ABSTRACT
The reactive phase (R1) is described, and the development of a therapeutic alliance emphasised with a case note example used to illustrate. Regression to the mean is considered, and resting position, coping mechanisms, and self-management discussed. Progressive walking programs are considered with several early-stage exercise progressions described in terms of starting position, method, and points to note focussing on exercise modifications and teaching. Pharmacological management of low back pain (LBP) is discussed with the NICE guidelines quoted. The use of manual therapy for LBP management is appraised and several techniques described. Mobilisation with movement (MWM) techniques are discussed. The use of acupuncture and dry needling is considered, and electrotherapy critiqued. Pain neuroscience education (PNE) is examined with a case note example used to illustrate. The use of metaphor and analogy is described, and the use of manual therapy as pain neuroscience education considered. Graded exposure is contrasted with graded activity. Symptom modification using mechanical diagnosis and therapy (MDT) is illustrated with passive and active techniques described with modifications and teaching methods.
