Low back pain and sciatica in over 16s: assessment and management

This guideline covers assessing and managing low back pain and sciatica in people aged 16 and over. It outlines physical, psychological, pharmacological and surgical treatments to help people manage their low back pain and sciatica in their daily life. The guideline aims to improve people’s quality of life by promoting the most effective forms of care for low back pain and sciatica.

Recommendations

This guideline includes recommendations on:

• assessment of low back pain and sciatica

Key Points

Exclude specific causes of low back pain, for example, cancer, infection, trauma or inflammatory disease such as spondyloarthritis

Consider using risk stratification (for example, the STarT Back risk assessment tool) at first point of contact with a healthcare professional for each new episode of low back pain with or without sciatica to inform shared decision-making about stratified management.

Consider using risk stratification (for example, the STarT Back risk assessment tool) at first point of contact with a healthcare professional for each new episode of low back pain with or without sciatica to inform shared decision-making about stratified management.

Consider imaging in specialist settings of care (for example, a musculoskeletal interface clinic or hospital) for people with low back pain with or without sciatica only if the result is likely to change management.

• non-invasive treatments for low back pain and sciatica

Non-pharmacological interventions

• invasive treatments for low back pain and sciatica

Non-surgical interventions

RACGP Guidelines for the Management of Hip & Knee OA

Full Guide here

Key Summary

Lifestyle:
• Regular exercise is important for relieving pain and improving function in people with knee and/or hip OA. For knee OA, land-based exercise such as muscle strengthening exercises, walking and Tai Chi are strongly recommended. Other land-based exercise that could be considered for some people with knee OA include stationary cycling and Hatha yoga. The best land-based exercise for people with hip OA could not be determined because of limited research. Aquatic exercise may be considered for some people with knee and/or hip OA.
• Weight management is strongly recommended for people with knee and/or hip OA who are overweight or obese.

Non-drug treatments:
• Cognitive behavioural therapy (CBT) could be considered for some people, particularly in conjunction with exercise, and taking into account existing mental health conditions, personal preference, cost and access.
• Heat packs or hot water bottles may be applied as a self-management strategy.
• Using a cane or other devices (eg walker, crutches) may be appropriate for some people with knee and/or hip OA to help improve pain, mobility and balance.
• A short course of manual therapy or massage could be considered for some people with knee and/or hip OA as an adjunct to lifestyle management.
• Transcutaneous electrical nerve stimulation (TENS) that can be used at home may be appropriate for some people with knee and/or hip OA.
• There is a conditional recommendation against the following treatments (refer to Section 3. Recommendations for an explanation on conditional recommendation)
– therapeutic ultrasound
– shockwave therapy
– laser therapy
– interferential therapy
– footwear marketed for knee OA
– cold therapy
– valgus braces and lateral wedge insoles for medial knee OA
– patellofemoral braces
– kinesio taping.

Due to a lack of high-quality evidence, no recommendation can be made for the following
– formal self-management programs
– varus unloading braces and medial wedge insoles for lateral knee OA
– shock-absorbing insoles
– arch supports
– patellar taping
– pulsed electromagnetic/shortwave therapy.

Medication:
• Nonsteroidal anti-inflammatory drugs (NSAIDs; eg ibuprofen), taken orally at low doses for short periods are recommended for some people with knee and/or hip OA. Monitoring for possible adverse effects of the drugs is necessary.
• Although there is no recommendation either for or against NSAIDs applied locally to the skin, it may be reasonable to trial topical NSAIDs for a short period, with monitoring of possible adverse effects, then discontinue use if not effective.
• Although there is no recommendation either for or against paracetamol, it may be reasonable to trial paracetamol for a short period in some people with knee and/or hip OA, with monitoring of possible adverse effects, then discontinue use if not effective.
• Corticosteroid injections could be offered for short-term symptom relief for some people with knee and/or hip OA, but care should be taken with repeated injections because of potential harm.
• Duloxetine could be considered for some people with knee and/or hip OA when other forms of pain relief are inadequate.
• There is a strong recommendation against the use of the following
– oral and transdermal opioids
– viscosupplementation injection for hip OA
– doxycycline
– strontium ranelate
– interleukin-1 (IL-1) inhibitors
– stem cell therapy.

There is a conditional recommendation against the use of the following
– capsaicin for knee and/or hip OA
– bisphosphonates
– calcitonin
– anti-nerve growth factor (NGF)
– colchicine
– methotrexate
– viscosupplementation injection for knee OA
– dextrose prolotherapy
– omega 3 fatty acids
– diacerein.

Due to a lack of high-quality evidence, no recommendation can be made for the following
– injections of platelet-rich plasma (PRP)
– nonsteroidal anti-inflammatory creams applied locally
– capsaicin for hip OA
– collagen
– methylsulfonylmethane.

Complementary and alternative therapies, and nutraceuticals:
• The following complementary and alternative therapies should not be offered
– glucosamine and chondroitin nutraceuticals
– vitamin D
– acupuncture.

• Due to a lack of high-quality evidence, no recommendations can be made about the following herbal supplements
– avocado/soybean unsaponifiables (ASU)
– Indian frankincense (Boswellia serrata extract)
– turmeric
– pine bark extract.

Surgical interventions:
• There is a strong recommendation against surgery such as arthroscopic lavage and debridement, meniscectomy and cartilage repair for people with knee OA, unless the person also has signs and symptoms of a ‘locked knee’.

When? Saturday June 22nd Join us for a Trail Run Clinic on the Gold Coast

What you will Learn:
Trail Running skills & technique for:
– Downhill Running: learn how to run more efficiently, safer and faster downhill
– Night Running skills: bring a headlamp & join us for a run under lights after the Downhill Technique Focus

Start time: 5pm, meeting a Nerang Velodrome, Gold Coast to run in Nerang State Forest

Run Timing of the afternoon:
-Downhill technique tips and practice: 5pm-5.40pm (if you have been before, we will give you advanced cues and progressions)
-Discussion of tips for Night running with the chance to share & trial headlamps as we will have some testers courtesy of Wildearth
-5.45-6.30pm a guided run with Britt and Kyle: 2 groups with an Advanced Group running under lights and a Beginner group running the easier trails under lights
-Come for part, or all, of the session

Bring: Yourself, $20 (or FREE if you are a Run@mygcphysio group Member), shoes, a headlamp & a willingness to LEARN

For more info about the Run@mygcphysio group,click HERE