The Gap Between Evidence and Practice when Treating Low Back Pain

The Gap Between Evidence and Practice when Treating Low Back Pain

While all health professionals agree that clinical practice should follow the most recent evidence, many consumers of health care would be surprised to learn about the pervasive gap between treatment and the most current research. Despite numerous clinical practice guidelines, this is very evident in the treatment of low back pain. A March 2018 article in The Lancet summarizes the evidence for prevention and treatment of low back injuries, identifies the gaps between evidence and clinical practice and offers examples of solutions that may provide alternatives to current care. (Abstract -

With regards to prevention, exercise with the combination of education is demonstrated to be most appropriate for low back pain. Despite this, there are numerous interventions with a very poor quality of evidence such as shoe inserts, education alone without exercise and use of back belts that continue to be prevalent. In regards to treatment of low back pain, self-management, physical therapy, and psychological therapy have been most highly supported by current evidence as most appropriate. Despite current guidelines deemphasizing the need for surgical and pharmacological interventions for low back pain, these options continued to be used with a high amount of prevalence.

So why do we continue to over-utilize less effective interventions and under-utilize the most effective interventions? The authors of this article identified some barriers including the limited amount of time providers get to spend with their patients, clinicians’ poor knowledge of clinical guidelines, fear of litigation and clinicians’ desire to maintain a harmonious relationship with their patients. The article did identify emerging solutions that align prevention and practice with the most current evidence; including a redesign of clinical pathways, integrating health and occupational to reduce work disability, changes in compensation and disability claims policies and public health and prevention strategies.

As a Physical Therapist, we see this every day in our practice. While Direct Access has helped to some extent, there is still a long way to go to change clinical pathways to get the right treatment to the right patient at the right time. In Workers’ Compensation, Physical Therapy continues to be viewed as a commodity and a cost driver rather than a cost saver, where the evidence proves to be exactly the opposite. It is up to the profession to demonstrate our value, and up to individual Physical Therapists to consume and follow the current evidence in order to treat patients appropriately. 

Physical Therapy organizations like Results Physiotherapy provide the type of evidence-based care that make the profession proud and will eventually contribute to more effective clinical pathways.  If you have questions about Results please reach out to us at

Posted by Brian Murphy at 1:12 PM

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