Cited by 608Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPregnancy-related medical research

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Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association

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George, Steven Z., Fritz, Julie M., Silfies, Sheri P., Schneider, Michael J., Beneciuk, Jason M., Lentz, Trevor A., Gilliam, John R., Hendren, Stephanie, Norman, Katherine S.·2021·Journal of Orthopaedic & Sports Physical Therapy

DOI 10.2519/jospt.2021.0304PMC PMC10508241

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Abstract

Low back pain (LBP) remains a musculoskeletal condition with an adverse societal impact. Globally, LBP is highly prevalent and a leading cause of disability. This is an update to the 2012 Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), clinical practice guideline (CPG) for LBP. The overall objective of this update was to provide recommendations on interventions delivered by physical therapists or studied in care settings that included physical therapy providers. It also focused on synthesizing new evidence, with the purpose of making recommendations for specific nonpharmacologic treatments. J Orthop Sports Phys Ther 2021;51(11):CPG1–CPG60. doi:10.2519/jospt.2021.0304

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“Cervical and lumbar conditions account for approximately 40–50% of the orthopedic diagnoses in outpatient physical therapy [1,3].”
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Kim, F. S., Kahle, D. J., Fleming, N. S., Gallaugher, M. P. B., Houston, T., Lamsal, S., & Sturdivant, R. X. (2025) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2024.09.013
Mendelian randomization and drug repurposing analysis identifies APOE as a potential therapeutic target for low back pain
Yang, J., Qi, W., Wang, D., Mei, Z., Pan, H., & He, Y. (2026) · Medicine · doi:10.1097/md.0000000000050269
“[5–8] However, due to the significant etiological heterogeneity and diverse pathophysiological mechanisms underlying LBP, not all therapeutic approaches are effective across different patient subgroups.”
Referral of people with low back pain to physical therapists in Brazilian primary healthcare: A challenge revealed
Lacerda, T. L., Montes, P. L., Macedo, L. G., Ostelo, R., Peixoto, H. M., & Carregaro, R. L. (2025) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2025.101538
“14,15,19 The Ministry of Health recommends that people with LBP be followed up through PHC, 3,20 with referral to specialists only when clinical treatment has failed or when there are red flags.”
Bibliometric Analysis of Chronic Low Back Pain Research: Trends and Perspectives
Tirla, S., Niculescu, V., Deac, Ș., Gherle, A., Jurcău, M. C., Iosub, M. E., & Nistor-Cseppento, C. D. (2025) · Balneo and PRM Research Journal · doi:10.12680/balneo.2025.854
Factors associated with nonpharmacological treatment use among older adults with chronic low back pain tapering opioids
Lin, L.-Y., Ghodke, O., Siddiqua, C., Eden, S. V., Yang, Y., & Bhattacharya, K. (2025) · Pain Management · doi:10.1080/17581869.2025.2567839
Aerobic Exercise May Be a Feasible Therapeutic Option for Improving Pain and Function in Patients With Chronic Lumbar Radicular Pain: A Case Series
Esposto, M., Arca, A., & Schmid, A. B. (2025) · JOSPT Cases · doi:10.2519/josptcases.2025.0171
The effect of manual therapy on abdominal scars in patients with nonspecific chronic low back pain - a double-blind, randomized, and controlled study
Makita, D. K., Ferreira, C. R., Vieira, L. S., Guimarães, C. Q., & Borges, B. L. A. (2025) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2025.09.041
Chiropractic Palliative Care for a Veteran With Chronic Low Back Pain and Advancing Testicular Cancer: A Case Report
Roecker, C. B., Schut, S. M., & Scott, Z. E. (2025) · Journal of Chiropractic Medicine · doi:10.1016/j.jcm.2025.09.017
Diagnosis and management of axial spondyloarthritis
Demeter, J. M., Bogenschutz, K. M., & Chastain, A. P. (2025) · JAAPA · doi:10.1097/01.jaa.0000000000000263
Combined Aquatic and Pilates Exercises Improve Pain, Mobility, Functional Disability, and Quality of Life in Women With Lumbar Disc Herniation: A Randomized Controlled Trial
Moghadasi, A., & Mousavi, F. (2025) · Biological Research For Nursing · doi:10.1177/10998004251388995
“Interventions range from pharmacological approaches (e.g., NSAIDs, analgesics) to conservative therapies (e.g., physiotherapy, electrotherapy, chiropractic care) and invasive procedures (e.g., discectomy, spinal fusion) (Alamaydeh et al., 2022; George et al., 2021).”
Virtual Reality Training for Balance in Patients with Chronic Low Back Pain: A Systematic Review and Meta-Analysis
AlSadiq, A. I., Abdulla, F. A., & Alshami, A. M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14207247
The Role Of Movement Confidence And Kinesiophobia In The Clinical Course Of Low Back Pain: A Prospective StudyPreprint
Nieto-Marcos, S., Álvarez, M. J. Á., Leirós‐Rodríguez, R., González-Castro, A., Rodríguez‐Nogueira, Ó., & Pinto‐Carral, A. (2025) · Research Square · doi:10.21203/rs.3.rs-7095709/v1
Inter-Rater Reliability of a 6-Item Movement Control Test Battery in Individuals With and Without Chronic Non-Specific Low Back Pain
Thana-Udomnan, T., Chansirinukor, W., Kongoun, S., Klahan, K., & Wattananon, P. (2025) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2025.10.041
Individualised exercise for patients with persistent low back pain and lateral abdominal muscle impairments: a randomised feasibility study
Prentice, C. L. S., Flavell, C. A., Massy‐Westropp, N., & Milanese, S. (2025) · Pilot and Feasibility Studies · doi:10.1186/s40814-025-01723-4
Efeito do exercício físico na redução da dor na coluna em pilotos e tripulantes militares: uma revisão sistemática
da Silva, N. S., Meirelles, F. D. O., & Bomfim, A. B. C. (2025) · Revista de Educação Física / Journal of Physical Education · doi:10.37310/ref.v94i2.3001
How is musculoskeletal spinal content taught in entry-level doctor of physical therapy programs? A mixed-methods study
Kirker, K., Young, J. L., & Masaracchio, M. F. (2025) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2025.2600089
