SGSKC BNN :D FPZ .

\GKRKNY \GKIRF
QG\I\ CD KCBM \TKRP .1

\GPKKY \GKRKNY \GKIRFG \GK\JK[ \GZKYS NT SSGCP
COST 13B \KBVGZKBF FEGCTF \XGCY \GXNPF
\KNBZ[KF FEGCTF \XGCY SGHRXRGYG
Q G\I\ CD CBM \TKRPN \GX NPF
(34=30 'PT ,FTKRP B[GRC FKVZDGKNCKCN \GSIKK\P \GBCGPF)
:(\"DM) QG\I\ CD CBM \TKRPN ZG[YF TEKPF \KXP\
\GHMZ\P FNB \GXNPF .QG[BZ \"DM UY\F N[ FTKRP KCDN \GZVSC QPKFP TEKP QKB &
.QG\I\ CD CBM N[ GK\GBXG\G G\TV[F \\IVFC
BKCK IZMFC BN QGMKS KPZGD KGRK[ .OKZGZC BN QKKET GZB[R QG\I\ CD CBMN OKPZGDF &
.\"DM \TKRPN
\GMR ,(OKZHGI OKTGZKB) \GR[KF \TKRP :\"DM UY\F N[ \GBXG\F \TKRPN OGYP [K &
.FEGCT KPK ESVFG
\\ N[ \GXNPF QKC FVKVI FR[K ONGB ,\GRG[ \GKSGNMGBN \GPKB\P \GRG[ \GKGCZT\F &
.(OKENKG OKECGT) \GXGCY
.FTKRPM \GC[IR BN { OKPKKY OKRKPS\C NGVKJ F[TPN QRKF[ \GKGCZT\F &
FKKSGNMGB
K\[ GZEDGF FMG\C[ ,Z\GKC FVKYPFG FCIZF BKF[ \KNNMF FKKSGNMGBN \GSIKK\P \GKIRFF
.OKENKG OKECGT ,FR[P=\GXGCY
\PB\F GPM FEGCTF OGYPN \GKEGIKK \GKGCZT\F GYECR OFC OKZYIP :\KNNMF FKKSGNMGBF
\GXNPFF LZGXN ."OKECGTF" \XGCY \\ \GXNPFN GMKG[ ,(FKPGRGDZB) FEGCT \RI\
OGYP \ZDSPN WGIP OD OG[KKN \GR\KR Z[B \GKGCZT\F YZ GZYSR \KNNMF FKKSGNMGBN
.FEGCTF
.OEGY \"DM BNN GB OT ,OKECGT (18 NKD NTP) OKZDGCP \NNGM FKKSGNMGBC GH FXGCY :OKECGT
\"DM N[ OKMGCKS GB ,CD KCBM \TKRPN \GXNPF YVSN BKF GH FKKSGNMGB \XGCY \ZEDF \ZJP
OKECGTG \"DM CYT NGVKJN GTKDF Z[B OKECGT GYECR OFC OKZYIP .FEGCTF IGM \ZDSPC
GNNMR \"DM N[ \GZHGI \GEGHKVB GYECR OFC OKZYIP .GNNMR BN FNIP \[VGIC OKBXPRF
OFC OKZYIP .(modified work) FEGCTF \PB\F FYECR OFC OKZYIP KCDN OD LMG FZKYSC
.\BH FYKZSC GNNMR BN ('GMG \GIGR KB ,CD \GVKKT) OKMZ OKEEP GB QGMKS KPZGDC KGRK[ GEEP
OKEKPN\ CZYC \"DM \GIKM[[ GBXP OKCGZP OKZYS ,\GRGZIBF OKR[C :ZVS \KC KEKPN\
.OKZDGCPC \"DM BCRP \GENKC \"DM[ BXPR QM GPM .ZCTC GC[I[P FCZFC FFGCD

GZYSR[ OKB[GRF
\GSIKK\F GNNM \GKBVGZKBF \GXNPFC FZKYSN GBCGF[ TEKPF KZDBPC [GVKIF \GBXG\
:OKBCF OKB[GRN
OKRZHP ,FKPGRGDZB ,CD \GZGDI ,\KRVGD \GNGTV ,CDN ZVS K\C ,TEKP Q\P :\KNNMF FKKSGNMGBC
OKZYIP GNNMR ,USGRC .\"DM \TKRPN KGSKTG ,FKXNGVKRP ,OKSZEP ,OKC[GPG \GBSKM ,\GJKPG
.QGKZFC \"DM \TKRPC GYST[
ZVSPC KGRK[ :QGDM) \GBKZC KBXG\ NT FTV[FF FYECR BN OFC QGMKS KPZGD KGRK[ NT OKZYIP
.GNNMR BN (QG\I\ CD KCBM N[ OKVY\FF
\TKRPN \GCZT\FF .ECGTF NT F\TV[FG FKPGRGDZBF NT [DE O[GF :OKECGTF \KKSGNMGBC
,ECGTF N[ \KRMPGKCF FVK[IF \B FR[PF FKPRGDZBN \SIKK\P OKECGTF CZYC \"DM
.FEGCTF QGDZB \B FR[PF FKPGRGDZBNG
KGRK[N K\GCZT\F ZYIP QKBG JTPM .QGMKS KPZGDC HMZ\P ZYIPF CGZ :ZVS \KC KEKPN\C
.\"DM \GIKM[ NT FTV[FF \EKEP LG\ GNB QGMKS KPZGD
.OKZYIPG \GPKKY \GXNPF ,\K\JK[ \GZKYS NT \GSSGCP \GXNPFF
:\GKNNM \GZTF
.\"DM N[ FTKRP KCDN \GRPKFP \GKBZ JTP [K &

.\KZ[VB \"DM N[ \GBXG\F \TKRP[ \GKBZ [K &
BN \EEGC \GCZT\F .\KRGRKC FTV[FF \PXGT { \GNKTKN FIMGF [K QFN \GKGCZT\F &
.\"DM \TVGF TRPK\
NMC \KMGRKI \KRMG\G OKNKDZ\/\KRVGD \GNKTV \GNNGM Z\GKC \GIKJCPF \GJK[F &
.FZJPF \GXGCY
.OKRG[ OKPZGD N[ UG\K[ LG\ ,FCGJ \GMKBC ,ZYIPC LZGX [K &
\KNNMF FKSGNMGBN \GXNPFF KZYKT

N[ UY\FF L[P ZGXKYG \GR[KF \TKRP ,FNIP KPK ZVSP \RJYFN \XNPGP \KRVGD \GNKTV .
.(A FPZ) \"DM
.\KRVGD \GNKTV N[ OKGSP DGS \GNNG[ GB \GMPG\F \GTRM[P \GKBZ QKB {

\NCDGP FTV[F [K KNBKXGS=GMKSV=GKC NEGP NT \GSSGCPF FMZEFG LGRKI \GNKTVN .
.(C FPZ)
.OKXNPGP ORKB KRMP=GKC GB KNYKEP=GKC NEGP NT OKSSGCP FMZEFG LGRKI {

\GKRM\ (A FPZ) OKXNPGP ORKB \KRMPGKC F[KD NT OKSSGCPF "CDN ZVS K\C" .
OKZHGI OKTGZKB OT OKNGIN Q\RKFN \GNGMK KNBKXGS=GMKSV=GKCF NEGPF NT \GSSGCPF
.KRGZM \"DM GB
NGDZK\C OKCNG[P FMZEFG LGRKI \NNGMF \K\XGCY \GCZT\FM ZEDGP "CDN ZVS \KC" .
.\KHKV \GNKTVG
\"DM FTKRP LZGXN (FEKNF ZIBNG QGKZFF L[PC OD) \KZ[VB OKPC \KRVGD \GNKTV .
.(C FPZ)
.(A FPZ) \GXNPGP QRKB CD \GZGDI .

.(D FPZ) OKEIGKP OKRZHPC GB \GBSKMC [GPK[ EDR/ETC FXNPFN \GKBZ YKVSP QKB .
(FYKJYZVGZKM NNGM) \KREK FKXNGVKRPC NGVKJ EDR/ETC FXNPFN \GKBZ YKVSP QKB .
.(D FPZ)
LZGB KNECF QGYK\ EDR/ETC \GKBZ YKVSP QKB .(A FPZ) OKXNPGP ORKB OKKNTRN OKSZEP .
.(D FPZ) OKNDZF QKC
OKECGT
:N \YNI\P OKECGTF CZYC \"DM \TKRPN \GCZT\FF
.EEGCF ECGTC \HMGZP .1
.ECGTF N[ \KRMPGKCF FVK[IF \B FR[PF FKPGRGDZB .2
.FEGCTF QGDZB \B FR[PF FKPGRGDZB .3
OKECGTN \GXNPFF KZYKT

;(A FPZ) UY\FF L[P ZGXKYG \GR[KF \TKRPN ,\"DM \TKRPN \XNPGP \KRVGD \GNKTV .
.(C FPZ) Z\GK FMGPR \"DM CYT \GZHGI \GKGZETKF \TKRP \NGMK
.(A FPZ) OKXNGPP ORKB KRMP=GKC GB KNYKEP=GKC NEGP NT OKSSGCP FMZEFG LGRKI .
KNBKXGS=GMKSV=GKC TEKP \GNKMPF \GZCGI N[ Q\TV[F \EKPN \GKBZ YKVSP QKB {
.(C FPZ)
.(C FPZ) \GNKTK \GKFN \GNGMK G\KB \GEEGP\FF LZEG \"DM N[ FZCSFG FMZEF {
.(A FPZ) \GXNPGP QRKB CD \GZGDI .
.(A FPZ) OKXNPGP ORKB OKKNTRN OKSZEP .
OKRGIKJ[ GB \GMZ \GVXZ ,\GMZ OKKNTR ,OKKNTR \GEKVZ EDR/ETC \GKBZ YKVSP QKB .
.(D FPZ)

ZIBN FEGCTN FZHI EEGTN OKKG[T FEGCTF OGYPC OKKPGRGDZB OKKGRK[G FEGCTC OKKGRK[ .
.(B FPZ) \"DM UY\F
.(C FPZ) OKVY\FF ZVSPG G\ZPGI ,UY\F \TVGF QKJYFN OKNGMK OKKPGRGDZB OKKGRK[ .
.(C FPZ) FEGCTF OGYPC \KRGDZKB \GCZT\F EDR/ETC \GKBZ YKVSP QKB .
OKEKPN\
Q\P LZGXN \GKBZG OKZYIP QKKET QKB .\GIKJCP \GBZR \"DM \TKRPN \GKMGRKI \GKGCZT\F .
.\GXNPF

OGMKS
FMKZEPG \NVJPF NBZ[KC \GBKZCF \GTGXYP KZCI \NKFY NNMN \GETGKP GNB \GKIRF
.OKECGTG ZVSF K\C KENK FMG\CG ,\KNNMF FKKSGNMGBF \B
UY[NG ,QG\I\ CD KCBMC OKYSGTF NMN U\G[P FRMP \\N \GBC FH LPSPC \GXNPFF
.CD KCBM \TKRPN TDGRC OGKM \GPKKYF \GKBZF \B
LKZEFN NVJPF \B \GEEGTP ,KCKJYB NGDZ\G \KRVGD \GNKTVC \GMPG\ \GXNPFF ZYKT
.\"DM B[GRC ZCM TGEKF NT NVGJPN ZKCSFNG
[GPK[ NT \GXKNPP QRKBG ,F[VGI GB FIGRP EGEKTC \GMPG\ QRKB GZYSR[ \GKBZF
.OKSZEP GB CD \GZGDIC
\GXNPFF QKB QMNG \"DMN QGMKSF KPZGD \B GR\RCFC K\GTP[P ZSI QKKET OKKY
.B[GRC KEK\T ZYIPN CZ OGYP GR[KG ,\GPN[

\GKRKNY \GKIRF
QG\I\ CD CBMC NGVKJ .2

(KJGYB) EI
BGCP
\GZJP
FBGVZC KVKXVS BN EI \"DMC NGVKJF \B ZV[N BKF FNB \GKIRF N[ \KZYKTF FZJPF
:K"T NBZ[KC \KRG[BZ
.(KVKXVS) KNGDS BN QG\I\ CD CBMC NGVKJN \GKIRF Q\P .1
.OKKJRGGNZF \GTGXYPF NM K"T NNM LZEC \GPMSGPG \GNCGYP \GKIRF Q\P .2
OGXPKXG \KRG[BZ FBGVZC OKBRKNYF QKC FNGTV UG\K[ EGEKT ,\KTGXYP=CZ F[KD \PXTF .3
.\KNGVKJ \GRG[
ETKF NFY
,FKEVG\ZGB) \KRG[BZ FBGVZN OKKTGXYP OKXTGK ,OKJSKVZ\GKHKV ,OKKRG[BZ OKBVGZ
,FKJVGBSGB ,FYKJYZVGZKM) OKZIB OKNVJP ,(OGYK[G FYGST\ ,CBM ,FKDGNGJPGBKZ
OKNCGSF OKNVGJP ,CIZF NFYN OD \GETGKP GNB \GKIRF .OKNFRPG ,(C"GKMG ZERSMNB
.\GBKZCF \MZTPC \GJNIF KNCYPG \"DMP
FEGCTF \JK[
N[ CIZR DGXKK FNNMG 2004 ET 1999 =P FNTV[ \KVGZKB FEGCT \XGCY K"T GISGR \GKIRFF
\GZKYS NT GSSC\FG 2004 =C QGMET GZCTG 2002 =C GPSZGV GNB \GKIRF .\GRKEPG \GTGXYP
FPKB\F[ \KNBZ[K FEGCT \XGCY FSRM\F 2004 ZCPJVSC .\GKBZ KSSGCP \GKIRFG \GK\JK[
.NBZ[KN GNNF \GKIRFF \B
\GZEDF
OKNVYN NTPG QG\I\F \GTNXF GY=N \I\P ,\GIGR KB GB CBMM ZEDGP (\"DM) QG\I\ CD CBM
.NDZN QZGY CBM KNC GB OT ,OKKNBKJGNDF
EKEI QG\I\ CD CBM ,\GTGC[ 6=P \GIV L[PRF TGZKBM NNM LZEC ZEDGP EI QG\I\ CD CBM
.Z\GK GB \GTGC[ 12=M L[PR KRGZM QG\I\ CD CBM .\GTGC[ 12=N 6 QKC L[PR (KJGYB=CGS)
.\ZIB ZEDGF OB BNB ,EKEIG EI QG\I\ CD CBMN \GSIKK\P \GXNPFF FNB \GKIRFC

QGMKS KRPS
"OKPGEB OKNDE" .I
NT OKHPZPF "OKPGEB OKNDE" \GFHN BKF \KRG[BZF \KRKNYF FKZGJSKFF \NCY \ZJP
OKNGIC OKND\PF QGMKS KRPS ORKF "OKPGEB OKNDE" .(3) FZE[F EGPT N[ \KZ[VB FKDGNG\V
QG\I\ CD CBMN \GPZGDF \GZEDGP \GCKSN FGCD QGMKSC OKZG[YG QG\I\ CD CBM N[ FHRPRB OT
E[IC) USGR ZGZKC ,OKKY QMB OFP EIB OB ."OKPGEB OKNDE" BNN OKNGIN FBGG[FC
ZC[ ,\KJPGBZ \K\YNE FNIP ,OGFKH :QGDM Z\SGP CXP NGN[N KEM [ZEKK (\Z\SR FKDGNG\VN
.QJZS GB
|3~ ORKF OKPGEB OKNDE

FR[ 55=P ZDGCP GB FR[ 18=P ZKTX :FNI\FF NKD Q
\K\GTP[P FNCI Q
(FJKPC FIGRPC FNYF BNN) KRMP BN CBM ,OEY\P CBM Q
FHIC CBM Q
ZKBPP NGEKD N[ ZCTC \KBGVZ FKZGJSKF Q
OKEKBGZKJSC L[GPP [GPK[ Q
(HIV NNGM) KRGSKI KGMKE ,OKPSC [GPK[ Q
\KNNM FNIPN OKRPKS OT FNGI Q
NY[PC \ZCSGP BN FEKZK Q
(CAUDA EQUINA SYNDROME NNGM) OKCIZR OKDGNGZKGR OKRPKS Q
KRCP OGP Q
OGI Q
OKNGIC FFGCD \GZKCSC \PKKY ,(CAUDA EQUINA SYNDROME) SGSF CRH \RGPSK\
FTZVF (FJKN[ KB OK\KTN ,Q\[ \ZKXT NNM LZEC) Q\[F KMZEC FJKN[ ZSGI OKZB\PF
GB \KNNM F[NGI ,(saddle anaesthesia) UMGB \ZGXC WKKIF ZGHBC F[GI\ ZSGI ,OKZDGSC
KTGXYP OZGDN FVGIE FKRVF [ZGE FH CXP .FMKNFC FTZVF GB ,OKRG\I\F OKZCBC \PEY\P
.\KRG[KN[ GB \KRGKR[ FBGVZC

"OKCGFX OKNDE" .II
CBM L[PF GB \GI\V\FN QGMKSF \B OKZKCDPF OKKNBKXGSGMKSV OKPZGD OF "OKCGFX OKNDE"
NGVKJN NKCGFN ZGPB "OKCGFX OKNDE" KGFKH .|4~ \"DM QKDC FEGCT KPK QECB NNGM ,\GMRG KRGZM
GB \KNBKXGS=GMKSVF FMZTFF \GNKTKN FIMGF QKB ,ONGB .OKB\P K\GDFR\FG KCKJKRDGY
.EI QG\I\ CD CBMC FH OGI\C \GCZT\F
|4~ ORKF "OKCGFX OKNDE"

\GMRN OZGD GB YKHP GRKF CD CBM[ FZCSF :FPDGEN) CD CBMN \GPKB\P BN \GRGPBG \G[KD &
QMB FNKTV \GCZT\F[ FRGPB OGYPC O\VETFG OKKCKSV OKNGVKJP FFGCD FKKVKX ,F[Y
.(ZGHT\
.(EIV NNDC EGYV\C FEKZKG \GTRPKF FPDGEN) FPKB\P BN CBM \GDFR\F &
.(FEGCTFP FMGPR QGXZ \GTKC[ :FPDGEN) FEGCTN \GZG[YF \GKTC &
\GNKTVP F[KZV ,OKEGZK IGZ KCXPN FKKJR ,WIN ,FEZI ,QGBMKE QGDM) \GK[DZ \GKTC &
.(\K\ZCI
FKDGNGKPEKVB
\GBXPKF) \G[TG\P \GRKEPC FKKSGNMGBFP 70%=P FNTPN KEK NT IGGEP QG\I\ CD CBM
QKC OKBNKDC TKVGP \GBXPKFF BK[ (FR[N 5% OKZDGCP NXB \GTZBKF ,45% ET 15% FR[N
.|5~ 55=N 35
GB FKDGNG\VN SIGKP GRKB CBMF .QJY FKPEF KBXPPG ,FKDGNG\V ,OKRKPS\ QKC OB\PF
NNDC \GKRG[BZ \GBVZPC OKYECRF OK[RBFP 4% LZTC .OKNGIFP 85%=MC \KCXT FTKDV
FZEK[ EGPT \NIP .NGEKDP OKNCGS 1%=P \GIVG FSKIE KZC[P OKNCGS QG\I\ CD CBM
3%=N 1% QKC LZTC BKF K\KKNGI YSKE \XKZV GB JNC \GBXPKF .Z\GK OKZKER GC OKPGFKHG
.|6~
7%=2% NCB (\GTGC[ 6 LG\C 90% N[ FPNIFF) .GPXTP UNGI NNM LZEC EI QG\I\ CD CBM
N[ \GKGZETKFP 85% ET 75%=N OKBZIB KRGZM CBMG ZHGI CBM .KRGZM CBM OKI\VP OK[RBFP
.|5,9~ OKECGT
TGRPNG ,EGYV\F \NGMK \B ZV[N ,CBMF NT NYFN QRKF EI QG\I\ CD CBMC NGVKJF \GZJP
.KRGZMF CBMF \TVGFG CBMF \GR[KF

EI QG\I\ CD CBM N[ QGICB
FZJPF .FZXY \KRKNY FYKECG \KEGSK FHRPRBC KE EI QG\I\ CD CBMP OKNCGSF OKNGIF CGZC
,M"VTB .\KVKXVS FRICBN TKDFNG OF[NM "OKPGEB OKNDE" \GFHN BKF FYKECF N[ \KRG[BZF
SKSC NT FRICBN TKDFN Z[VB KB EI QG\I\ CD CBM N[ OKZYPF CGZC[ \GZGZC \GIMGF [K
,CBMF \GDFR\F ,CBMF ZGHKV KVN QGKP OT FRICB \GJK[ FPM GTXGF ,QMN .OKKDGNG\V OKKGRK[
.\KZYIP FVYG\ BN FNB DGGKS \GJK[P \IB UB .C"GKMG OKKRKNY OKRPKS ,\KEGYV\F FTZVFF
[GN[N EI QG\I\ CD CBM \YGNIC GRKF \KPGBNRKC FZMFN FMH Z[B KJYZVG JG[V DGGKS
:"K\RICB QGKP" N[ \GKZGDJY
FZE[F EGPT N[ FZGPI FKDGNG\V Q

