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  • Lian Yun-Perng, Physiotherapist

Treatment suggestions for Low Back Pain

These are a few things I would do when my patients visit me with LBP.

Pain History

Where the pain was, what type of pain it was, any pins and needles (P+N), any numbness (N), intermittent/constant and the VAS.

Aggravating factors: Sitting, standing, driving, sports etc

Relieving factors: Meds, massage, rest etc

24 hours pattern: Better, same or worse


Area = Reinforces my hypothesis of what needs to be treated

Dull ache = Muscular related

Sharp or shooting = Nerve related

P+N and/or N = Nerve related

Intermittent = Something is aggravating it

Constant = Rare and might be a red flag

VAS: Insights to my patient’s pain threshold and tolerance

Aggravating factors: Guides my HEP

Relieving factors: Guides my passive treatment, allows me to assume what my patient finds beneficial

24 hours pattern: AM better or PM worse – Fatigue

AM worse – Joint related or sleep related


- to determine the patient’s sensitivity to pain/touch stimuli.

- I don’t check how “tight” their muscles are through palpation.


Guides the amount of pressure I can apply on my patient during manual therapy


I only concentrate on MSE, MSF and ODS for the lower back.


Joint related, motor control dysfunction or true mobility issue.

Mostly motor control dysfunction


Dull ache management: IASTM, STM, taping or any other electrotherapy modalities

Sharp, shooting, P+N and/or N management: Nerve mobilisation and/or IASTM/STM along the nerve pathway

24 hours pattern: PM worse – Resistance exercise, or pacing

AM worse – Change pillows/bed and some mobility exs in bed

MSE dysfunction can be treated with repeated extension in lying (REIL)/ Mckenzie exs.

MSF dysfunction can be managed with Active SLR with band assistance, sciatic nerve mobs or by activating the anterior chain.

ODS dysfunction can be improved with REIL, cat and camel exs, Lx manip, knee or ankle mobilisation.

Thanks for reading! Drop me a comment if you have any questions!

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Lian Yun-Perng  

UK Qualified Physiotherapist
Bachelor of Physiotherapy

Keele University, United Kingdom
Diploma in Physiotherapy

AIMST University, Malaysia

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