Low back pain in disorders of the intervertebral disc – bio-psycho-social conditions

Maciej Chrzanowski


Low back pain is a very common health problem affecting about 80% of the global population and has an impact on biomedical, psychological and sociological areas. There are many types of treatment centered around evidence-based practice. This paper tries to present most of the therapeutic methods used to ease pain and improve the quality of life. Manual therapy, core exercises, dry needling, kinesiotaping and transcutaneous electrical nerve stimulation have different efficacies and result in treating and managing pain. It could be quite certain to indicate a superiority of manual therapy and core exercises over the rest of evaluated methods. This article demonstrates examples of core exercises that in some cases may be useful to help with low back pain.


pain management; low back pain; TENS; dry needling; manual therapy; kinesiotaping; kinesiophobia; core exercises

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Rajabi R, Ahmadi Barati A, Farhadi L. Effect of Core Stability Exercises at Home on Functional Ability and Chronic Low Back Pain (LBP) in Male Dentists. J Clin Res Paramed Sci 2018;7(2):1-4.

Philadelphia Panel. Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions for low back pain. Phys Ther 2001;81(10):1641-74.

Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conentional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther 2017;25(2):66-73.

Hulens M, Vangant G, Claessens AL, Lysens R, Muls E. Predictors of 6-minute walk test results in lean, obese and morbidly obese women. Scand J Med Sci Sports 2003;13(2):98-105.

Wojtyna E. O bólu i radzeniu sobie z nim w kontekście współczesnej mentalności. In: Górnik-Durose M, editor. Kultura współczesna a zdrowie. Sopot: Gdańskie Wydawnictwo Psychologiczne; 2013. p. 135-53.

LeResche L. Gender considerations in the epidemiology of chronic pain. In: Epidemiology of Pain. Seattle: IASP Press; 1999. p. 45-7.

Jeffries LJ, Milanese SF, Grimmer-Somers KA. Epidemiology of adolescent spinal pain: a systematic overview of the research literature. Spine (Phila Pa 1976) 2007;32(23):2630-7.

Dionne CE, Dunn KM, Croft PR. Does back pain prevalence really decrease with increasing age? A systematic review. Age Ageing 2006;35(3):229-34.

Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum 2012;64(6):2028-37.

Solomou A, Kraniotis P, Rigopoulou A, Petsas T. Frequent benign, nontraumatic, noninflammatory causes of low back pain in adolescents: MRI findings. Radiol Res Pract 2018;2018: 7638505.

Sheeran L, Coales P, Sparkes V. Clinical challenges of classification based targeted therapies for non-specific low back pain: what do physiotherapy practitioners and managers think? Man Ther 2015;20(3):456-62.

Herndon CM, Zoberi KS, Gardner BJ. Common questions about chronic low back pain. Am Fam Physican 2015;91(10):708-14.

van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A, et al. Chapter 3. European guildelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 Suppl 2(Suppl 2):S169-91.

Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15 Suppl 2(Suppl 2):S192-300.

Urban JPG, Roberts S. Degeneration of the intervertebral disc. Arthritis Res Ther 2003;5(3):120-30.

Yu J, Winlove PC, Roberts S, Urban JPG. Elastic fibre organization in the intervertebral discs of the bovine tail. J Anat 2002;201(6):465-75.

Shapiro IM, Risbud MV, editors. The intervertebral disc: molecular and structural studies of the disc in health and disease. Wien: Springer-Verlag; 2014. p. 177-99.

Taher F, Essig D, Lebl DR, Hughes AP, Sama AA, Cammisa FP, et al. Lumbar degenerative disc disease: current and future concepts of diagnosis and management. Adv Orthop 2012;2012:970752.

Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 2006; 88 Suppl 2:21-4.

Vibe Fersum K, O’Sulivan P, Skouen JS, Smith A, Kvåle A. Efficacy of classification-based cognitive functional therapy in patients with non-specific chronic low back pain: A randomized controlled trial. Eur J Pain 2013;17(6):916-28.

Thorbjornsson CO, Affredsson L, Fredriksson K, Koster M, Michelsen H, Vingard E, et al. Psychological and physical risk factors associated with low back pain: a 24 year follow up among women and men in a broad range of occupations. Occup Environ Med 1998;55(2):84-90.

Hansson TH, Keller TS, Spengler DM. Mechanical behavior of the human lumbar spine. II. Fatigue strength during dynamic compressive loading. J Orthop Res 1987;5(4):479-87.

Abou-Elroos DA, El-Toukhy MAE, Nageeb GS, Dawood EA, Abouhashem S. Prolongated physiotherapy versus early surgical intervention in patients with lumbar disc hermitatnion: short-term outcomes of clinical randomized trial. Asian Spine J 2017;11(4):531-7.