“…has been observed in the clinical management of patients with spinal conditions, which is often attributed to clinicians’ lack of adherence to CPGs, evidence-based practice, or treat-ment algorithms supported by extensive research (Blanpied et al, 2017; George et al, 2021; Kirker et al, 2025).”
SmartBack: a preliminary study of remotely-delivered, personalized education for patients with chronic low back pain
Hassman, A., Xu, Y., Zhou, L., Wang, Y., & Bove, A. M. (2025) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2025.2601189
“…education handouts created based on recommendations from recent and prominent CPGs (Adjao et al, 2021; College of Family Physicians of Canada, 2011; George et al, 2021; Kreiner et al, 2020; Maher et al, 2023; Oliveira et al, 2018; Pangarkar et al, 2019; Qaseem et al, 2017; World Health…”
Influential
Manual Therapy in Conjunction With Other Multimodal Interventions in a Patient With Chronic Pain and Hypertension: A Case Report
Hensley, C. P., Mendoza, R., Ryan, J., & Yung, E. (2025) · Clinical Case Reports · doi:10.1002/ccr3.71697
“Interventions, such as exercise [10, 11], education [12, 13], and meditation [11, 14], have been used to target chronic pain and HTN. Manual therapy has been a recommended intervention for several chronic pain conditions [15–17].”
Type of health locus of control predicting pain, function, and global perceived effect in patients with chronic low back pain receiving active versus passive interventions: an observational study
Barros, I. D. A., Ferreira, A. D. S., Horsth, T. D. S., Holmes, T. D. J., dos Santos, A. A., & Lunkes, L. C. (2025) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2025.101560
“5,7,8 HLC may be an important predictor of treatment success for patients with CNLBP. 5 Several treatments are recommended for CNLBP, including health education, physical exercise, traditional Chinese medicine, spinal manipulation, ultrasound, electrical stimulation, cognitive therapies, and drugs.”
Influential
Additional file 3 of The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis
Tang, S., Sheng, L., Xia, J., Xu, B., & Jin, P. (2024) · Figshare · doi:10.6084/m9.figshare.26710412
Additional file 4 of Effect of different weekly frequencies of Chen-style Tai Chi in elders with chronic non-specific low back pain: study protocol for a randomised controlled trial
Wan, R., Shi, J., Hu, K., Wang, Y., Jiang, X., Yan, W., Cao, M., & Wang, Y. (2022) · Figshare · doi:10.6084/m9.figshare.21621908
Additional file 2 of Recent clinical practice guidelines for the management of low back pain: a global comparison
Zhou, T., Salman, D., & McGregor, A. H. (2024) · Figshare · doi:10.6084/m9.figshare.25734662
Additional file 1 of Recent clinical practice guidelines for the management of low back pain: a global comparison
Zhou, T., Salman, D., & McGregor, A. H. (2024) · Figshare · doi:10.6084/m9.figshare.25734583
Additional file 2 of The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis
Tang, S., Sheng, L., Xia, J., Xu, B., & Jin, P. (2024) · Figshare · doi:10.6084/m9.figshare.25678688
Three decades of neurofeedback in motor behavior research: A systematic review in healthy young adults
Bicalho, L. E. A., Fortuna, B. C., Fernandes, L. A., Pinto, J. A. R., & Lage, G. M. (2025) · Learning and Motivation · doi:10.1016/j.lmot.2025.102163
Additional file 1 of Effect of different weekly frequencies of Chen-style Tai Chi in elders with chronic non-specific low back pain: study protocol for a randomised controlled trial
Wan, R., Shi, J., Hu, K., Wang, Y., Jiang, X., Yan, W., Cao, M., & Wang, Y. (2022) · Figshare · doi:10.6084/m9.figshare.21621899
Additional file 1 of The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis
Tang, S., Sheng, L., Xia, J., Xu, B., & Jin, P. (2024) · Figshare · doi:10.6084/m9.figshare.25678523
Additional file 3 of Recent clinical practice guidelines for the management of low back pain: a global comparison
Zhou, T., Salman, D., & McGregor, A. H. (2024) · Figshare · doi:10.6084/m9.figshare.26714641
Additional file 1 of Efficacy and safety of extracorporeal shockwave therapy in chronic low back pain: a systematic review and meta-analysis of 632 patients
Liu, K., Zhang, Q., Chen, L., Zhang, H., Xu, X., Yuan, Z., & Dong, J. (2023) · Figshare · doi:10.6084/m9.figshare.23575480
Additional file 4 of The effectiveness of instrument-assisted soft tissue mobilization on range of motion: a meta-analysis
Tang, S., Sheng, L., Xia, J., Xu, B., & Jin, P. (2024) · Figshare · doi:10.6084/m9.figshare.26710415
Additional file 1 of “Cooperation between physicians and physios fosters trust you know”: a qualitative study exploring patients’ experience with first-contact physiotherapy for low back pain in French primary care
Kechichian, A., Pommier, D., Druart, L., Lowry, V., Pinsault, N., & Desmeules, F. (2024) · Figshare · doi:10.6084/m9.figshare.25282850
Additional file 1 of Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up
Mikkonen, J., Luomajoki, H., Airaksinen, O., Goubert, L., & Leinonen, V. (2023) · Figshare · doi:10.6084/m9.figshare.22774246
Additional file 1 of Attitudes, beliefs, and recommendations for persistent low back pain patients: cross-sectional surveys of students and faculty at a chiropractic college
Muller, R. D., Cooper, J. C., Gliedt, J. A., & Pohlman, K. A. (2024) · Figshare · doi:10.6084/m9.figshare.25322882
Additional file 2 of Effect of different weekly frequencies of Chen-style Tai Chi in elders with chronic non-specific low back pain: study protocol for a randomised controlled trial
Wan, R., Shi, J., Hu, K., Wang, Y., Jiang, X., Yan, W., Cao, M., & Wang, Y. (2022) · Figshare · doi:10.6084/m9.figshare.21621902
Additional file 3 of Protocol of identical exercise programs with and without specific breathing techniques for the treatment of chronic non-specific low back pain: randomized feasibility trial with two-month follow-up
Mikkonen, J., Luomajoki, H., Airaksinen, O., Goubert, L., & Leinonen, V. (2023) · Figshare · doi:10.6084/m9.figshare.22774252
Additional file 1 of Effectiveness of motor control exercise, aerobic walking, and muscle strengthening programs in improving outcomes in a subgroup of population with chronic low back pain positive for central sensitization: a study protocol for a randomized controlled trial
Ganesh, G. S., Khan, A. R., Das, S. P., Khan, A., Alqhtani, R. S., Alshahrani, A., Jarrar, M. A. M., Jarrar, M., & Ahmed, H. (2024) · Figshare · doi:10.6084/m9.figshare.26588052

