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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Shah, M., Ford, J. J., Raja, K., & Hahne, A. J. (2026) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2026.06.041
Cognitive-behavioural treatment for neck pain
Kamarova, S., Henschke, N., Newton-John, T. R. O., & Kamper, S. J. (2026) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015052
From mechanotransduction to manual therapy: advances in piezo/TRP channels and lumbar degeneration
Liu, Z., Peng, T., Li, W., & Zhu, M. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1853712
“Exercise modalities can also be selected according to functional de ﬁ cits (Owen et al., 2019; George et al., 2021).”
Spine-related leg pain: Definitions, etiology, clinical presentation, and management
Ballay, C. M., Mansfield, C. J., Cook, C. E., Erickson, M. M., McCormick, Z. L., & Remis, A. (2026) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2026.103623
TREINAMENTO DE FORÇA SUPERVISIONADO NA LOMBALGIA CRÔNICA INESPECÍFICA: UMA REVISÃO SOBRE DOR, FUNCIONALIDADE E SEGURANÇA NA PRESCRIÇÃO DO EXERCÍCIO
da Rocha, B. C. (2025) · Revista de Geopolítica · doi:10.56238/revgeov16n4-095
¿Cómo evolucionan el dolor, la discapacidad y el catastrofismo tras un tratamiento kinésico en sujetos con dolor lumbar crónico? Estudio descriptivo y retrospectivo
López, J., Bossio, T. A., & Morales, J. (2026) · Argentinian Journal of Respiratory & Physical Therapy · doi:10.58172/ajrpt.v8i2.413
Evaluation of rehabilitation outcomes in chronic low back pain: fascial therapy versus conventional physiotherapy
Trąbka, R., Gluza, J., Szymanik, S., Szarota, M., & Boba, M. (2026) · Acta Balneologica · doi:10.36740/abal202603101
Ultrasound-assessed segmental lumbar motion and clinical outcomes following spinal manipulation: a randomized, controlled pilot study
Winslow, J., Costello, M., Pantina, V., Tamburri, G., Penhollow, R., Milad, J., Coffey, C., Byers, M., & Puentedura, E. J. (2026) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2026.2701340
The impact of pain neuroscience education on physical therapy students’ pain knowledge, attitudes, beliefs, and clinical recommendations: a randomized controlled trial
Muhsen, A., & Sheeha, B. H. B. (2026) · BMC Medical Education · doi:10.1186/s12909-026-09994-y
Low Back Pain as a Nursing Education Priority
Sanchis‐Gimeno, J. A., Valenzuela‐Fuenzalida, J. J., Zuld, A., Orellana‐Donoso, M., & Granite, G. (2026) · International Medical Education · doi:10.3390/ime5030072
Aquatic Exercises for Physical Function and Pain Intensity in Chronic Low Back Pain: A Systematic Review and Meta-analysis
Santos, E. H., Paixão, L., Munaro, G. R., Surmani, N. N., Grigonis, M. P., Obara, K., Silva, M. F., & Cardoso, J. R. (2026) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2026.100678
The therapeutic exercise framework: an integrative approach to optimizing tissue capacity
Inman, C., Schrey, P., & Borstad, J. (2026) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2026.2709826
Do adherence-focused interventions in low back pain have an impact on rehabilitation outcomes? A systematic review with meta-analysis
Domínguez‐Navarro, F., Gámez-Paya, J., Blasco, J., Hernández‐Guillén, D., Costa-Moreno, E., & Pérez-Maletzki, J. (2026) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2026.103619
Combined Effects of Physiotherapy and Vitamin D Supplementation on Pain, Disability, and IL-6 Expression in Chronic Low Back Pain: A Randomized Controlled Trial
Albalwi, A. A., Amer, H. S. A., Mir, R., Mohamed, S. H. P., Javid, J., Mir, R., Alamri, W., Alshehre, Y. M., & Alharbi, A. A. (2026) · Life · doi:10.3390/life16081288
“This finding is consistent with the broader understanding that exercise-based rehabilitation, in the absence of nutritional correction, does not reliably resolve the biological drivers of inflammation in vitamin D-deficient patients with CLBP [61,62].”
