Prior Page                              Next Page 
The US Department of Health and Human Services 
      AHCPR Clinical Practice Guideline 
  Number 14 
        Acute Low Back Problems in Adults 
   Stanley J. Bigos, MD (Panel Chair) 
Panel Members 
   Rev. O. Richard Bowyer                             Margareta Nordin, RPT, DrSci 
   G. Richard Braen, MD                                Bernice D. Owen, PhD, RN 
   Kathleen Brown, PhD, RN                          Malcolm H. Pope, DrMedSc, PhD 
   Richard Deyo, MD, MPH                            Richard K. Schwartz, MS, OTR, FSR 
   Scott Haldeman, DC, MD, PhD                  Donald H. Stewart, Jr., MD 
   John L. Hart, DO                                                Jeff Susman, MD 
   Ernest W. Johnson, MD                                  John J. Triano, MA, DC 
   Robert Keller, MD                                             Lucius C. Tripp, MD, MPH, FACPM 
   Daniel Kido, MD, FACR                              Dennis C. Turk, PhD 
   Matthew H. Liang, MD,                                Clark Watts, MD, JD 
   Roger M. Nelson, PT, PhD MPH               James N. Weinstein, DO 
   U.S. Department of Health and Human Services 
   Public Health Service 
   Agency for Health Care Policy and Research 
   Rockville, Maryland 
   AHCPR Publication No. 95-0642 
   December 1994 
This document is in the public domain and may be used and reprinted without special permission.  AHCPR will appreciate citation of the source, and the suggested format is provided below: 
Bigos S, Bowyer O, Braen G, et al.  Acute Low Back Problems in Adults.  Clinical Practice Guideline No. 14.  AHCPR Publication No. 95-0642.  Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.  December 1994. 
Guideline Development and Use 
   Guidelines are systematically developed statements to assist practitioner and patient decisions about appropriate health care.  This guideline was developed by an independent multidisciplinary panel of private-sector clinicians and other experts convened by the Agency for Health Care Policy and Research (AHCPR).  The panel employed explicit, science-based methods and expert clinical judgment to develop specific statements on acute low back problems in adults. 
  Extensive literature searches were conducted and critical reviews and syntheses were used to evaluate empirical evidence and significant outcomes.  Peer review and field review were undertaken to evaluate the validity, reliability, and utility of the guideline in clinical practice. The panel's recommendations are primarily based on the published scientific literature.  When the scientific literature was incomplete or inconsistent in a particular area, the recommendations reflect the professional judgment of panel members and consultants. 
  The guideline reflects the state of knowledge, current at the time of publication.  Given the inevitable changes in the state of scientific information and technology, periodic review, updating, and revision will be done. 
  We believe that the AHCPR-assisted clinical guidelines will make positive contributions to the quality of care in the United States.  We encourage practitioners and patients to use the information provided in this Clinical Practice Guideline.  The recommendations may not be appropriate for use in all circumstances.  Decisions to adopt any particular recommendation must be made by the practitioner in light of available resources and circumstances presented by individual patients. 
                              Clifton R. Gaus, ScD 
                              Agency for Health Care Policy and Research 
Publication of this guideline does not necessarily represent endorsement by the U.S. Department of Health and Human Services. 
  Findings and recommendations on the assessment and treatment of adults with acute low back problems (activity limitations due to symptoms in the low back and/or back-related leg symptoms of less than 3 months' duration) are presented in this clinical practice guideline.  The following are the principal conclusions of this guideline: 
 -   The initial assessment of patients with acute low back problems focuses on the detection of "Red Flags" (indicators of potentially serious spinal pathology or other nonspinal pathology). 
 -   In the absence of red flags, imaging studies and further testing of patients are not usually helpful during the first 4 weeks of low back symptoms. 
 -   Relief of discomfort can be accomplished most safely with nonprescription medication and/or spinal manipulation. 
 -   While some activity modification may be necessary during the acute phase, bed rest >4 days is not helpful and may further debilitate the patient. 
 -   Low-stress aerobic activities can be safely started in the first 2 weeks of symptoms to help avoid debilitation; exercises to condition trunk muscles are commonly delayed at least 2 weeks. 
 -   Patients recovering from acute low back problems are encouraged to return to work or their normal daily activities as soon as possible. 
 -   If low back symptoms persist, further evaluation may be indicated. 
 -   Patients with sciatica may recover more slowly, but further evaluation can also be safely delayed.  
 -   Within the first 3 months of low back symptoms, only patients with evidence of serious spinal pathology or severe, debilitating symptoms of sciatica, and physiologic evidence of specific nerve root compromise corroborated on imaging studies can be expected to benefit from surgery. 
 -   With or without surgery, 80 percent of patients with sciatica recover eventually. 
 -   Nonphysical factors (such as psychological or socioeconomic problems) may be addressed in the context of discussing reasonable expectations for recovery. 
Panel Members 
Stanley J. Bigos, MD, Chair 
University of Washington 
Seattle, Washington 
Orthopedic Surgeon 
Reverend O. Richard Bowyer 
Fairmont State College 
Fairmont, West Virginia 
Consumer Representative 
G. Richard Braen, MD 
University of New York 
Buffalo, New York 
Emergency Medicine Physician 
Kathleen Brown, PhD, RN 
University of Alabama 
Birmingham, Alabama 
Occupational Health Nurse 
Richard Deyo, MD, MPH 
University of Washington 
Seattle, Washington 
General Internist 
Scott Haldeman, DC, MD, PhD 
University of California at Irvine 
Santa Ana, California 
John L. Hart, DO 
Still Regional Medical Center 
Columbia, Missouri 
Ernest W. Johnson, MD 
Ohio State University 
Columbia, Ohio 
Robert Keller, MD 
Maine Medical Assessment Foundation 
Belfast, Maine 
Orthopedic Surgeon 
Daniel Kido, MD, FACR 
Washington University Medical Center 
St. Louis, Missouri 
Matthew H. Liang, MD, MPH 
Harvard Medical School 
Boston, Massachusetts 
Roger M. Nelson, PT, PhD 
Thomas Jefferson University College of Allied Health Sciences 
Philadelphia, Pennsylvania 
Physical Therapist 
Margareta Nordin, RPT, DrSci 
Hospital for Joint Diseases 
New York, New York 
Physical Therapist/Orthopedic Researcher 
Bernice D. Owen, PhD, RN 
University of Wisconsin 
Madison, Wisconsin 
Community Health Nurse 
Malcolm H. Pope, DrMedSc, PhD 
University of Vermont 
Burlington, Vermont 
Orthopedic Researcher 
Richard K. Schwartz, MS, OTR, FSR 
San Antonio, Texas 
Occupational Therapist 
Donald H. Stewart, Jr., MD 
Arlington, Virginia 
Jeff Susman, MD 
University of Nebraska Medical Center 
Omaha, Nebraska 
Family Physician 
John J. Triano, MA, DC 
Texas Back Institute 
Plano, Texas 
Lucius C. Tripp, MD, MPH, FACPM 
General Motors-Henry Ford Hospital Rehabilitation Center 
Warren, Michigan 
Neurosurgeon/Occupational Medicine Specialist 
Dennis C. Turk, PhD 
University of Pittsburgh School of Medicine 
Pittsburgh, Pennsylvania 
Clark Watts, MD, JD 
University of Texas Health Sciences Center 
San Antonio, Texas 
James N. Weinstein, DO 
University of Iowa Hospitals 
Iowa City, Iowa 
Orthopedic Surgeon 
Back to the Top of Page                  Prior Page                    Next Page 
SRC Spinemate - only used or reproduced with written permission from