Authors: George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T. A., Gilliam, J. R., Hendren, S., & Norman, K. S.
ORCID: George, Steven Z.
Fritz, Julie M.
Silfies, Sheri P.
Schneider, Michael J.
Beneciuk, Jason M.
Lentz, Trevor A.
Gilliam, John R.
Hendren, Stephanie
Norman, Katherine S.
Venue: Journal of Orthopaedic & Sports Physical Therapy
Publisher: Journal of Orthopaedic & Sports Physical Therapy (JOSPT)
Published: 2021-11
Volume: 51
Issue: 11
Pages: CPG1-CPG60
ISSN: 0190-6011 (ISSN-L)
1938-1344
DOI: 10.2519/jospt.2021.0304
PMC: PMC10508241
OpenAlex: W3208162845
Cited by: 607
References: 171
Citations by year: 2026: 127 · 2025: 138 · 2024: 143 · 2023: 136 · 2022: 58 · 2021: 4
FWCI: 50.16
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: other-oa
Locations: Journal of Orthopaedic and Sports Physical Therapy (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion, other-oa)
Funders: American Physical Therapy Association
National Institutes of Health
National Institute of General Medical Sciences (T32GM081740, T32GM145226)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
Keywords: low back pain, acute low back pain, chronic low back pain, physical therapy intervention, non-pharmacological treatment, musculoskeletal pain, disability
MeSH terms: Humans, Low Back Pain, Physical Therapy Modalities, Chronic Pain, Physical Therapists

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Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association

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