An Interdisciplinary Screening and Referral Process for Individuals Who Developed Temporomandibular Disorders During Dental Treatment
Prodoehl, J., Brzozowski-Sawicki, P., Elliott-Burke, T., El-Maghraby, A., & Sangalli, L. (2026) · Journal of Dental Health and Oral Research · doi:10.46889/jdhor.2026.7231
Exercise prescription: Physiotherapy's most important and least standardized skill
Hinrichs‐Kinney, L., Mintken, P. E., & Zaffarano, B. (2026) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2026.103631
Physical Therapists’ and Patients’ Perceptions of Mindfulness-based Interventions Integrated Into Routine Physical Therapy: A Qualitative Study
Magel, J. S., Beneciuk, J. M., Blosser, P., Fritz, J. M., Hanley, A. W., Garland, E. L., Hartman, P., Matev, T., Shen, J., Gordon, A. J., et al. (2026) · Archives of Rehabilitation Research and Clinical Translation · doi:10.1016/j.arrct.2026.100680
Self-citation
Development and Content Validation of an Exercise‐Based Framework for the Management of Lumbar Radiculopathy
Naidu, S. P., Suresh, A., Haridass, S., & Harikesavan, K. (2026) · Physiotherapy Research International · doi:10.1002/pri.70315
“…flexibility exercises for hip flexors, glutes, piriformis, and ham-strings; hip flexor tightness has been identified as contributing to anterior pelvic tilt and increased lumbar lordosis, which may increase compressive loading on the lumbar spine (George et al. 2021; Delitto et al. 2012).”
Influential
Environmental Physiotherapy for Chronic Spinal Pain Management: An International Modified Delphi Study
Opsommer, E., Korogod, N., & Pereira, A. M. M. (2026) · European Journal of Pain · doi:10.1002/ejp.70354
Low back pain, occupational stress, and physical fitness in intensive care nursing professionals
Dias, U. M., de Oliveira-Junior, S. A., de Almeida, J. A., & Martinez, P. F. (2026) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2024-0583
Dor lombar, estresse ocupacional e aptidão física em profissionais de enfermagem de terapia intensiva
Dias, U. M., de Oliveira-Junior, S. A., de Almeida, J. A., & Martinez, P. F. (2026) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2024-0583pt
COMPARISON OF THE FREQUENCY OF PHYSIOTHERAPY ON QUALITY OF LIFE, ANXIETY, AND DEPRESSION IN PATIENTS WITH CHRONIC LOW BACK PAIN
SILVA, A. B. O. E., PEREIRA, H. C. S., Foss, M. H. D., Cavenaghi, S., Filho, G. M. D. A., & Rocha, J. N. F. (2026) · Coluna/Columna · doi:10.1590/s1808-185120262503301427
Hip Hinge Kinematics and Movement Confidence Before and After Founder Exercise Instruction in Healthy Adults: A Preliminary Study
Hanney, W. J., Chase, J., Coates, T., Rodriguez-Rolas, C., Masaracchio, M. F., & Wilson, A. T. (2026) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk11030322
“Exercise, movement-control training, and individualized movement instruction are incorporated into contemporary physical therapy management for some individuals with low back pain [9].”
Pilates-based stability training versus eccentric training in patients with multiple sclerosis suffering from chronic non-specific Low back pain
Younes, R. M., Ayad, K., Abdelgawad, D. M., Abdelsalam, M. S., & Hassan, K. A. (2026) · Muscles Ligaments and Tendons Journal · doi:10.32098/mltj_2026_7463
A qualitative inquiry into the environmental barriers and facilitators to non-specific low back pain clinical practice guideline adherence among Canadian physiotherapists
Sargent, S., Webber, S. C., Desmeules, F., & Brown, C. L. (2026) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2026.2716384
Multidisciplinary expert consensus on clinical diagnosis and therapies for low back pain
Gao, B., Chai, R., Wang, G., Song, Y., Shang, L., Huang, J., Cao, X., Hai, Y., Luo, Z., Hai, Y., et al. (2026) · Bone Research · doi:10.1038/s41413-026-00572-y
“31 These ﬁ ndings suggest that aquatic exercise is particularly suitable for patients who have dif ﬁ culty tolerating land-based exercise because of pain, obesity, deconditioning, fear of movement, reduced balance, joint comorbidity, or poor baseline exercise capacity.”
Dry cupping therapy for non-specific chronic low back pain: A prospective, randomized, sham-controlled, single-blind trial
Pourahmadi, M., Sahebalam, M., Ahmadi, M., & Bagheri, R. (2026) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2026.08.063
Sex Differences in Experiencing and Reporting Low Back Pain Using Standardised Questionnaires: A Cross‐Sectional Study
Ferreira, F. S. S., Colmenarez, A., dos Santos, A. C. N., Santos, V. D. S. D., Herzer, M. F., Ribeiro, J. A. D. O., Leonardo, I. D. S., & de Macedo, A. C. B. (2026) · Musculoskeletal Care · doi:10.1002/msc.70259
“Women and men 1 aged 18–80 years with nonspecific chronic low back pain (unspecified back pain for > 3 months) were recruited (George et al. 2021).”
