Specific Low Back Research Articles

Efficacy of Cupping Therapy and Oral Medications in the Management of Non Specific Low Back Pain-A Pilot Study

Efficacy of Cupping Therapy and Oral Medications in the Management of Non Specific Low Back Pain-A Pilot Study

Effect of Non Specific Low Back Pain on Knee Function

Effect of Non Specific Low Back Pain on Knee Function

Effect of Soft Tissue Mobilisation on Somatic Symptoms in Chronic Low Back Pain Patients: A Pilot Pretest Post-test Randomised Clinical Trial

Introduction: Numerous studies suggest a significant correlation between Chronic Low Back Pain (CLBP) and somatic symptoms. These symptoms often stem from altered fascial biomechanics. Implementing Soft Tissue Mobilisation (STM) techniques aimed at restoring fascial biomechanics can markedly alleviate somatic symptoms associated with CLBP. Aim: To assess the efficacy of STM in alleviating somatic symptoms in patients with Chronic Low Back Pain (CLBP). Materials and Methods: A pilot pretest post-test randomised clinical trial was conducted in the Department of Physiotherapy, Maharishi Markandeshwar Institute of Physiotherapy and Rehabilitation, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, Haryana, India, from July 2023 to December 2023, on participants diagnosed with Non Specific Chronic Low Back Pain (NSCLBP) accompanied by somatic symptoms. The experimental group (Group 1), n=6 (41.00±6.29 years), received myofascial unwinding and myofascial release. In contrast, the clinical group (Group 2), n=6 (43.83±11.20 years), received conventional physiotherapy care, including structured exercises and electrophysical modalities, over 4 weeks. Both groups underwent three sessions per week, amounting to 12 sessions in total. The evaluation of somatic symptoms was conducted using the Hamilton Depression Rating Scale (HDRS) at baseline and after the 4 weeks. Results: The statistical analysis demonstrated significant withingroup differences in HDRS (p-value=0.002) in Group 1, and no statistically significant difference in Group 2 (p-value=0.749). The between-group analysis demonstrated a statistically significant difference in HDRS (p=0.035) with a large effect size (d=1.4). Conclusion: STM effectively improves somatic symptoms in NSCLBP patients. The beneficial effect of STM on somatic symptoms can be translated into clinical practice after strengthening results in the larger population.

A Review on Effects of Exercises Therapy for Office Workers with Chronic No Specific Low Back Pain

Study Design: A literature review was conducted in order to provide an overview of the effect of exercise therapy for office workers with chronic Non-specific low back pain. Review provides a summary of large bodies of evidence and reviews help to explain differences among studies. Objectives: The aim of this study is to review exercises therapy for office workers with chronic nonspecific low back pain treatment. Background: Low back pain is a common syndrome that causes disability and absence from work. Although there are several causes, the most common type of back pain is nonspecific. Exercises are often used to treat back pain, but there is controversy regarding its effectiveness. Exercise therapy is widely used as an intervention in low back pain. Low back pain is defined as discomfort that develops above the posterior glutelines and below the costal edge of the final ribs, with or without lower limb pain(1).Between 60 and 85% of people experience it at some point throughout their lives(2). Methods: Search strategy: Relevant articles were identified by engines such as SCIENCE DIRECT, PUBMED, GOOGLESCHOLAR, and COCHRANE DATA BASE OF SYSTEMATIC REVIEW (www.cochrane.org), and CINALE.Website like physiopedia (www.physiopedia.com) was searched and published texts were `also reviewed in these studies.

To Determine the Effect of Iliopsoas MET along with the Conventional Therapy on Pain, Functional Disability and lumbar lordosis in the Patients with Non-Specific Low Back Pain

Background: Low back pain is one of most frequent causes of disability. Non-specific low back pain is the lowback pain not attributable to a recognizable, known specific pathology (e.g. infection, tumour, osteoporosis,fracture, structural deformity, inflammatory disorder, radicular syndrome, cauda equina syndrome, etc.) IliopsoasMET helps to improve pain, functional disability and hyper Lordotic curve. Combination of Iliopsoas MET andconventional therapy may have positive effects on non- specific low back pain.Method: 40 female subjects with non-specific low back pain participated in the experimental study, underwenttreatment for duration of 4 weeks after receiving informed consent. They were evaluated and randomized into2 groups’ i.e. experimental group receiving Iliopsoas MET along with conventional therapy and control groupreceiving conventional therapy only. . The Pre and Post values of NPRS, MODI and lumbar lordosis were recordedat the start of the treatment and consecutively after the end of the treatment.Conclusion: Iliopsoas MET along with the conventional therapy was found to be more effective in decreasingpain and disability in patients with non – specific low back pain. Iliopsoas MET shows better results in reducinghyperlordotic curve and hence decreasing low back pain.

