A classification and treatment protocol for low back disorders Part 3 – Functional restoration for intervertebral disc related disorders

Abstract

Background: It has been widely recommended that clinical trials on people with low back disorders (LBDs) should have a greater focus on subgroup specific treatment in order to increase the likelihood of clinically meaningful effects being demonstrated. Functional restoration is a treatment approach that has demonstrated some evidence of effectiveness in subacute and chronic LBDs. However, studies to date have not used a clearly defined and appropriately detailed clinical protocol or applied the treatment to homogenous pathoanatomical based subgroups.

Objectives: This paper presents a detailed classification and treatment protocol for people with LBDs and clinical features thought to be indicative of non-reducible discogenic pain or disc herniation with associated radiculopathy.

Discussion: A pathoanatomical interpretation of traditional functional restoration, classification principles and particular treatment components in the clinical protocol are discussed.

Conclusion: The described clinical protocol will be used in the Specific Treatment for Problems of the Spine trials comparing specific physiotherapy to evidence-based advice.

Keywords:

• Back pain
• Classification
• Functional restoration
• Exercise
• Lumbar intervertebral disc
• Subgroup