Effect of Passive Versus Active Aquatic Therapy Over Conventional Physiotherapy in Patients With Chronic Low Back Pain: A Randomized Crossover Trial — Study Protocol
Mohamed, A., Watson Arulsingh, D. R., Kandakurti, P. K., & Muthukrishnan, R. (2026) · F1000Research · doi:10.12688/f1000research.188685.1
Planning a Clinical Practice Guideline Revision for a Core Set of Outcome Measures in Adults Undergoing Neurologic Physical Therapy, Part 2: Determining Stakeholders' Uptake and Recommendations
Sullivan, J. E., Potter, K., Bland, M. D., Anderl, E., Romney, W. M., Erkoc, Z. G., & Moore, J. L. (2026) · Clinical and Public Health Guidelines · doi:10.1002/gin2.70085
Research hotspots and trends in exercise interventions for chronic nonspecific low back pain
Wang, X., Xiang, H., Liu, Z., Jiang, S., Hongping, P., Liu, X., Zhou, B., Gao, D., & Zhu, C. (2026) · Medicine · doi:10.1097/md.0000000000050593
“…psychological, and social contributors to pain and disability facilitates the treatment of various chronic pain conditions, including CNLBP. [46–48] The integration of evidence-based rehabilitation methods based on this model and the development of personalized treatment protocols may become…”
Assessment and Management of Chronic Low Back Pain
Guyot, J. P., & Litrico, S. (2026) · Springer eBooks · doi:10.1007/978-3-032-32689-8_3
Comments on: “Effects of muscle energy technique and positional release technique on low back pain: A comparative study”
Sharma, A., & Aggarwal, A. (2026) · Journal of Musculoskeletal Surgery and Research · doi:10.25259/jmsr_306_2026
Clinical outcomes associated with the use of a rigid lumbar belt in people with Modic type 1 active discopathy
Cormier, C., Homs, A., Pereira, B., Dupeyron, A., Coudeyre, E., & Lanhers, C. (2026) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2026.102171
Benchmarking Automatic Question Generation from Clinical Practice Guidelines for Education: A Case Study for Low Back Pain Management
Bonfigli, A., Merone, M., Dell’Orletta⋄, F., Papalia, G. F., Maltese, G., Russo, F., Vadalà, G., Papalia, R., Pecchia, L., & Bacco, L. (2026) · World Congress on Medical Physics and Biomedical Engineering, September 7 - 12, 2009, Munich, Germany · doi:10.1007/978-3-032-37739-5_54
Immediate effects of myofascial release and Kinesio taping on muscle viscoelasticity and functional performance in low back pain: a three-arm controlled study
Kardeş, K., Tütüneken, Y. E., & Alpözgen, A. Z. (2026) · Physiotherapy Theory and Practice · doi:10.1080/09593985.2026.2731246
Comparative effectiveness of telerehabilitation vs. face-to-face rehabilitation in adults with chronic low back pain: a systematic review and meta-analysis of randomized controlled trials
Liu, S., Yang, J., Lei, B., Yage, W. A. N. G., Zhuang, W., & Liu, H. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1965765
“This approach therefore remains a mainstay of clinical management (3–6).”
Biomechanical comparison of lumbar rotational manipulations in two different positions using force measurement and finite element analysis
Shen, J., Gao, X., 郑洪恩, Zhang, X., Li, Z., 范岳, Zhang, W., & Wang, P. (2026) · Chiropractic & Manual Therapies · doi:10.1186/s12998-026-00683-7
Responsiveness and minimal important change of Turkish pain-related psychological measures in chronic non-specific low back pain
Safran, E. E., Alaca, N., Çavuşoğlu, I., İldeniz, Y., & KOÇAK, A. (2026) · Annals of Medicine · doi:10.1080/07853890.2026.2725978
“Exercise-based rehabilitation and education were considered the core components of the program, while electrotherapy was delivered as a standardized adjunctive component of routine care, consistent with contemporary recommendations emphasizing active management for chronic LBP [20].”
Evaluating Athletic Ability Assessment Performance in Individuals With and Without Nonspecific Low Back Pain
Devorski, L., Lininger, M. R., Reester, E., & Desmond, E. (2026) · International Journal of Athletic Therapy & Training · doi:10.1123/ijatt.2026-0011
Manual therapy across the professional continuum: a comparative analysis of educational, accreditation, and specialty organizations
Smith, M. P., & Hagan, C. R. (2026) · Journal of Manual & Manipulative Therapy · doi:10.1080/10669817.2026.2744226
Clinical Decision Making, Red-Flag Recognition, and Scope-of-Practice Perspectives for Direct Access Physical Therapy in Saudi Arabia
Alzhrani, M. (2026) · Healthcare · doi:10.3390/healthcare14193347
Effects of a Combined Lumbar Motor Control and Hip Strengthening Program on Pain and Function in Chronic Non-Specific Low Back Pain: A Randomized Clinical Trial
Rodríguez-López, M., Losada-Baz, L., Arias-Gómez, F. A., Cigarroa, I., Marzetti, E., Arroyo-Fernández, R., & Bravo-Esteban, E. (2026) · Sports · doi:10.3390/sports14100456
“…and to align the intervention with implementation recommendations proposed by previous reviews and international clinical practice guidelines [6,12,19], the present study employed an in-person lumbar motor control program structured into four phases of progressively increasing difficulty and with…”

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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