(KZNGYKEZ) K[ZG[ CBM/CXTF [ZG[ CBM Q
(KVKXVS) KNGDS BN QG\I\ CD CBM Q
IKJCFN [K QG[BZ CN[C :\KRKNY FCK[I N[ FH GY KZIB \GCYGT K\RICBF LKNF\F KCN[
.FZE[F EGPTP FRKB[ FKDGNG\V NGN[NG FZGYPC (\KRMP) \KNJNYSGNGYSGP BKF FKTCF[
FHM[ E[I ZG[KB/\NKN[ .FZE[F EGPT ZGYPP FEI FKDGNG\V \GIMGR NGN[N BGF BCF ETXF
.\GVSGR \GYKEC KEK NT \GPKBN Q\KRG \KRVGDF FYKECF GB/G FHRPRBF \GTXPBC F[TR
NXB CBMF ZGHKV .CXTF [ZG[ NT WIN CYT CBMP NCGS FNGIF OBF JKNIFN BGF BCF CN[F
.LMC LGP\\ CGZN \KRVGDF FYKECFG ,LM NT GTKCXK G\KRC\G FNGIF
.(KVKXVS) KNGDS K\NC QG\I\ CD CBMM DGGSP CBMF ,EYGPP BXPP QKBC
\KKRC LZE ."FRICBF" \TKCYN JZV \GZIB \GCG[I \GZJP \\Z[P \KRG[BZF FYKECF
\[P[P USGRC .EGYV\F ZSGIG CBMF \DZE \B LKZTFN Z[VB ,\KRVGDF FYKECF TGXKCG FHRPRB
FN [KG FHGRDGZVG NGVKJ ,QGICB \GEGB NVGJPN TEKP Q\PN SKSCM \KREVYF \KRG[BZF FYKECF
.KNGVKJ EKYV\ OD

EI QG \I\ CD CBMC NGV KJ
,OKRG[BZ OKBVGZ .\KRG[BZ FBGVZC EI QG\I\ CD CBMC NGVKJC OKCZGTP GKFK OKRG[ OKBRKNY
\KNYKHKV FBGVZC OKIPGP ,OKDGNGJPGBZ ,OKKEVG\ZGB GPM OKTGXYP OKBVGZG ,OKJSKVZ\GKHKV
.EI \"DMP OKNCGSF OK[RBN KRG[BZ NGVKJ Q\PC OKCZGTP \GKFN OKNGMK ,OKZIBG OGYK[G
.FNGTV GV\[K \GZK[F KR\GR NM[G ,\GTGXYPF NMC OKKCYT GKFK NGVKJFG TEKPF[ CG[I
NNGM EI \"DMC KRG[BZ NGVKJ
.(OKPGJVPKS) OKRKPS\C \KCZP FJKN[ &

FZKFP FPNIFN \GVXN [K[G ,FZGPI FNIP GRKB CGZN \"DM[ ,NVGJPN OKB\P TEKP Q\P &
.OKZYPF CGZC
.FEGCT NNGM ,\GKNPZGR \GKGNKTVN \PEYGP FZHIG ,Z[VB[ FPM ET \GNKTV NT FXNPF &
\GJK[C NGVKJP TRPKFN [K .\"DMC Z\GKC FCGJF \KNGVKJF FVGNIF FRKF FNKTV F[KD
ZHKKN ,KNP[I NGVKJ ,(ERGBSZJNGB) TP[-NT ,'DSP ,FJKPC FIGRP { FPDGEN) \GKCKSV
.\KRGZM FNIPG KNGI \GDFR\F N[ FRMSF \B OKZKCDP OF[ QGGKMP ,KEKIK NGVKJM (FIK\PG
OKNGIN GB \GNKTVC FNCDFN OZGDF CBMN ZYKTC \GSIKK\P FNB \GKIRFC \GNGNMF \GXNPFF
.NGVKJ OK[YCPF
Z[B OKNGIN \NCDGP \GKFN FMKZX (KRGK[KN[ GB) KRGKR[ KBGVZ NGVKJN (REFFERAL) FKKRVF
.("K\RICB QGKP" FBZ) FZGPI FKDGNG\VN E[I OKKY OFC

:(KVKXVS) KNGDS K\NC EI QG\I\ CD CBM N[ QGICBN \GXNPFF KZYKT
.(C FPZ) \KJRGGNZ \KRVGD FYKEC K/TXCG (A FPZ) FBNP FHRPRB K/NCY &
TXCN KGXZ ,\K[ZG[ \RGPSK\ GB "OKPGEB OKNDE" \GFHN Q\KR ZGZKC KEM LG\ OB &
(A FPZ) FPKB\P \KCXT FYKEC \NNGMF \CIZR \KRVGD FYKEC
(D FPZ) \GJNIFN KRG[BZ SKSCM K\RICB QGKP K/TXC &
OKNDE" \GFHN Q\KR ,KRG[BZF QGKBZF KEM LG\ OB .OKKNBKXGSGMKSV OKPZGDN CN K/OK[ &
QKB OB ,L[PFC ,JGZKVC O\GB ZGYSN [K .OFKNB SIKK\FN NKI\FN Q\KR ,"OKCGFX
.(A FPZ) \GRGN\C ZGVK[
(OXT KGVKPG MRI ,\C[IGPP FYKZS ,QDJRZ KPGNKX \GNNGMF) \GPKE \GYKECN OGYP QKB &
(A FPZ) .(KVKXVS) KNGDS K\NC \"DM ZGZKCC K\ZD[ QVGBC
:(D FPZ) SGHRXRGYC KNBZ[KF \GGXF \GXNPF &
\ZDSPC \TDNG GN CBGM[ OGYPF NT TKCXFN NVGJPFP [YCN :\KRVGDF FYKECC .B
.CBMF \EGYRC FYKECF
Z[B FEGHKVBF NGPZKRG FTDZF ,QGPB ,Z[Y \ZKXKC EKYV\ OD FYKECNG FHRPRBN .C
CBT \GRGZYTC \[P\[PF \ZG[Y\ EPNNG I\VN ,[P\[FN [K .FKGVKZN OKPZG\
F\GBC OK[DVPF NM[ KGXZ .\KRG[BZ FBGVZC (Cognitive Behavioral Therapy)

.EIB KZYKT NVJP OT GKFK FEGHKVB
(D FPZ) ,QG[BZF OZGYKC ZIBN ZKPIF GB ZV\[F BN OCXP[ OKNGI [EIP LZTF &
:(KVKXVS) KNGDS K\NC EI QG\I\ CD CBMC NGVKJN \GXNPFF KZYKT
(C FPZ) FNGIF \EZI \\IVFC TKKSNG ONGF TEKP \\N [K &

(A FPZ) NGVKJM FJKPC FIGRP NT K/XKNP\ NB &
FH OB ,FEGCT NNGM ,FNKDZ \KPGK \GNKTVC LK[PFNG OKNKTV \GKFN OKNGIN K/XNPF &
(A FPZ) KZ[VB
(A FPZ) OKKVKXVS OKRVGD OKNKDZ\ NT K/XKNP\ NB &
QG[BZ GY :\GTGCY \GYSVFC FIKYNN ,CBM \TDZFN ,LZGX [K OB ,\GVGZ\ OG[Z &
(A FPZ) NSAIDS KR[ GY ,NGPJXBZBV
(C FPZ) (OKPK ZVSPN FPPKC \GT[ 8 L[PN) KPGYP OGPKIC NGVKJN OGYP [K &
ZGHIN OKIKNXP ORKB Z[B OKNGI ZGCT FZE[F EGPT N[ FKXNGVKRPN FKKRVF GNYK[ &
(C FPZ) FNKDZ \GNKTVN
NGVKJ ,(B FPZ) CD ZVS \KC ,(C FPZ) \GKNZGEKVB \GKEKBGZKJS \GYKZHC G[P\[\ NB &
UKZI CD CBMC NGVKJN TENS=G (B FPZ) KGSKT ,(C FPZ) \GIK\P ,(B FPZ) K\GDFR\F
(C FPZ)
CBM OT OKECGTN \GZ[VB \GKFN \GNGMK \K\YGST\ \GZDSPC \KPGI\ CZ NGVKJ \GKRM\ &
(B FPZ) \GTGC[ 8=4 =P Z\GK N[ \GZETFG EKEI QG\I\ CD

KEK\T ZYIPN \GXNPF
.OKNBKXGSGMKSV QGMKS KPZGD \MZTFN ,OKVY\ OKNMN DGBEN UGIE LZGX OKKY Q
.(MRI =G CT ) FKKPEF \YKEC N[ K\RICB YGKE KCDN \GK\JK[ \GZKYSC LZGX OKKY Q
.K\GDFR\F NGVKJC OKRG[ OKCKMZP N[ FTV[FF \B \GFHN LKZX Q
FGCD QGMKS OT GB ,FGCD KNBKXGSGMKSV QGMKSC OKNGI N[ \GXGCY \\ \GFHN LZGX [K Q
.\GKRGZMN
\GKGCZT\FC FNI\FC EYP\FN OKMKZX \GKNGVKJ \GKDJZJSBN OKTDGRF OKKEK\T RCTs Q
.\GKZYKTF \GBXG\FP \IBM ,OKKRGZM OKCXP \TKRPCG ,FNKTV F[KD OT
.CD KCBMC NGVKJN \GKIRF N[ FTPJFN OKMZE BGXPN [K Q
\GKBZF JGTKPC BKF (KVKXVS) KNGDS K\NC CBMP NECGP K[ZG[ CBM[ FCKSF :FZTF
K[ZG[ CBMC NGVKJF[ ZGCS \GKIRFF KC\GM \GGX \KCZP ,\BH \GZPN .FH CXPC \GRPKFPF
NVJPF NXB OPGYP GH FKZGDJYC OKNGIF \KCZP[G KNGDS K\NC CD CBMC[ FHP FRG[ GRKB
.KRG[BZF

:I IVSR
FEGCTG CD CBM
(40=39 'PT ,OKECGTC EKEI \"DM NT FKVZDGKNCKCN \GSIKK\P \GBCGPF)
\GNGNT FEGCT N[ \GKHKVF \G[KZEF .FEGCTF NKDC OK[RBC FIKM[ FKTC FRKF QG\I\ CD CBM
:QFC [K Z[B \GEGCTC Z\GK OKFGCD OKRGMKSF .QG\I\ CD CBM N[ OKVY\F ZZGTN
.UGDF NMC \GKXZCKGG \GP[GDP \GIGR\ ,OKKREK OKZK[MPC NGVKJ ,F[Y \KRVGD FEGCT
.(1) CBM N[ TGZKB ZIBN FEGCTN FZHI NT TKV[FN OD \GNGMK FEGCTF \G[KZE
CD CBM .CBM KTGZKB N[ FGCD HGIBN \KBZIB BN BKF ,OZG\ OZGD \GKFN FNGMK FEGCT[ \GZPN
ZSGIN \GNKCGPF \GCKSF \IBG ,FEGCTFP \GZETKFN FCKS FGGFPG ,\GTGXYPF NMC TKVGP
.\GKBGVZ \GCKSP F[KZVNG LGZB IGGJN EGYV\
[DEGP (9) \KZCF \GXZBG ,(8) QVK ,(7 ,6) FKNZJSGB ,(5 ,4 ,3) FKRJKZC ,(2) ERNGF N[ \GKIRFC
.CD KCBMC K\YGST\ NGVKJC LZGXF
:\GNNGM K\YGST\F Z[YFC CD CBMN F[KDF
.CDF KCBM \GTZBF \B QKJYK BN ,OKECGT SGKDC QGRKS[ ZKMFN &
\GKFN OKNGMK QMB ,QDJRZ KPGNKX QGDM \GKJSGRDBKE \GYKEC GB \GKRKNY \GYKEC[ \GET QKB &
.FEGCTF \NKI\ KRVN FYKECC OGYP OFN QKB ,QMN .KEK\T QGMKS BCRP OZGD
OKVY\F QKJGNIN TGRPN Q\KR BN ,\KYNI OKNKTK OKKZJPGRGDZB OKKGRK[[ \GZPN[ QKCFN &
.OKECGT QKC CD CBM N[
OKECGTF KEK NT QCGP FKFK ,FKTCC NGVKJN NKTV NGFKR N[ F[KDC LZGXF[ IKJCFN &
.OKEKCTPFG
LZEF ,NNM LZEC ,FKF\ OKCBMP ZZIG[P FNGIF[ KRVN FEGCTN FZHI[ FRCFN BKCFN &
.NCSF N[ ZKFP OGKSN BKCFN FCGJF
.\GTGC[ 4=P Z\GKN G\EGCTP ZETR[ KP NMN ,OGYK[N TKDFN Z[VBN &
www.backpaineurope.org/results (guidelines) :N FRV \GRG[F \GKBZF N[ BNP JGZKVN

\GKRKNY \GKIRF
KRGZM CD CBMC NGVKJ .3

(KVKXVS) KNGDS K\NC
K RG ZM CD CBMC NG VKJN \G KIRFF \KXP\
(KV KXV S) KNG DS K\NC
FNGI \MZTF .B
FZE[F EGPT N[ \KZ[VB \KVKXVS FKDGNG\V \GFHN KEM FBNP \KBGVZ FHRPRB NCYN [K .1
\GKVKXVSG FFGCD \G[KDZ \NTC \IB FYKEC QKKET QKB[ \GZPN \BH .(A FPZ) K[ZG[ CBMG
.(B FPZ) \GKNGIC QJZSG ANKYLOSING SPONDYLITIS ,FK\VGNGYKEZN
\KRVGD FYKEC TXCN [K ,K[ZG[ CBM NT GB \KVKXVS FKDGNG\V NT FTKCXP FHRPRBF OB .2
.(A FPZ) FPKB\P \KCXT FYKEC \NNGMF
BN SLR \GRPKFP .(B FPZ) OKZIB OKBXPPP Z\GK QPKFP CBMF \B ZZGTPF [G[KP .3
.(B FPZ) FTCYR
FZE[F EGPT N[ \KNGDS FKDGNG\V NGN[N FZJPC FRG[BZ FMZTFC K\RICB QGKP TXCN [K .4
OKNDE) OKNBKXGS=GMKSV OKBCRP OKPZGDN FYKEC NT OKXKNPP GRB .(D FPZ) K[ZG[ CBMG
.1C UKTS FBZ .(OKCGFX
FPZ) (KVKXVS) KNGDS BN QG\I\ CD CBMP OKNCGSF OKNGI ZGCT \GPKE NT OKXKNPP GRRKB .5
E[I ONXB OKKY[ FNBM GB ,IG\KR OKNYG[F OKNGIN MRI N[ TGXKC OKXKNPP GRB .(B
QGICBN FNB \GCKSRC OKB\P NKDZ OGNKX .(B FPZ) (OKPGEB OKNDE) \KPJSKS FNIPN FGCD
ZGYPP CBM GB KRDGYSKE CBM QGICBN FKVZDGYSKE GB MRI NT OKXKNPP GRRKB .KRCP \GGT
.facetes N[
\GZKBPP \NKN[CG (KGIKB \TKCYN) IG\KR ZIBN ,WPBP ZC[ KZYPC TKKSN KG[T OXT KGVKP
.FRKZYC FGGNPG WGIR GRKB NNM-LZEC LB (C FPZ)
.(B FPZ) .TCYR BN M"\DM N[ K\RICBF UXZC FKVZDGKPGZJYNBF EKYV\ .6
.(A FPZ) CD CBM N[ OKCG[I OKBCRP OF OKKNBKXGS=GMKSV OKPZGD[ FYHI \GET \PKKY .7
CG[I EKYV\ OKKNBKXGS=GMKSV QGMKS KPZGDN[ FECGTN OKZT \GKFN OKCKKI OKBRKNY
\GGFN NGMK ,QGMKSF KPZGD N[ OEYGP KGFKH[ LM ,\GMRG KRGZM QG\I\ CD CBM \GI\V\FC
.QG\I\ CD CBMP OKNCGSF OKNGIC NGVKJFP YNI
FYGXP :\"DM N[ KRGZM CXP OKBCRP OKBCF OKPZGDF[ (B FPZ) FRG\P FKKBZ \PKKY .8
\GZ[VB BNN \KHKV FEGCT ,FEGCTC \GCKXK ZSGI \VGY\ ,KRGBME IGZ CXP ,\KNBKXSGMKSV
,\GPEGY \GEGHKVB ,\KEGYV\F G\TV[FG CBM \PXGT ,IGGKEC ZGIKB ,SPGTC F\IVF
.OK[Y OKRKPS\ NT IGGKEG OKK[ZG[ OKBXPP

FHGRDGZV ,CD CBM KBCRP ,QGMKS KPZGD .C
OKZG[Y ORKB ,UGDF NM N[ \GKXZCKGG ,FEGCTC FCK[K ,NGFGMNB \MKZX ,QG[KT ,UGD NY[P .1
,KRMP SPGT BN LB ,OKKNBKXGS=GMKSV OKPZGD ,OEGY KHKV CBM .(A FPZ) QG\I\ CD CBMN
.(D FPZ) ZVS \KC KEKPN\C QGMKS KPZGD ORKF
FPZ) EI CD CBMP OKNCGSF OKNGIC \GKRGZMN BCRP FRKF FEGCTF OGYPC F[NI FMKP\ .2
.(A
.(B FPZ) GM[P \B BN LB ,CBMF \ZHI \B \BCRP FPGE CBM N[ FKZGJSKF .3
KRGZM QG\I\ CD CBMP OKNCGSF OKNGIC [NI KJSGRDGZV LZT [K \KRVGD FYKECC OKBXPPN .4
.(B FPZ)
NGVKJ .D
\ G V G Z \ .1
NT QPKFP TEKP QKB .(B FPZ) KRGZM QG\I\ CD CBMC NGVKJN OKXNPGP NSAID .I
.(NSAID NGP NGPJXZV NT ZYIP [YC\P) M"\DMC FYKJDNRB
OKNGVKJ OB ,(NGEPZJ GPM) OK[NI OKJBKVGBC [GPK[F \B GNYK[ :OPIOIDS .II
UKETG \M[GPP \GNKTV OT \GVGZ\N \GVKET \PKKY .(C FPZ) OKNKTK GKF BN OKZIB
.LZGXF KVN [GPK[P ZKES [GPK[
GB NORADRENERGIC { DGSP QGBME KEDGRC [GPK[ GNYK[ :QGBME KEDGR .III
CBMP OKNCGSF OKNGIC CNG[P NGVKJM NORADRENERGIC-SEROTONERGIC
NGVKJM QGBMKE KEDGRC G[P\[\ NB .(C FPZ) EDR \GKZGF BNN KRGZM QG\I\ CD
KEDGR[ (B FPZ) \Z\GS \GET \PKKY .(D FPZ) KRGZM QG\I\ CD CBMC KETNC
QGBME KEDGR .EGYV\F \B OKNKEDP BN NCB ,CBMF \PXGT \B OKRKJYP QGBMKE
Z\GK OKNKTK SEROTONERGIC-ADRENERGIC=G NORADRENERGIC DGSP
.(A FPZ) SEROTONINERGIC=P
KNGDS BN KRGZM QG\I\ CD CBMP OKNCGSF OKNGIC GABAPENTIN=C G[P\[\ NB .IV
.(C FPZ) QG\I\ CD CBMC KRGZM CBM ZV[P GRKB GABAPENTIN .(KVKXVS)
KRGZM QG\I\ CD CBMN OKNKDZ\G OKKNYKHKV OKNGVKJ .2

[GPK[ OKXKNPP GRB .M"\DMC QG[BZ NGVKJM WNPGP IGYKV \I\ OKNKDZ\C NGVKJ .I
WNPGP .LMN EIGKPC QPGBP \GGX GB \GZYK QGPKB \GRGMP OK[ZGE ORKB[ OKNKDZ\C
OKTXGCP \GRG[ \GPZC OKNKDZ\ FC[ ,\KCKJKRDGY \K\GDFR\F F[KDC [GPK[F
/YGHKI) TXGCPF OKNKDZ\F DGS .FCGJ FVGNI OKGGFP OKK\XGCY OKNKDZ\ .FDZEFC
.(A FPZ) CG[I GRKB ,('GMG ,OKKCGZKB OKNKDZ\ ZKZ[F \KKR\F

.(B FPZ) .KRGZM QG\I\ CD CBMC ZXY IGGJN NGVKJM FTRF/FKXNGVKRP GNYK[ .II
ZV[P ,CBMC \GDFR\F ZV[P ,EGYV\F \GPZ \B ZV[P KCKJKRDGY K\GDFR\F NGVKJ .III
BN[ OKZYPN FBGG[FC CBM \PXGT EKZGPG ,CBMC FZMF ,\K\GBKZC \GDFR\F
GRPP \GTRPKFFG CBMP EIV .(A FPZ) \GVGZ\C NGVKJ NNGM ,FHM[ NGVKJ OKNCYP
\GI\V\F N[ OKKIZMF OKJCKF OF ,FYGXPG QGBMEN USGRC (FEAR AVOIDANCE)
.(A FPZ) KRGZM QG\I\ CD CBMP OKNCGSF OKNGIC \KRGZM FKTC
,KNBKXGS=GMKSVF NEGPF KVN TEKP Q\KR QFC K\XGCY LGRKING FMZEFN FKRVF GNYK[ .IV
.(C=G B FPZ) (\GTGC[ 6<) ETGP \ZXY KEGYV\F CXPC ZGVK[G CBMC FNYF LZGXN
ZCGEP Z[BM ,M"\DMC NGVKJ N[ FH DGS NT FXNPFN \GKBZ YKVSP QKB ,ONGB
.(C=G B FPZ) (OK[EGI 12>) LGZB IGGJN \GTV[FC
Q\P N[ [DEC ,BVGZG JSKVZ\GKHKV K"T CGZN ,FZXY \KMGRKI \GCZT\FC [GPK[ WNPGP .V
\GTXPBC ,JRZJRKBC ,OKRV NB OKRV) \GCZT\FF DGS .FNKDZ \GNKTVN EGEKTG TEKP
K"T M"EC TCYRG K\GTP[P GRKB (C"GKMG FMKP\ \XGCYC GB FXGCYC ,FMZEF QGZVS
.\GRKPH
,(D FPZ) OGPKIC NGVKJ ,(C FPZ) M"\DMC NGVKJM ERGBSZJNGB :C [GPK[ GXKNP\ NB .VI
EGPT KMPG\ \ZKDI ,(B FPZ) \GKR\GP \GIK\P ,(C FPZ) "NP[I" GB OKZXY OKND
.(C FPZ) KGSKT GB (C=A \GPZ) KR\GP FZE[
NGVKJNG ,(A FPZ) KRGZM QG\I\ CD CBMC NGVKJN TENS NT FXNPFN \GKBZ YKVSP QKB .VII
.ZHKKNC
\GRG[ \GZGEXGZV .3
CBMP OKNCGSF OKNGIC \G[KDZ \GEGYRN \GYZHFC [GPK[F \B GNYK[ .I
.ZXY QPH YZVN KJPGJVPKSF CBMF \NYFN ,MYOFASCIAL
KZPGI N[ \KPGYP FRRSF N[ ZXY IGGJN \GNKTKF NT (C FPZ) \GNCDGP \GKBZ \GPKKY
.M"\DMC [GINB
OKEKBGZKJS \GYKZH ,(B FPZ) M"\DMC NGVKJN FZGJYRGVGYB NT GXKNP\ NB .II
FPZ) KR\GP K[ZG[ CBM BNN ,ZEDGP BN QG\I\ CD CBM N[ OKZYPC OKKNZGEKVB
,YBKNKBGZYSF YZVN GB facetes=N GB (YGNC) CXT \PKSIN OKEKBGZKJS \RRSFC ,(D
GB (B FPZ) (PROLOTHERAPY) SCLEROSANTS \YZHF ,(C FPZ) M"\DMC NGVKJN
\GNKTK NT \GTKCXPF (C FPZ) \GNCDGPF \GKBZF \GZPN .BOTULINUM TOXIN
EDR NY[P OKGGFP OKRGMKSF ,QG\I\ CD CBMC BOTULINUM TOXIN=C [GPK[F
.\GNKTKN
intradiscalNT GB ,(B FPZ) M"\DMC NGVKJC YSKEF LG\N \GYKZH NT GXKNP\ NB .III
OKRG[ radiofrequency KNGVKJ ,(C FPZ) radiofrequency and electrothermal coagulation
.(D-C FPZ) KNP[I FZE[ EGPT KGZKD GB

F K D Z G Z K M .4
.KRZP[ NGVKJC \GIVN OKK\R[ UGNI ZIBN BNB M"\DMN KIG\KR NGVKJ NT WKNPFN Q\KR BN
NGVKJG \KRVGD \GNKTV N[ \GCNG[P \GKRMG\ GN[MR[ ZIBN YZ WNPGP KDZGZKM NGVKJ
N[ NCSFG \GNTF ,K\GTP[PF OKMGCKSF HGIB \B ZGMHN [K .\GRKPH QRKB[ GB KCKJKRDGY
OT OKZGVS OKZYPC YZG ZKFH NGYK[ ZIBN YZ FKDZGZKM NGY[N OKXKNPP GRB .KIG\KR QGN[M
.(A-C \GPZ) .ZGPI CBM
SKSC NT GB (KVKXVS K\NC BN) K[ZG[ ZGYPP \"DMC NGVKJN OKNCGYP OKIG\KR ZVSP OKPKKY
.\KVKXVS FKDGNGKJB OFN [K[ OKCXPC ZCGEP BN FNB \GKIRFC KM OK[KDEP GRB .\GCKXK ZSGI
O G Y K [ .5
OKZSIG KRGZM QG\I\ CD CBM OT OKNGIC KNBKXGS=GMKSVGKC KTGXYP CZ OGYK[ GNYK[
OT OKNGIN ,\GKCKSRJRKBG \GZYK NGVKJ \GKRM\C ,Z\K NGVKJ GR\\ NB .OKK\GTP[P OKKDGNGMKSV
\K\GDFR\F \KCKJKRDGY F[KD \GNNGMF KRVGDF Z[GMF NT \GTKV[PF \GKRM\ .FCGJ FHGRDGZV
OKNCGSF OKECGT N[ \GZETFF \VGY\ \B QKJYFN \GNGMK ,FEGCTF OGYP OT YGEF Z[YG
.(B \GKBZ \PZ) KRGZM QG\I\ CD CBMP
,EGYV\N FZHIF OT ,KNBKXGS=GMKSVGKC KTGXYP CZ KCKSRJRKB OGYK[[ FYHI \GET \PKKY
GRKB[ OGYK[C OKNGIN FBGG[FC \GBKZC K\GZK[C [GPK[F OKRKJYPG ,\GMR ,EGYV\ OKZV[P
.(A \GKBZ \PZ) KTGXYP=CZ
KCKSRJRKB OGYK[ N[ (FEGCTN FZHI) \GK\YGST\ \GBXG\N Z[YC \GZ\GS \GKBZ [K
.\KPGBNF \GBKZCF \MZTPC KGN\ FBZRM FH NECF .(C \GKBZ \PZ) KNBKXGS=GMKSVGKC

\ KNNM F KVZD GK NCK C
1. Anonymous. Philadelphia panel evidence-based clinical practice guidelines on selected
rehabilitaion interventions for low back pain. Physical Therapy 2001;81(10):1641-1674.
2. Bogduk N. Draft evidence based clinical guidelines for the management of acute low back
pain. In: National Health and Medical Research Council, Australia; 2000.
3. ACC tNHC. New Zealand Acute Low Back Pain Guide. Wellington, New Zealand: ACC, the
National Health Committee; 1997.
4. Anonymous. Acute and Chronic Low Back Pain. Effective Health Care 2000;6(5).
5. Abenhaim L, Rossignol M, J-P. V, al. e. The role of activity in the therapeutic management of
back pain. Report of the International Paris Task Force on Back Pain. Spine 2000;
25(Suppl4S): 1S-33S.
6. Medicine DAoO. Dutch guideline for the management of occupational physicians of
employees with low back pain.; 1999 April.
7. Burton AK, Balagu f, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et al. European
Guidelines for Prevention in Low Back Pain. In: COST B13 Working Group on Guidelines
for Prevention in Low Back Pain; 2004.
8. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, et al.
Multidisciplinary biopsychosocial rehabilitation for subacute low-back pain among working
age adults. The Cochrane Database of Systematic Reviews 2001 (3).
9. Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for
low-back pain and sciatica. The Cochrane Database of Systematic Reviews 2001 (4).
10. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-
specific low-back pain. The Cochrane Database of Systematic Reviews 2004; 2.
11. van Tulder MW, Ostelo RWJG, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ.
Behavioural treatment for chronic low-back pain. The Cochrane Database of Systematic
Reviews 2000 (2).
12. van Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low-back pain.
The Cochrane Database of Systematic Reviews 2000 (2).
13. van Tulder MW, Jellema P, van Poppel MNM, Nachemson AL, Bouter LM. Lumbar
supports for prevention and treatment of low-back pain. The Cochrane Database of
Systematic Reviews 2000 (3).
14. Schonstein E, Kenny DT, Keating J, Koes BW. Work conditioning, work hardening and
functional restoration for workers with back and neck pain. The Cochrane Database of
Systematic Reviews 2002 (4).

15. de Vet HC, Heymans MW, Dunn KM, Pope DP, van der Beek AJ, Macfarlane GJ, et al.
Episodes of low back pain: a proposal for uniform definitions to be used in research. Spine
2002; 27(21): 2409-16.
16. Watson KD, Papageorgiou AC, Jones GT, Taylor S, Symmons DPM, Silman AJ, et al. Low
back pain in schoolchildren: occurance and characteristics. Pain 2002; 97: 87-92.
17. Taimela S, Kujala UM, Salminen JJ, Viljanen T. The prevalence of low back pain among
children and adolescents: A nationwide, cohort-based questionnaire survey in Finland. Spine
1997; 22: 1132-1136.
18. Balague F, Troussier B, Salminen JJ. Non-specific low back pain in children and adolescents:
risk factors. European Spine Journal 1999; 8 (438-429).
19. Andersson GBJ. The epidemiology of spinal disorders. In: Frymoyer JW, editor. The Adult
Spine: Principles and Practice. Philadelphia: Lippincott-Raven; 1997. p. 93-141.
20. Hestbaek L, Iachine IA, Leboeuf-Yde C, Kyvik KO, Manniche C. Heredity of low back pain
in a young population: A classical twin study. Twin Research 2004; 7: 16-26.
21. Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A
review of studies of general patient populations. European Spine Journal 2003b; 12: 149-165.
22. Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Systematic
review of psychosocial factors at work and in private life as risk factors for back pain. Spine
2000; 25: 2114-2125.
FTKRP B[ GRC F KVZD GK NCK C

1. Hoogendoorn WE, van Poppel MNM, Bongers PM et al. Systematic review of psychosocial
factors at work and in private life as risk factors for back pain. Spine 2000; 25: 2114-2125.
2. Linton SJ. A review of psychological risk factors in back and neck pain. Spine 2000; 25: 1148-
1156.
3. IhlebaÁk C & Eriksen HR. Are the 'myths' of low back pain alive in the general Norwegian
population? Scand J Public Health 2003; 31: 395-398.
4. Scheel IB, Hagen KB, Herrin J et al. Blind faith? The effects of promoting active sick leave for
back pain patients: a cluster-randomized controlled trial. Spine 2002; 27: 2734-2740.
5. Linton SJ & van Tulder MW. Preventive interventions for back and neck pain problems: what
is the evidence? Spine 2001; 26: 778-787.
6. Lahad A, Malter A, Berg AO & Deyo R. The effectiveness of four interventions for the
prevention of low back pain. JAMA 1994; 272: 1286-1291.
7. US Preventive Services Task Force. Primary Care Interventions to Prevent Low Back Pain in
Adults: Recommendation Statement. Rockville, MD: Agency for Healthcare Research and
Quality, 2004. Online Available at: www.ahrq.gov/clinic/3rduspstf/lowback/lowbackrs.htm.
8. Young G & Jewell D, Interventions for Preventing and Treating Pelvic and Back Pain in
Pregnancy (Cochrane Review) The Cochrane Library, Issue 4. Chichester: Wiley; 2003.

9. van Poppel MN, Koes BW, Smid T & Bouter LM. A systematic review of controlled clinical
trials on the prevention of back pain in industry. Occup Environ Med 1997; 54: 841-847.
10. Buchbinder R, Jolley D & Wyatt M. Population based intervention to change back pain
beliefs and disability: three part evaluation. BMJ 2001; 322: 1516-1520.
11. Heymans MW, van Tulder MW, Esmail R, Bombardier C et al, Back schools for non-specific
low back pain (Cochrane Review) The Cochrane Library. Chichester: Wiley; 2004.
12. Kovacs FM, Abraira V, Pena A et al. Effect of firmness of mattress on chronic non-specific
low-back pain: randomised, double-blind, controlled, multicentre trial. Lancet 2003; 362:
1599-1604.
13. Fauno P, Kalund S, Andreasen I & Jorgensen U. Soreness in lower extremities and back is
reduced by use of shock absorbing heel inserts. Int J Sports Med 1993; 14: 288-290.
14. Tooms RE, Griffin JW, Green S & Cagle K. Effect of viscoelastic insoles on pain.
Orthopedics 1987; 10: 1143-1147.
15. Gebhardt WA. Effectiveness of training to prevent job-related back pain: a meta-analysis. Br
J Clin Psych 1994; 33(571): 574.
16. Maher CG. A systematic review of workplace interventions to prevent low back pain. Aust J
Physiother 2000; 46: 259-269.
17. Tveito TH, Hysing M & Eriksen HR. Low back pain interventions at the workplace: a
systematic literature review. Occup Med 2004; 54: 3-13.
18. Waddell G & Burton AK. Occupational health guidelines for the management of low back
pain at work: evidence review. Occup Med 2001; 51: 124-135.
19. Kool J, de Bie R, Oesch P et al. Exercise reduces sick leave in patients with non-acute non-
specific low back pain: a meta-analysis. J Rehabil Med 2004; 36: 49-62.
20. Maier-Riehle B & HaÈrter M. The effects of back schoolsÐa meta-analysis. Int J Rehabil Res
2001; 24: 199-206.
21. Symonds TL, Burton AK, Tillotson KM & Main CJ. Absence resulting from low back
trouble can be reduced by psychosocial intervention at the work place. Spine 1995; 20: 2738-
2745.
22. Leclaire R, Esdaile JM, Suissa S et al. Back school in a first episode of compensated acute low
back pain: a clinical trial to assess efficacy and prevent relapse. Arch Phys Med Rehabil 1996;
77: 673-679.
23. Indahl A, Haldorsen EH, Holm S et al. Five-year follow-up study of a controlled clinical trial
using light mobilization and an informative approach to low back pain. Spine 1998; 23: 2625-
2630.
24. Verbeek JH, van derWeideWE & van Dijk FJ. Early occupational health management of
patients with back pain: a randomized controlled trial. Spine 2002; 27: 1844-1851.
25. Jellema P, van Tulder MW, van Poppel MNM et al. Lumbar supports for prevention and
treatment of low back pain. Spine 2001; 26: 377-386.

26. Kraus JF, Schaffer KB, Rice T et al. A field trial of back belts to reduce the incidence of acute
low back injuries in New York City home attendants. Int J Occup Environ Health 2002; 8: 97-
104.
27. MuÈndermann A, Stefanyshyn DJ & Nigg BM. Relationship between footwear comfort of
shoe inserts and anthropometric and sensory factors. Med Sci Sports Exerc 2001; 33: 1939-
1945.
28. Larsen K,Weidich F & Leboeuf-Yde C. Can custom-made biomechanic shoe orthoses prevent
problems in the back and lower extremities? A randomized, controlled intervention trial of
146 military conscripts. J Manipulative Physiol Ther 2002; 25: 326-331.
29. Westgaard RH & Winkel J. Ergonomic intervention research for improved musculoskeletal
health: a critical review. Int J Ind Ergon 1997; 20: 463-500.
30. Evanoff BA, Bohr PC & Wolf LD. Effects of a participatory ergonomics team among hospital
orderlies. Am J Ind Med 1999; 35: 358-365.
31. Brisson C, Montreuil S & Punnett L. Effects of ergonomics training program on workers with
video display units. Scand J Work Environ Health 1999; 25: 255-263.
32. Yassi A, Cooper JE, Tate RB et al. A randomized controlled trial to prevent patient lift and
transfer injuries of health care workers. Spine 2001; 26: 1739-1746.
33. Fredriksson K, Bildtc C, HaÈgga G & Kilboma A 8. The impact on musculoskeletal disorders
of changing physical and psychosocial work environment conditions in the automobile
industry. Int J Ind Ergon 2001; 28: 31-45.
34. Smedley J, Trevelyan F, Inskip H et al. Impact of ergonomic intervention on back pain
among nurses. Scand J Work Environ Health 2003; 29: 117-123.
35. Marras WS, Allread WG, Burr DL & Fathallah FA. Prospective validation of a low-back
disorder risk model and assessment of ergonomic interventions associated with manual
materials handling tasks. Ergonomics 2000; 43: 1866-1886.
36. Brophy MO, Achimore L & Moore-Dawson J. Reducing incidence of low-back injuries
reduces costs. AIHAH 2001; 62: 508-511.
37. Koda S, Nakagiri S, Yasuda N & Ohara H. A follow-up study of preventive effects on low
back pain at worksites by providing a participatory occupational safety and health program.
Ind Health 1997; 35: 243-248.
38. Owen BD, Keene K & Olson S. An ergonomic approach to reducing back/shoulder stress in
hospital nursing personnel: a five year follow up. Int J Nursing Studies 2002; 39: 295-302.
39. CharneyW. The lift team method for reducing back injuries: a 10 hospital study. AAOHN
1997; 45: 300-304.
40. Wergeland EL, Veiersted B, Ingre M et al. A shorter workday as a means of reducing the
occurrence of musculoskeletal disorders. Scand J Work Environ Health 2003; 29: 27-34.
41. Gatty CM, Turner M, Buitendorp DJ & Batman H. The effectiveness of back pain and injury
prevention programs in the workplace. Work 2003; 20: 257-266.
42. Krause N, Dasinger LK & Neuhauser F. Modified work and return to work: a review of the
literature. J Occup Rehabil 1998; 8: 113-139.

43. van der Beek AJ, Frings-Dresen MHW& Elders LAM. Effectiviteit van werkaanpassingen bij
werhervatting na klachten aan het bewegingsapparaat. Tijdschrift voor Bedrijfs-en
Verzekeringsgeneeskunde 2000; 8: 137-143.
44. van der Beek AJ. In van Mechelen W & Twisk JWR (eds.) Werkaanpassingen vanwege
klachten aan het bewegingsapparaat. Maarsen: Elsevier Gezondheidszorg, 2004, pp. 14-22.
45. Hadler NM. Back pain in the workplace. What you lift or how you lift matters far less than
whether you lift or when. Spine 1997; 22: 935-940.
46. Waddell G & Burton AK. Concepts of Rehabilitation for the Management of Common
Health Problems. London: The Stationery Office; 2004.
47. Harreby M, Neergaard K, Hesselsoe G & Kjer J. Are radiologic changes in the thoracic and
lumbar spine of adolescents risk factors for low back pain in adults? A 25-year prospective
cohort study of 640 school children. Spine 1995; 20: 2298-2302.
48. Mendez FJ & Gomez-Conesa A. Postural hygiene program to prevent low back pain. Spine
2001; 26: 1280-1286.
49. Cardon GM, De Clercq DLR & De Bourdeaudhuij IMM. Back education efficacy in
elementary schoolchildren: a 1-year follow-up study. Spine 2002; 27: 299-305.
50. Feingold AJ & Jacobs K. The effect of education on backpack wearing and posture in a
middle school population. Work 2002; 18: 287-294.
51. Storr-Paulsen A. The body-consciousness in schoolÐa back pain school. Ugeskr Laeger 2002;
165: 37-41.
52. Balague F, Nordin M, Dutoit G &Waldburger M. Primary prevention, education, and low
back pain among school children. Bull Hosp Jt Dis 1996; 55: 130-134.
53. Goubert L, Crombez G & De Bourdeaudhuij I. Low back pain, disability and back pain
myths in a community sample: prevalence and interrelationships. Eur J Pain 2004; 8: 385-394.
54. Milgrom C, Finestone A, Lubovsky O, Zin D, Lahad A. A Controlled Randomized Study of
the Effect of Training with Orthoses on the Incidence of Weight Bearing Induced Back Pain
among Infantry Recruits. Spine. 2005; 30: 272-5.
(K JG YB) EI CD CBM B[ GRC F KVZD GK NCK C

1. Bigos S, Bowyer O, Braen G et al. Acute low back problems in adults. Clinical practice
guideline no. 14. AHCPR publication no. 95-0642. Rockville, MD: Agency for Health Care
Policy and Research, Public Health Service, U.S. Department of health and Human Services.
December 1994. [USA]

2. Van Tulder MW, Furlan A, Bouter LM, Bombardier C and the Editorial Board of the
Cochrane Back Review Group. Updated Method Guidelines for Systematic Reviews in the
Cochrane Collaboration Back Review Group. Spine 2003; 28: 1290-9.
3. Royal College of General Practitioners. Clinical Guidelines for the Management of Acute
Low Back Pain. London, Royal College of General Practitioners, 1996 and 1999. [UK]

4. Kendall NAS, Linton SJ, Main CJ. Guide to assessing psychosocial yellow flags in acute low
back pain: risk factors for long-term disability and work loss. Accident Rehabilitation &
Compensation Insurance Corporation of New Zealand and the National Health Committee.
Wellington, New Zealand, 1997. [New Zealand]

5. Andersson GBJ. The epidemiology of spinal disorders. In: Frymoyer JW, ed. The adult spine:
principles and practice. 2nd ed. New York: Raven Press, 1997: 93-141.
6. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about
low back pain? JAMA 1992; 268: 760-5.
7. Hoogendoorn WE, van Poppel MNM, Bongers PM, Koes BW, Bouter LM. Systemic review
of psychosocial factors at work and private life as risk factors for back pain. Spine 2000; 25:
2114-25.
8. Linton SJ. A review of psychological risk factors in back and neck pain. Spine 2000; 25: 1148-
56.
9. Frymoyer JW. Back pain and sciatica. N Engl J Med 1988; 318: 291-300.
10. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, Malmivaara A, Roland
M, Von Korff M, Waddell G. Outcome measures for low back pain research. A proposal for
standardized use. Spine 1998; 23: 2003-13.
11. Van den Hoogen HMM, Koes BW, van Eijk JThM, Bouter LM. On the accuracy of history,
physical examination and erythrocyte sedimentation rate in diagnosing low back pain in
general practice. A criteria-based review of the literature. Spine 1995; 20: 318-27.
12. Deville WL, van der Windt DA, Dzaferagic A, Bezemer PD, Bouter LM. The test of Lasegue:
systematic review of the accuracy in diagnosing herniated discs. Spine 2000; 25: 1140-7.
13. ACC and the National Health Committee. New Zealand Acute Low Back Pain Guide.
Wellington, New Zealand, 1997. [New Zealand]

14. Linton SJ, Hallden K. Can we screen for problematic back pain? A screening questionnaire
for predicting outcome in acute and subacute back pain. Clin J Pain 1998; 14: 209-15.
15. Van Tulder MW, Assendelft WJJ, Koes BW, Bouter LM. Spinal radiographic findings and
nonspecific low back pain: a systematic review of observational studies. Spine 1997; 22: 427-
34.
16. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann
Intern Med 2002; 137: 586-97.
17. Jarvik JG, Hollingworth W, Martin B, Emerson SS, Gray DT, Overman S, Robinson D,
Staiger T, Wessbecher F, Sullivan SD, Kreuter W, Deyo RA. Rapid magnetic resonance
imaging vs radiographs for patients with low back pain: a randomized controlled trial. JAMA
2003; 289: 2810-8.
18. Borkan J, Reis S, Werner S, Ribak J, Prath A. Guidelines for treating low back pain in
primary care (Hebrew; available in English). The Israeli Low Back Pain Guideline Group.
Harfuah 1996; 130: 145-151. [Israel]

19. Danish Institute for Health Technology Assessment: Low back pain. Frequency, management
and prevention from an HTA perspective. Danish Health Technology Assessment 1999.
[Denmark]
20. Kendrick D, Fielding K, Bentley E, Kerslake R, Miller P, Pringle M. Radiography of the
lumbar spine in primary care patients with low back pain: randomised controlled trial. Br
Med J 2001; 322: 400-5.
21. Faas A, Chavannes AW, Koes BW, Van den Hoogen JMM, Mens JMA, Smeele IJM,
Romeijnders ACM, Van der Laan JR. Clinical practice guidelines for low back pain. (Dutch,
available in English). Huisarts Wet 1996; 39: 18-31. [the Netherlands]

22. Turner JA. Educational and behavioral interventions for back pain in primary care. Spine
1996; 21: 2851-9.
23. Burton AK, Waddell G, Tillotson KM, Summerton N. Information and advice to patients
with back pain can have a positive effect. A randomized controlled trial of a novel educational
booklet in primary care. Spine 1999; 24: 2484-91.
24. Keel P, Perini Ch, Schutz-Petitjean D, et al Chronicisation des douleurs du dos:
problematique, issues. Rapport final du Programme National de Recherche No 26B. Bale:
Editions EULAR 1996. [Switzerland]

25. Keel P, Weber M, Roux E, et al. Kreuzschmerzen: HintergruÈ nde, praÈvention, behandlung.
Basisdokumentation. Verbindung der Schweizer AÈ rzte (FMH), Bern, 1998. [Switzerland]

26. Malmivaara A, Kotilainen E, Laasonen E, Poussa M, Rasmussen M, Clinical Practice
Guidelines: diseases of the low back. (Finnish, available in English) The Finnish Medical
Association Duodecim 1999. [Finland]

27. Evans G, Richards S. Low back pain: an evaluation of therapeutic interventions. Bristol:
Health Care Evaluation Unit, University of Bristol, 1996.
28. Hagen KB, Hilde G, Jamtvedt G, Winnem M. Bed rest for acute low back pain and sciatica
(Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
29. Koes BW, van den Hoogen HMM. Efficacy of bed rest and orthoses of low back pain. A
review of randomized clinical trials. Eur J Phys Med Rehabil 1994; 4: 86-93.
30. Van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic
nonspecific low back pain: a systematic review of randomized controlled trials of the most
common interventions. Spine 1997; 22: 2128-56.
31. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for
acute low back pain. Br J Gen Pract 1997; 47: 647-52.
32. Nachemson AL, Jonsson E. (Eds.) Neck and back pain: the scientific evidence of causes,
diagnosis, and treatment. Lippincott Williams & Wilkins, Philadelphia, 2000. [Sweden]
33. Victorian Workcover Authority. Guidelines for the management of employees with
compensable low back pain. Melbourne, Victorian Workcover Authority. 1993 and revised
edition 1996. [Australia]

34. Handlungsleitlinie ± Ruckenschmerzen. Empfehlungen zur Therapie von RuÈ ckenschmerzen,
Artzneimittelkommission der deutschen AÈ rzteschaft. (Treatment guideline ± backache. Drug

committee of the German Medical Society). Zeitschrift fur Artzliche Fortbildung und
Qualitatssicherung Aug 1997; 91(5): 457-460. [Germany]

35. Hilde G, Hagen KB, Jamtvedt G, Winnem M. Advice to stay active as a single treatment for
low back pain and sciatica (Cochrane Review). In: The Cochrane Library, Issue 1, 2004.
Chichester, UK: John Wiley & Sons, Ltd.
36. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program
reduce long-term sick leave for low back pain? Spine 2000; 25: 1973-6.
37. Rozenberg S, Delval C, Rezvani Y, et al. Bed rest or normal activity for patients with acute
low back pain: a randomized controlled trial. Spine 2002; 27: 1487-93.
38. Bekkering GE, van Tulder MW, Hendriks HJM, Oostendorp RAB, Koes BW, Ostelo RWJG,
Thomassen J. Dutch physiotherapy guideline for low back pain. (KNGF richtlijn lage
rugpijn) Ned Tijdschr Fysiother 2001;111 (Suppl. 3): 1-24. [the Netherlands]
39. Nasjonalt ryggnettverk - Formidlingsenheten. Akutte korsryggsmerter. Tverrfaglige, kliniske
retningslinjer. Oslo, 2002: Nasjonalt ryggnettverk. [Norway]

40. Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, Charlot J, Dreiser
RL, Legrand E, Rozenberg S, Vautravers P. The role of activity in the therapeutic
management of back pain. Report of the International Paris Task Force on Back Pain. Spine
2000; 25 (Suppl):1S-33S.
41. Van Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for non-specific low
back pain (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update
Software.
42. De Craen AJM, Di Giulio G, Lampe-Schoenmaeckers AJEM, Kessels AGH, Kleijnen J.
Analgesic efficacy and safety of paracetamol-codeine combinations versus paracetamol alone:
a systematic review. Br Med J 1996; 313: 321-325.
43. Koes BW, Scholten RJPM, Mens JMA, Bouter LM. Efficacy of non-steroidal anti-
inflammatory drugs for low back pain: a systematic review of randomised clinical trials. Ann
Rheum Dis 1997; 56: 214-23.
44. Van Tulder MW, Scholten RJPM, Koes BW, Deyo RA. Non-steroidal anti-inflammatory
drugs (NSAIDs) for non-specific low back pain (Cochrane Review). In: The Cochrane
Library, Issue 4, 2000. Oxford: Update Software.
45. Pohjalainen T, Jekunen A, Autio L, Vuorela H. Treatment of acute low back pain with the
COX-2-selective anti-inflammatory drug Nimesulide: results of a randomized, double-blind
comparative trial versus ibuprofen. Spine 2000; 25: 1579-85.
46. Van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM. Muscle relaxants for non-
specific low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2004.
47. Henry D, Lim LLY, Rodriguez LAG, et al. Variability in risk of gastrointestinal
complications with individual non-steroidal anti-inflammatory drugs: results of a collabora-
tive meta-analysis. Br Med J 1996; 312: 1563-6.

48. Koes BW, Scholten RJPM, Mens JMA, Bouter LM. Epidural steroid injections for low back
pain and sciatica: an updated systematic review of randomized clinical trials. Pain Digest
1999; 9: 241-7.
49. Nelemans PJ, de Bie RA, de Vet HCW, Sturmans F. Injection therapy for subacute and
chronic benign low back pain. In: The Cochrane Library, Issue 4, 2001. Oxford: Update
Software.
50. Watts RW, Silagy CA. A meta-analysis on the efficacy of epidural corticosteroids in the
treatment of sciatica. Anaesth Intensive Care 1995; 23: 564-9.
51. Koes BW, Assendelft WJJ, van der Heijden GJMG, Bouter LM. Spinal manipulation for low
back pain. An updated systematic review of randomized clinical trials. Spine 1996; 21: 2860-
71.
52. Shekelle PG, Adams AH, Chassin MR, Hurwitz EL, Brook RH. Spinal manipulation for low
back pain. Ann Intern Med 1992; 117: 590-8.
53. Bronfort G. Spinal manipulation: current state of research and its indications. Neurol Clin
1999; 17: 91-111.
54. Assendelft WJJ, Morton SC, Yu Emily I, Suttorp MJ, Shekelle PG. Spinal manipulative
therapy for low back pain (Cochrane Review). In: The Cochrane Library, Issue 1, 2004.
55. Assendelft WJJ, Bouter LM, Knipschild PG. Complications of spinal manipulation: a
comprehensive review of the literature. J Fam Pract 1996; 42: 475-80.
56. Van Tulder MW, Esmail R, Bombardier C, Koes BW. Back schools for non-specific low back
pain (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
57. Van Tulder MW, Ostelo RWJG, Vlaeyen JWS, Linton SJ, Morley SJ, Assendelft WJJ.
Behavioural treatment for chronic low back pain (Cochrane Review). In: The Cochrane
Library, Issue 4, 2000. Oxford: Update Software.
58. Van der Heijden GJMG, Beurskens AJHM, Koes BW, de Vet HCW, Bouter LM. The
efficacy of traction for back and neck pain: a systematic, blinded review of randomized
clinical trial methods. Phys Ther 1996; 75: 93-103.
59. Furlan AD, Brosseau L, Welch V, Wong J,. Massage for low back pain (Cochrane Review).
In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
60. Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B.
Multidisciplinary biopsychosocial rehabilitation for subacute low back pain among working
age adults. (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update
Software.
61. Araki S, Kawamura O, Mataka T, et al. RCT ni yoru kyusei yotsu-sho ni taisuru shishin-gun
to gishin-gun no tiryou koka [Randomized controlled trial comparing manual acupuncture
and sham acupuncture for acute low back pain]. J Japan Soc Acupuncture Moxibustion 2001;
51: 382.
62. He RY. The effect of acupuncture with moxibustion plus herb on lumbago. Chinese
Acupuncture 1997; 5: 279-80.