Rim DC. Quantitative pfirrmann disc degeneration grading system to overcome the limitation of pfirrmann disc degeneration grade. Korean J Spine 2016;13(1):1-8.

Hancock MJ, Maher CG, Latimer J, Spindler MF, McAuley JH, Laslett M, et al. Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain. Eur Spine J 2007;16(10):1539-50.

Teraguchi M, Samartzis D, Hashizume H, Yamada H, Muraki S, Oka H, et al. Classification of high intensity zones of the lumbar spine and their associaation with other spinal mri phenotypes: the wakayama spine study. PLoS One 2016;11(9):e0160111.

Moore RJ. The vertebral endplate: disc degeneration, disc regeneration. Eur Spine J 2006;15(Suppl 3):333-7.

Pagé GM, Lacasse A, Quebec Back Pain Consortium. The Quebec Low Back Pain Study: a protocol for an innovative 2-tier provincial cohort. Pain Rep 2019;5(1);e799.

Hadjistavropoulos HD, Craig KD. Acute and chronic low back pain: cognitive, affective, and behavioral dimensions. J Consult Clin Psychol 1994;62(2):341-9.

De Walden-Gałuszko K. Psychologiczne aspekty bólu i jego leczenia. Med Palat Prakt 2007;1(2):66-70.

Butler DS, Moseley GL. Explain pain. Adelaide: Noigroup Publications; 2003. p. 94-100.

Asmundson G, Gomez-Perez L, Richter AA, Cerleton RN. The psychology of pain: models targets comprehensive assessment. In: van Griensven H, Strong J, Unruh AM, editors. Pain: a textbook for health professionals. Amsterdam: Elsevier; 2012. p. 35-43.

Linton SJ, Boersma K, Jansson M, Overmeer T, Lindblom K, Vlaeyen JW. A randomized controlled trial of exposure in vivo for patients with spinal pain reporting fear of work-related acrivities. Eur J Pain 2008;12(6):722-30.

Karos K, Williams AC, Meulders A, Vlaeyen JW. Pain as a threat to the social self: a motivational account. Pain 2018;159(9):1690-5.

Mescouto K, Olson RE, Hodges PW, Setchell J. A critical review of the biopsychosocial model of low back pain care: time for new approach? Disabil Rehabil 2020:1-15.

Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull 2007;133(4):581-624.

Klyne DM, Moseley GL, Sterling M, Barbe MF, Hodges PW. Are signs of central sensitization in acute low back pain a precursor to poor outcome? J Pain 2019;20(8):994-1009.

Cowell I, O’Sullivan P, O’Sullivan K, Poyton R, McGregor A, Murtagh G. Perceptions of physiotherapists towards the management of non-specific chronic low back pain from a biopsychosocial perspective: a qualitative study. Musculoskeletal Sci Pract 2018;38:113-9.

Flink IK, Reme S, Jacobsen HB, Glombiewski J, Vlaeyen JWS, Nicholas MK, et al. Pain psychology in the 21st century: lessons learned and moving forward. Scand J Pain 2020;20(2):229-38.

Leerar P, Boissonnault W, Domholdt E, Roddey T. Documentation of red flags by physical therapists for patients with low back pain. J Man Manip Ther 2007;15(1):42-9.

Flink IK, Smeets E, Bergboma S, Peters ML. Happy despite pain: pilot study of a positive psychology intervention for patients with chronic pain. Scand J Pain 2015;7(1):71-9.

Richle KA, Romano JM, Jensen MP. Partner responses to patient pain and well behaviors and their relationship to patient pain behavior, functioning, and depression. Pain 2011;152(1):82-8.

Zangoni G, Thomson OP. ‘I need to do another course’ – Italian physiotherapists’ knowledge and beliefs when assessing psychosocial factors in patients presenting with chronic low back pain. Musculoskelet Sci Pract 2017;27:71-7.

Innes E, Crowther A, Fonti F, Quayle L. Women’s health at work program: Musculoskeletal pain experience by women of Chinese background working on market gardens in the Sydney basin. Work 2010;36(2):129-40.

Abad V, Boyce E. Issues in psychiatric evaluations of Puerto-Ricans. A sociocultural perspective. J Operational Psychiatry 1979;10(1):28-39.

Sex and Gender Issues in Pain. In: Charlton JE, editor. Core curriculum for professional education in pain. Seatle: IASP Press; 2005. p. 1-5.

Kerns RD, Rosenberg R, Jacob MC. Anger expression and chronic pain. J Behav Med 1994;17(1):57-67.

Cano A, Mayo A, Ventimiglia M. Coping, pain severity, interference, and disability: the potential mediating and moderating roles of race and education. J Pain 2006;7(7):459-68.

Bakker EWP, Verhagen AP, Lucas C, Koning HJ, Koes BW. Spinal mechanical load: a predictor of persistent low back pain? A prospective cohort study. Eur Spine J 2007;16(7):933-41.

Roland M, Fairbank J. The Roland–Morris disability questionnaire and the oswestry disability questionnaire. Spine (Phila Pa 1976) 2000;25(24):3115-24.

Sullivan MJL, Bishop S, Pivik J. The pain catastrophizing scale: development and validation. Psychology Assessment 1995;7(4):524-32.

Fairback JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976) 2001;25(22):2940-52.

Jaeschke R, Singer J, Guyatt GH. Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials 1989;10(4):407-15.

Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA 1992;268(6):760-5.

Acute low back problems in adults: assessment and treatment. Agency for Health Care Policy and Research. Clin Pract Guidel Quick Ref Guide Clin 1994;(14):iii-iv, 1-25.

Kraus JF, Schaffer KB, McArthur DL, Peek-Asa C. Epidemiology of acute low back injury in employees of a large home improvement retail company. Am J Epidemiol 1997;146(8):637-45.

Oliphant D. Safety of Spinal Manipulation in the Treatment of Lumbar Disk Herniations. J Manipulative Physiol Ther 2004;27(3):197-210.

Schwind J, Learman K, O’Halloran B, Showalter C, Cook C. Different minimally important clinical difference (MCID) scores lead to different clinical prediction rules for the Oswestry disability index for the same sample of patients. J Man Manip Ther 2013;21(2):71-8.

Andicochea CT, Fulkerson J, Taylor BM, Portouw SJ. Manual Therapy for Chronic Low Back Pain in an f-5 Pilot. Mil Med 2015;180(10):e1132-5.

Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med 2013;11(2):122-9.

Draper DO. Facts and misfits in ultrasound therapy: steps to improve your treatment outcomes. Eur J Phys Rehabil Med 2014;50(2):209-16.

Rantonen J, Karppinen J, Vehtari A, Luoto S, Viikari-Juntura E, Hupli M, et al. Effectiveness of three interventions for secondary prevention of low back pain in the occupational health setting – a randomised controlled trial with a natural course control. BMC Public Health 2018;18(1):598.

Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am 2014;98(4):777-89.

Buchmuller A, Navez M, Milletre-Bernardin M, Pouplin S, Presles E, Lantéri-Minet M, et al. Value of TENS for relief of chronic low back pain with or without radicular pain. Eur J Pain 2012;16(5):656-65.

Facci LM, Nowotny JP, Tormem F, Trevisani VF. Effects of transcutaneous electrical nerve stimulation (TENS) and interferential currents (IFC) in patients with nonspecific chronic low back pain: randomized clinical trial. Sao Paulo Med J 2011;129(4):206-16.

Vance CGT, Dailey DL, Rakel BA, Sluka KA. Using TENS for pain control: the state of the evidence. Pain Manag 2014;4(3):197-209.

Kalichman L, Vulfsons S. Dry needling in the management of musculoskeletal pain. J Am Board Fam Med 2010;23(5):640-6.

Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, et al. Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration. Spine (Phila Pa 1976) 2005;30(8):944-63.

Cummings TM, White AR. Needling therapies in the management of myofascial trigger point pain: a systematic review. Arch Phys Med Rehabil 2001;82(7):986-92.

Koppenhaver SL, Walker MJ, Smith RW, Booker JM, Walkup ID, Su J, et al. Baseline examination factors associated with clinical improvement after dry needling in individuals with low back pain. J Orthop Sports Phys Ther 2015;45(8):604-12.

Kase K, Tatsuyuki H, Tomoki O. Development of Kinesio™ Tape Kinesio™ Taping perfect manual. Kinesio Taping Association 1996;6-10:117-8.

Parreira Pdo C, Costa Lda C, Takahashi R, Hespanhol Junior LC, Luz Junior MA, Silva TM, et al . Kinesio taping to generate skin convolutions is not better then sham taping for people with chronic non-specific low back pain: a randomised trial. J Physiother 2014;60(2):90-6.

Luz Júnior MA, Sousa MV, Neves LA, Cezar AA, Costa LO. Kinesio Taping® is not better then placebo in reducing pain and disability in patients with chronic non-specific low back pain: a randomized controlled trial. Braz J Phys Ther 2015;19(6):482-90.

Vincent HK, Seay AN, Montero C, Conrad BP, Hurley RW, Vincent KR. Kinesiophobia and fear-avoidance beliefs in overweight older adults with chronic low-back pain: relationship to walking endurance – part II. Am J Phys Med Rehabil 2013;92(5):439-45.

Vincent HK, Omli MR, Day TI, Hodges M, Vincent KR, George SZ. Fear of movement, quality of life, and self-reported disability in obese patients with chronic lumbar pain. Pain Med 2011;12(1):154-64.

Rostami M, Ansari M, Noormohammadpour P, Mansournia MA, Kordi R. Ultrasound assessment of trunk muscles and back flexibility, strength and endurance in off-road cyclists with and without low back pain. J Back Musculoskeletal Rehabil 2015;28(4):635-44.

van der Hulst M, Vollenbroek-Hutten MM, Rietman JS, Schaake L, Groothuis-Oudshoorn KG, Hermens HJ. Back muscle activation patterns in chronic low back pain during walking: a “guarding” hypothesis. Clin J Pain 2010;26(1):30-7.

Hofmann SG, Asnaani A, Vonk IJ, Sawyer AT, Fang A. The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognit Ther Res 2012;36(5):427-40.

Smeets RJ, Vlaeyen JW, Hidding A, Kester AD, van der Heijden GJ, van Geel AC, et al. Active rehabilitation for chronic low back pain: Cognitive-behavioral, physical, or both? First direct post-treatment results from a randomized controlled trial. BMC Musculoskeletal Disord 2006;7:5.

Synnott A, O’Keeffe M, Bunzli S, Dankaerts W, O’Sullivan P, Robinson K, et al. Physiotherapists report improved understanding of and attitude toward the cognitive, psychological and social dimensions of chronic low back pain after Cognitive Functional Therapy training: a qualitative study. J Physiother 2016;62(4):215-21.

Leeuw M, Goossens MEJB, Linton SJ, Crombez G, Boersma K, Vlaeyen JWS. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007;30(1):77-94.

Kang KY. Effects of core muscle stability training on the weight distribution and stability of the elderly. J Phys Ther Sci 2015;27(10):3163-5.

Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol 2003;13(4):371-9.

Chang WD, Lin HY, Lai PT. Core strength training for patients with chronic low back pain. J Phys Ther Sci 2015;27(3):619-22.

Moseley GL, Hodges PW, Gandevia SC. Deep and superficial fibers of the lumbar multifidus muscle are differentially active during voluntary arm movements. Spine (Phila Pa 1976) 2002;27(2):E29-36.

Nadler SF, Malanga GA, Bartioli LA, Feinberg JH, Prybicien M, Deprince M. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc 2002;34(1):9-16.

Hibbs AE, Thompson KG, French D, Wrigley A, Spears I. Optimizing performance by improving core stability and core strength. Sports Med 2008;38(12):995-1008.

Macedo LG, Litimer J, Maher CG, Hodges PW, McAuley JH, Nicholas MK, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized control trial. Phys Ther 2012;92(3):363-77.

Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RW, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev 2016;8(1): CD012004.

Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord 2014;15:416.

Akuthota V, Ferreiro A, Moore T, Fredericson M. Core stability exercise principles. Curr Sports Med Rep 2008;7(1):39-44.

Moseley GL, Hodges PW, Gandevia SC. External perturbation of the trunk in standing humans differentially activates components of the medial back muscles. J Physiol 2003;547(Pt 2):581-7.

Bryant J. Train Smarter with the 7 best core strengthening exercises. https://www.bodyset.co.uk/fitness/train-smarter-with-the-7-best-core-strengthening-exercises/ (28.04.2017).

Barbado D, Iries-Vidal B, Prat-Luri A, Garcia-Vaquero MP. Training intensity quantification of core stability exercises based on a smartphone accelerometer. PloS One 2018;13(12):e0208262.

Joseph LH, Hancharoenkul B, Sitilertpisan P, Pirunsan U, Paungmali A. Comparison of effects between core stability training and sports massage therapy among elite weightlifters with chronic non-specific low back pain: a randomized cross-over study. Asian J Sports Med 2018;9(1): e58644.

De Walden-Gałuszko K, Majkowicz M. Psychologiczno-kliniczna ocena bólu przewlekłego. Wskazania dla lekarzy pierwszego kontaktu oraz poradni przeciwbólowych i paliatywnych. Gdańsk: Akademia Medyczna; 2003.

Chojnacka-Szawłowska G. Jakość przekonań o doświadczanym bólu a funkcjonowanie emocjonalne i zachowanie chorych. In: Leppert W, Majkowicz M, editors. Ból przewlekły. Ujęcie kliniczne i psychologiczne. Warszawa: PZWL Wydawnictwo Lekarskie; 2018. p. 81-99.

Pincus T, Kent P, Bronfort G, Loisel P, Pransky G, Hartvigsen J. Twenty-five years with the biopsychosocial model of low back pain – is it time to celebrate? A report from the twelfth international forum for primary care research on low back pain. Spine (Phila Pa 1976) 2013;38(24):2118-23.

Bath B, Lovo Grona S. Biopsychosocial predictors of short-term success among people with low back pain referred to a physiotherapy spinal triage service. J Pain Res 2015;8:189-202.

DOI: https://doi.org/10.21164/pomjlifesci.556

Copyright (c) 2021 Maciej Chrzanowski

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