Current trends in the rehabilitation of low back pain – a systematic review

Wioletta Łubkowska, Bożena Mroczek



Introduction: Back pain is considered a lifestyle disease due to its prevalence and the increasingly young age of patients.

The aim of this paper is a critical analysis of available guidelines, reports and evidence of diagnostic and therapeutic procedures in low back pain. This paper presents epidemiology, aetiology, diagnosis and selected methods of treatment and prevention of low back pain.

Materials and methods: The literature was reviewed based on the Polish Medical Bibliography computer database and the English-language PubMed, Web of Sciences and Cochrane Library database. Additionally, the Google Scholar search engine was used. The presented works have been analyzed in terms of their scientific reference and compliance with the principles of Evidence-Based Medicine. In order to obtain high-quality recommendations, the review included current scientific evidence based on peer-reviewed scientific publications, systematic reviews, meta-analyses and randomized controlled trials.

Results: According to numerous studies, bed rest is ineffective and should not be recommended. The literature on the effects of acupuncture, TENS, cold therapy and traction on low back pain is too heterogeneous; further high-quality research is needed before any final conclusions are drawn. Strongly recommended methods for treating low back pain symptoms are: physical exercise, manual therapy, and education.

Conclusions: Further research is required to identify effective non-pharmacological treatments for low back pain, and to understand the additional benefits of combining individual interventions, as well as which treatment combinations and sequences are most effective.


low back pain; back pain syndromes; M54 ICD-10; diagnosis; epidemiology; treatment; rules of conduct

Full Text:

PDF (Język Polski)


ICD-10 (International Statistical Classification of Diseases and Health Related Problems – Tenth Revision) – Międzynarodowa Statystyczna Klasyfikacja Chorób i Problemów Zdrowotnych – X Rewizja. Genewa: World Health Organization, Centrum Systemów Informacyjnych Ochrony Zdrowia; 2012.

Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2163-96. doi: 10.1016/S0140-6736(12)61729-2.

Manek NJ, MacGregor AJ. Epidemiology of back disorders, prevalence, risk factors, and prognosis. Curr Opin Rheumatol 2005;17(2):134-40.

Lidgren L. The bone and joint decade 2000–2010. Bull World Health Organ 2003;81(9):629. doi: 10.1590/S0042-96862003000900002.

Rubin DI. Epidemiology and risk factors for spine pain. Neurol Clin 2007;25(2):353-71. doi: 10.1016/j.ncl.2007.01.004.

Centers for Disease Control and Prevention (CDC). Prevalence and most common causes of disability among adults United States, 2005. MMWR Morb Mortal Wkly Rep 2009;58(16):421-6.

Kent PM, Keating JL. The epidemiology of low back pain in primary care. Chiropr Osteopat 2005;13:13-20. doi: 10.1186/1746-1340-13-13.

Nowakowski A, Kubaszewski Ł. Zespoły bólowe kręgosłupa. Choroba zwyrodnieniowa kręgosłupa. In: Kruczyński J, Szulc A, editors. Wiktora Degi ortopedia i rehabilitacja. Wybrane zagadnienia z zakresu chorób i urazów narządu ruchu dla studentów i lekarzy. Warszawa: Wydaw. Lekarskie PZWL; 2015. p. 463-8.

Goertz M, Thorson D, Bonsell J, Bonte B, Campbell R, Haake B, et al. Adult acute and subacute low back pain. 15th ed. Bloomington (MN): Institute for Clinical Systems Improvement; 2012.

Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 2006;88(Suppl 2):21-4. doi: 10.2106/JBJS.E.01273.

Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008;8(1):8-20. doi: 10.1016/j.spinee.2007.10.005.

Luo X, Pietrobon R, Sun SX, Liu GG, Hey L. Estimates and patterns of direct health care expenditures among individuals with back pain in the United States. Spine 2004;29(1):79-86. doi: 10.1097/01.BRS.0000105527.13866.0F.

Korabiusz K, Lubkowska A, Wawryków A. Przegląd najczęściej stosowanych metod fizjoterapii w zespołach bólowych kręgosłupa wśród pacjentów NZOZ ŚROD-MED w Policach. J Educ Health Sport 2016;6(4):127-40. doi: 10.5281/zenodo.49894.

de Campos TF. Low back pain and sciatica in over 16s: assessment and management NICE Guideline [NG59]. J Physiother 2017;63(2):120. doi: 10.1016/j.jphys.2017.02.012.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007;147:478-91.

Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendation. BMJ 2008;336(7650):924-6. doi: 10.1136/bmj.39489.470347.AD.

Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol 2010;24(6):769-81. doi: 10.1016/j.berh.2010.10.002.

Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73(6):968-74. doi: 10.1136/annrheumdis-2013-204428.

Manchikanti L, Singh V, Falco FJ, Benyamin RM, Hirsch JA. Epidemiology of low back pain in adults. Neuromodulation 2014;17(Suppl 2):3-10. doi: 10.1111/ner.12018.

Yiengprugsawan V, Hoy D, Buchbinder R, Bain C, Seubsman SA, Sleigh AC. Low back pain and limitations of daily living in Asia: longitudinal findings in the Thai cohort study. BMC Musculoskelet Disord 2017;18(1):19. doi: 10.1186/s12891-016-1380-5.

Palmer KT, Walsh K, Bendall H, Cooper C, Coggon D. Back pain in Britain: comparison of two prevalence surveys at an interval of 10 years. BMJ 2000;320(7249):1577-8.

Freburger JK, Holmes GM, Agans RP, Jackman AM, Darter JD, Wallace AS, et al. The rising prevalence of chronic low back pain. Arch Intern Med 2009;169(3):251-8. doi: 10.1001/archinternmed.2008.543.

Michalik R, Kowalska M, Kotyla P, Owczarek AJ. Częstość hospitalizacji pacjentów z bólami krzyża w Polsce na tle krajów europejskich. Pomeranian J Life Sci 2015;61(2):214-9. doi: 10.21164/pomjlifesci.81.

Domżał TM. Neurologiczne postępowanie w bólach krzyża – standardy i zalecenia. Pol Prz Neurol 2010;6(2):59-9.

Domżał TM. Przewlekłe nieswoiste bóle krzyża – stara dolegliwość czy nowa choroba neurologiczna? Pol Prz Neurol 2007;3(4):216-27.

Fanuele JC, Birkmeyer NJ, Abdu WA, Tosteson TD, Weinstein JN. The impact of spinal problems on the health status of patients: have we underestimated the effect? Spine 2000;25(12):1509-14.

Hayden JA, Dunn KM, van der Windt DA, Shaw WS. What is the prognosis of back pain? Best Pract Res Clin Rheumatol 2010;24(2):167-79. doi: 10.1016/j.berh.2009.12.005.

da Costa BR, Vieira ER. Risk factors for work-related musculoskeletal disorders: a systematic review of recent longitudinal studies. Am J Ind Med 2010;53(3):285-323. doi: 10.1002/ajim.20750.

Hampel P, Moergel MF. Staging of pain in patients with chronic low back pain in inpatient rehabilitation: validity of the Mainz Pain Staging System of pain chronification. Schmerz 2009;23(2):154-65. doi: 10.1007/s00482-008-0743-8.

Pinheiro MB, Ferreira ML, Refshauge K, Ordoñana JR, Machado GC, Prado LR, et al. Symptoms of depression and risk of new episodes of low back pain: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2015;67(11):1591-603. doi: 10.1002/acr.22619.

Ng SK, Cicuttini FM, Wang Y, Wluka AE, Fitzgibbon B, Urquhart DM. Negative beliefs about low back pain are associated with persistent high intensity low back pain. Psychol Health Med 2017;22(7):790-9. doi: 10.1080/13548506.2016.1220602.

Wong WS, Chen PP, Yap J, Mak KH, Tam BK, Fielding R. Chronic pain and psychiatric morbidity: a comparison between patients attending specialist orthopedics clinic and multidisciplinary pain clinic. Pain Med 2011;12:246-59. doi: 10.1111/j.1526-4637.2010.01044.x.

Kendall NA, Burton AK, Main CJ, Watson P. Tackling musculoskeletal problems: a guide for clinic and workplace identifying obstacles using the psychosocial flags framework. London: The Stationery Office; 2009.

Kassolik K, Rajkowska-Labon E, Tomasik T, Pisula-Lewadowska A, Gieremek K, Andrzejewski W, et al. Recommendations of the Polish Society of Physiotherapy, the Polish Society of Family Medicine and the College of Family Physicians in Poland in the field of physiotherapy of back pain syndromes in primary health care. Fam Med Primary Care Rev 2017;19(3):323-34. doi: 10.5114/fmpcr.2017.69299.

Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M. Nonpharmacologic therapies for low back pain: a systematic review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med 2017;166(7):493-505. doi: 10.7326/M16-2459.