63. Kittang G, Melvaer T, Baerheim A. [Acupuncture contra antiphlogistics in acute lumbago].
Tidsskr Nor Laegeforen 2001; 121: 1207-10.
64. Wu YC ea. Acupuncture for 150 cases of acute lumbago. Shanghai J Acupuncture
Moxibustion 1991; 10: 18-9.
65. Chrubasik S, Zimpfer C, Schtt U, Ziegler R. Effectiveness of Harpagophytum procumbens in
treatment of acute low back pain. Phytomedicine 1996; 3: 1-10.
66. Chrubasik S, Junck H, Breitschwerdt H, Conradt C, Zappe H. Effectiveness of
Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a
randomized, placebo-controlled, double- blind study. Eur J Anaesthesiol 1999; 16: 118-29.
67. Chrubasik S, Eisenberg E, Balan E, Weinberger T, Luzzati R, Conradt C. Treatment of low
back pain exacerbations with willow bark extract: a randomized double-blind study. Am J
Med 2000; 109: 9-14.
68. Chrubasik S, Kunzel O, Model A, Conradt C, Black A. Treatment of low back pain with a
herbal or synthetic anti-rheumatic: a randomized controlled study. Willow bark extract for
low back pain. Rheumatology (Oxford) 2001; 40: 1388-93.
69. Ginsberg F, Mingard P, Weber T. Double-blind study on antitissue immunoglobulin
injections versus placebo in the treatment of acute lumbar pain with muscular spasms. Int J
Clin Pharmacol Res 1987; 7: 401-5.
70. Stam C, Bonnet MS, van Haselen RA. The efficacy and safety of a homeopathic gel in the
treatment of acute low back pain: a multi-centre, randomised, double-blind comparative
clinical trial. Br Homeopath J 2001; 90: 21-28.
71. Hurley DA, Minder PM, McDonough SM, Walsh DM, Moore AP, Baxter DG. Interferential
therapy electrode placement technique in acute low back pain: a preliminary investigation.
Arch Phys Med Rehabil 2001; 82: 485-93.
72. Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Abeln SB, Weingand KW. Continuous
low-level heatwrap therapy for treating acute nonspecific low back pain. Arch Phys Med
Rehabil 2003a; 84: 329-34.
73. Nadler SF, Steiner DJ, Petty SR, Erasala GN, Hengehold DA, Weingand KW. Overnight use
of continuous low-level heatwrap therapy for relief of low back pain. Arch Phys Med Rehabil
2003b; 84: 335-42.
74. Nadler SF, Steiner DJ, Erasala GN, Hengehold DA, Hinkle RT, Goodale MB, Abeln SB,
Weingand KW. Continuous low-level heatwrap therapy provides more efficacy than
ibuprofen and acetaminophen for acute low back pain. Spine 2002; 27: 1012-7.

OK ECGTC (K J GYB) EI CBM B[ GRC F KVZD GK NCK C
1. Research on work related low back disorders. Luxembourg Office for Official Publications of
the European Union (2000), ISBN 92 95007 02 6.
2. Nederlandse Vereniging voor Arbeids- en Bedrijfsgeneeskunde. Handelen van de bedrijfsarts
bij werknemers met lage rugklachten. Geautoriseerde richtlijn, 2 april 1999./Dutch
Association for Occupational Medicine. Management by the occupational physician of
employees with low back pain. Authorised Guidelines, April 2, 1999, ISBN 90 76721 01 7. [the
Netherlands]
3. Carter JT, Birrell LN. Occupational Health Guidelines for the Management of Low Back
Pain at Work: recommendations. Faculty of Occupational Medicine, London 2000, ISBN 1
86016 131 6 (also on www.facoccmed.ac.uk) [UK]

4. Waddell G, Burton AK. Occupational Health Guidelines for the Management of Low Back
Pain at Work: evidence review. Faculty of Occupational Medicine, London 2000, ISBN 1
86016 131 6 (also on www.facoccmed.ac.uk) [UK]

5. Waddell G, Burton AK. Occupational Health Guidelines for the Management of Low Back
Pain at Work: evidence review. Occup Med 2001; 51: 124-35. [UK]
6. Steven ID (Ed) Guidelines for the management of back-injured employees. Adelaide: South
Australia Workcover Corporation. 1993 [Australia]

7. Victorian Workcover Authority.. Guidelines for the management of employees with
compensable low back pain. Melbourne, Victorian Workcover Authority. 1993 and revised
Edition 1996 [Australia]

8. Yamamoto S. Guidelines on Worksite Prevention of Low Back Pain Labour Standards
Bureau Notification No.57. Industrial Health 1997; 35:143-172. [Japan]

9. Fordyce WE (Ed). Back Pain in the Workplace: Management of Disability in Nonspecific
Conditions. Seattle, IASP Press. 1995 [US ± International]
:Z\BC \GZK[K \GBZN Q\KR ,NGEDF OZVSP CYT ,KRGZM CD CBMC \GPGYP KBZP KCDN
www.backpaineurope.org
:\GCGD\G \GZTFN
reis@tx.technion.ac.il

Clinical Guidelines Lowerback

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Clinical Guidelines Lowerback

Uploaded by

Copyright:

Available Formats

Clinical Guidelines .

QG\I\ CD KCBMC NGVKJG FTKRP

NBZ[KC \KBGVZF \GZE\SFF

QG\I\ CD KCBM \TKRP .1

10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . QG\I\ CD CBM \TKRPN \GXNPF

(KJGYB) EI QG\I\ CD CBMC NGVKJ .2

(KVKXVS) KNGDS K\NC KRGZM QG\I\ CD CBMC NGVKJ .3

26 . . . . . . . . . . . . (KVKXVS) KNGDS K\NC KRGZM CD CBMC NGVKJN \GKIRFF \KXP\

WKCGZMH EGE Z"E

NBZ[KC FIV[PF KBVGZ EGDKB Z"GK

3 A CD CBMC NGVKJG FTKRP

5 A CD CBMC NGVKJG FTKRP

,\GTGC[ 6=P \GIV L[PRF CBMM ZEDGP (KJGYB) EI \"DM .

CD CBMC NGVKJG FTKRP A 6

FIV[P BVGZ ,OGZGVF Z"GK SKKZ .[ Z"E

FIV[P BVGZ ,U\G[ { Z"GK EFN .B Z"E

OGEKYN F\GPTFG ,FVKI \JKSZCKRGB ,FKVZ\GKHKVN DGIF \DKXR JFC=DKZ[ .F 'CD

NBZ[KC FKVZ\GKHKVF OGEKYN F\GPTF DKXR NBNXC .D ZP

\GBKZCF EZ[P ,\K[BZF \KJSKVZ\GKHKVF DZV .B 'CD

FVKI ,QGKX KRC KBGVZ HMZP ,FKDGNGJPGBZ ZRHGZ .K Z"E

\KNJNYSGNGYSGP FBGVZN FEGDBF ,OGYK[ ZGP .K Z"E

\KNJNYSGNGYSGP FBGVZN FEGDBF ,FIV[P .Z KERGG .B Z"E

CD \KDZGZKMN 'IK ,FYGZGS ,EVG\ZGB QG[[ .B Z"E

N"FX ,EVG\ZGB QGJSRKKV .B Z"E

FRRTZ ,QKKJ[RKGN \KC ,OGYK[G \KNYKHKV FBGVZ ZDZJ .K Z"E

OKN[GZK ,FSEF KBJKSZCKRGBF I"KC ,FYKJYZVGZKM OZKN .R Z"E

7 A CD CBMC NGVKJG FTKRP

(Levels of evidence) \GKBZF \PZ DGZKE

CD CBMC NGVKJG FTKRP A 8

QG\I\ CD KCBM \TKRP .1

:(\"DM) QG\I\ CD CBM \TKRPN ZG[YF TEKPF \KXP\

CD CBMC NGVKJG FTKRP A 10

.\"DM N[ FTKRP KCDN \GRPKFP \GKBZ JTP [K &

\KNNMF FKSGNMGBN \GXNPFF KZYKT

.\KRVGD \GNKTV N[ OKGSP DGS \GNNG[ GB \GMPG\F \GTRM[P \GKBZ QKB {

.OKXNPGP ORKB KRMP=GKC GB KNYKEP=GKC NEGP NT OKSSGCP FMZEFG LGRKI {

11 A CD CBMC NGVKJG FTKRP

.(A FPZ) \GXNPGP QRKB CD \GZGDI .

OKECGTN \GXNPFF KZYKT

CD CBMC NGVKJG FTKRP A 12

13 A CD CBMC NGVKJG FTKRP

CD CBMC NGVKJG FTKRP A 14

QG\I\ CD CBMC NGVKJ .2

.(KVKXVS) KNGDS BN QG\I\ CD CBMC NGVKJN \GKIRF Q\P .1

.OKKJRGGNZF \GTGXYPF NM K"T NNM LZEC \GPMSGPG \GNCGYP \GKIRF Q\P .2

CD CBMC NGVKJG FTKRP A 16

|3~ ORKF OKPGEB OKNDE

.\KRG[KN[ GB \KRGKR[ FBGVZC

17 A CD CBMC NGVKJG FTKRP

|4~ ORKF "OKCGFX OKNDE"

.KRGZMF CBMF \TVGFG CBMF \GR[KF

CD CBMC NGVKJG FTKRP A 18

FZE[F EGPT N[ FZGPI FKDGNG\V Q

19 A CD CBMC NGVKJG FTKRP

NNGM EI \"DMC KRG[BZ NGVKJ

.(OKPGJVPKS) OKRKPS\C \KCZP FJKN[ &

CD CBMC NGVKJG FTKRP A 20

F\GBC OK[DVPF NM[ KGXZ .\KRG[BZ FBGVZC (Cognitive Behavioral Therapy)

:(KVKXVS) KNGDS K\NC EI QG\I\ CD CBMC NGVKJN \GXNPFF KZYKT

(C FPZ) FNGIF \EZI \\IVFC TKKSNG ONGF TEKP \\N [K &

21 A CD CBMC NGVKJG FTKRP

CD CBMC NGVKJG FTKRP A 22

23 A CD CBMC NGVKJG FTKRP

KRGZM CD CBMC NGVKJ .3