This presentation provides an overview of the 2016 NICE guidance for low back pain and sciatica. It pays particular attention to pragmatic issues surrounding the current call for evidence based medicine and the disconnect between patients wishes and the clinicians expertise and experience. This was presented at an evening seminar for London Sports Orthopaedic Consultant group for Musculoskeletal Physiotherapists.

1. Are NICE Guidelines for Low Back
Pain & Sciatica – A useful Tool or a
NHS Cost Reduction Exercise
Uzo Ehiogu
MSc,BSc,BSc,MMACP,CSCS
Specialist Musculoskeletal Physiotherapist
(Medical Education)
Strength and Conditioning Coach
Research and Education Department
Royal Orthopedic Hospital Birmingham
Info@insideedgephysio.com
www.insideedgephysio.com
@insideedgePT
@ConsultantPT

3. Introduction

4. Evidence Based Practice
Appropriate
research studies
Clinical expertise
Patients values
and expectations

5. What it does not talk about
How long someone should
wait to receive care
How long a treatment
session should last
Rehabilitation after surgery
The private sector!

6. Who does it include?
Above 16 years of age
Non specific low back pain in
the back between the
bottom of the rib cage and
the buttock creases .
A diagnosis of non- specific
low back pain =

7. The absence of :
Fracture
Cancer
Infection
Widespread inflammation

8. Special Thanks to: Miss
Lucy Shields MSc, BSc
MMACP

9. Assessment
Consider using STarBack
for shared decision
making
Counsel patients that
referral for specialist
opinion does not =
Imaging
Only offer Imaging if it
will change Management
Consider alternative
diagnosis – if the
symptoms change or
new symptoms start

11. Non Invasive Management
Self management
Exercise :
Consider group exercise within the NHS
(Consider specific needs , preferences and
capabilities )
Manual therapy :
Do what you want providing its not traction-
as part of multi modal package of care

12. Non Invasive Management
No orthotics ?
No rocker shoes ?
No Electrotherapy
Acupuncture is Out!
Who uses acupuncture as a stand
alone treatment for back pain?

13. Non Invasive Management
Combined physical and psychological
therapy
For persistent non specific pain with
significant psychosocial obstacles to
recovery or PREVIOUS failed
Treatment !
Return to work
Offer return to work and promote normal
activities of daily living

14. Invasive Management
Non Surgical interventions
No spinal injections
Radiofrequency denervation Yes
After failed non surgical treatment
After diagnostic medial branch block
Consider epidurals injection for acute and
severe sciatica

15. Invasive Management
Surgical Interventions
Spinal Decompression
Failed Conservative Care – History ,
Examination and Radiological findings align
Spinal Fusion No
Disk Replacement No

16. Conclusion
Is this practice changing ?
Is this patient centred ?
Will it change your practice ?
Is your place of work
resourced to offer combined
therapies?

17. References List
Croft et al 1998 Outcomes of low back pain in clinical practice. British
Medical Journal , 2, 316 , 1356-9
Dillingham T 1994 Evaluation and management of low back pain: and
overview. State of the Art Reviews 1995;9(3):559–74.
McCarthy C et al 2004 The
biopsychosocial classification of non-specific low back pain: a
systematic review. Physical Therapy Reviews ;9:17–30.
NICE Low back pain and sciatica in over 16s
www.nice.org.uk/guidance/NG59
O’Sullivan et al (2005) Diagnosis and classification of chronic low
back pain disorders: Maladaptive movement and motor control
impairments as underlying mechanism, Manual Therapy 10 242–255
Waddell G. The back pain revolution. Edinburgh: Churchill
Livingstone; 2004. Woby S, Watson P, R

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