Engers A, Jellema P, Wensing M, van der Windt DA, Grol R, van Tudler MW. Individual patient education for low back pain. Cochrane Database Syst Rev 2008;(1):CD004057. doi: 10.1002/14651858.CD004057.pub3.

Zhang Y, Wan L, Wang X. The effect of health education in patients with chronic low back pain. J Int Med Res 2014;42(3):815-20. doi: 10.1177/0300060514527059.

Buchbinder R, Jolley D, Wyatt M. Population based intervention to change back pain beliefs and disability: three part evaluation. BMJ 2001;322(7301):1516-20. doi:10.1136/bmj.322.7301.1516.

Waddell G, O’Connor M, Boorman S, Torsney B. Working Backs Scotland: a public and professional health education campaign for back pain. Spine 2007;32(19):2139-43. doi:10.1097/brs.0b013e31814541bc.

Werner EL, Ihlebaek C, Laerum E, Wormgoor ME, Indahl A. Low back pain media campaign: no effect on sickness behaviour. Patient Educ Couns 2008;71:198-203. doi:10.1016/j.pec.2007.12.009.

Coudeyre E, Tubach F, Rannou F, Baron G, Coriat F, Brin S, et al. Effect of a simple information booklet on pain persistence after an acute episode of low back pain: a non-randomized trial in a primary care setting. PLoS One 2007;2(8):e706. doi: 10.1371/journal.pone.0000706.

Lubkowska W. The potential of computer software that supports the diagnosis of workplace ergonomics in shaping health awareness. AIP Conference Proceedings 2017;1906(1):180008-1–180008-3. doi: 10.1063/1.5012461.

Picavest HS, Vlaeyen JW, Schouten JS. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 2002;156(11):1028-34.

Kool J, Bachmann S, Oesch P, Knuesel O, Ambergen T, de Bie R, et al. Function-centered rehabilitation increases work days in patients with nonacute nonspecific low back pain: 1-year results from a randomized controlled trial. Arch Phys Med Rehabil 2007;88(9):1089-94. doi: 10.1016/j.apmr.2007.05.022.

Schaafsma F, Schonstein E, Whelan KM, Ulvestad E, Kenny DT, Verbeek JH. Physical conditioning programs for improving work outcomes in workers with back pain. Cochrane Database Syst Rev 2010;(1):CD001822. doi: 10.1002/14651858.CD001822.pub2.

Wright A, Lloyd-Davies A, Williams S, Ellis R, Strike P. Individual active treatment combined with group exercise for acute and subacute low back pain. Spine 2005;30(11):1235-41.

Choi BK, Verbeek JH, Tam WW, Jiang JY. Exercises for prevention of recurrences of low-back pain. Occup Environ Med 2010;67(11):795-6. doi: 10.1136/oem.2010.059873.

Księżopolska-Orłowska K. Rehabilitation procedures in rheumatology. Reumatologia 2012;50(2):181-4.

Łubkowska W, Zdeb T, Mroczek B. Assessment of physiological spine curvature in girls who trained competitive swimming versus non-swimming girls. Fam Med Primary Care Rev 2015;17(3):189-92. doi: 10.5114/fmpcr/58738.

Rąpała A, Rąpała K, Lackowicz W, Łukawski S. Ocena kliniczna metody McKenzie w chorobie dyskowej w materiale Kliniki Ortopedii CMKP w Otwocku. Ortop Traumatol Rehabil 2004;6(2):183-9.

Ostelo RW, de Vet HC, Waddell G, Kerckhoffs MR, Leffers P, van Tulder M. Rehabilitation following first-time lumbar disc surgery: a systematic review within the framework of the cochrane collaboration. Spine 2003;28(3):209-18.

Friedrich M, Gittler G, Arendasy M, Friedrich KM. Long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic low back pain. Spine 2005;1(30):995-1000.

Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008;8(1):8-20. doi: 10.1016/j.spinee.2007.10.005.

Bendíková E, Dobay B. Physical and sport education as a tool for development of a positive attitude toward health and physical activity in adulthood. Eur J Contemp Educ 2017;6(1):14-21. doi: 10.13187/ejced.2017.1.144.

Nowak MA. Physical activity and its associations with other lifestyle elements in polish women. J Hum Kinet 2011;29:161-72. doi: 10.2478/v10078-011-0050-9.


Copyright (c) 2018 Wioletta Łubkowska, Bożena Mroczek

License URL: