ABSTRACT
The 3Rs approach is introduced as a clinical framework for the management of low back pain (LBP). The approach presents patient-centred management within a biopsychosocial framework. It consists of three interrelated phases, reactive (R1), recovery (R2), and resilience (R3), with treatment aims for each phase tabulated. Changes in tissue capacity through injury and recovery are considered, and the healing timescale described. The reactive phase (R1) is the stage in which a therapeutic alliance is formed, and treatment hypothesis developed. Treatment approaches for short-term pain relief are assessed, with education about setback and flare-ups given. The recovery phase (R2) introduces progressive exercise with a gradual reduction of therapist led management. The resilience phase (R3) addresses both physical and mental factors. Case notes are used to illustrate principles covered.