Effect of Core Muscle Stabilisation Exercises on Disability Associated with Non Specific Low Back Pain in Postmenopausal Women: A Prospective Longitudinal Study

Introduction: Non Specific Low Back Pain (NSLBP) is a frequent problem faced by the majority of postmenopausal women at some stage of their lives, resulting in a significant level of disability. Aim: To evaluate the effectiveness of core stabilisation exercises compared to traditional physical treatment in postmenopausal women with NSLBP. Materials and Methods: A prospective longitudinal study was conducted from January 2022 to August 2022, including 50 postmenopausal women aged 45-60 years with NSLBP. They were placed into two groups. Conventional LBP physical therapy methods were administered to group 2. The identical traditional and Core muscle Stabilisation Exercises (CSE) were implemented in the group 1. The Modified Oswestry Disability Index (MODI) was used for the assessment of disability. The Mann-Whitney U test and Friedman Analysis of Variance (ANOVA) were conducted to analyse changes in disability scores across and among groups at the ends of the second, fourth, and sixth weeks of treatment. Results: Of 50 patients initially enrolled in the study, 33 patients were available for the final follow-up. Group 1 consisted of 16 patients, while group 2 had 17 patients. Significant reduction in disability was found across the two groups at the second, fourth, and sixth weeks of treatment (p-value<0.05). In the sixth week of treatment, group 1 had a statistically greater decrease in ODI score (41.16±13.53) than group 2 (30.74±13.28) (p-value =0.003). Conclusion: CSE were found to be more effective than conventional physical therapy in reducing disability associated with NSLBP in postmenopausal women.

Use of Electrophysical Agents in Non Specific Low Back Pain: A Cross Sectional Survey on Physiotherapist in Karachi Pakistan

Objective: To determine the electro physical agents (EPA) commonly used by physiotherapist in the management of non-specific low back pain in Karachi, Pakistan. Methodology: A cross sectional study was conducted on physiotherapist practicing in different clinical settings in Karachi Pakistan between January to March 2016. Written informed consent were taken from each study participants. Data were collected from 90 physiotherapists who were selected through non probability purposive sampling. Structured questionnaire was used to collect data. Data was entered and analyzed by using SPSS version 21. Results: It was found that out of 90 physiotherapists, 27(30.0%) male and 63(70.0%) female had responded. With mean (S. D) Age was 28.8(4.32188). The EPA used mostly in patients with non-specific low back pain as TENS 18(20.0%), Thermotherapy 17(18.9%, Ultrasound therapy 12(13.3%) and Interferential therapy 9(10.0%). In combination TENS, ultrasound and thermotherapy is about 8(8.9%) and interferential and thermotherapy is about 7(7.8 %). Conclusion: Physiotherapists give preference to some EPA such as TENS, Thermotherapy, Interferential therapy (I.F.C) and Ultrasound (U.S) to manage nonspecific low back pain. However, there is a need to highlights the use of EPA according to Evidence based practice.

Combination Intervention Mulligan’s Sustained Natural Apophyseal Glides and Ultrasounds Better Than Combination Intervention Stretching And Ultrasounds For Increasing Functional Activity Non-Specific Low Back Pain Patient

Abstract— Non-specific low back pain is one of the complaints that very often encountered with a picture of complaints originating without a clear cause. Non-specific low back pain is often a reason for the limitation of functional activity in patients because of pain symptoms and muscle tightness around the patient's lower back. The aim of this research is to prove that the Mulligan intervention, namely SNAGS as the latest intervention combined with physiotherapy modalities of ultrasounds, is more effective in improving the functional quality of non-specific low back pain patients than the combination of conventional stretching interventions with ultrasounds. The research method used in this study is the design of experimental research methods in the form of a pre-test and post-test two group design. In its implementation, there will be two groups with the number of each sample in each group consisting of 16 samples selected at random with the block permutation technique. Group 1 will receive conventional stretching and ultrasounds, while group 2 will receive mulligan's “sustained natural apophyseal glides” (SNAGS) and ultrasounds. The patient's functional activity was measured by the MODI (Modified Oswestry Disability Index) questionnaire. The study was conducted at a physiotherapy clinic in Denpasar. The results obtained in this study after processing the Paired T-Test test data in each group to determine whether there is a significant difference between pre and post from each combination, obtained with a p value <0.05, this indicates that there is a difference significant. The difference test between groups was carried out showing that there was a significant difference between the treatment group and the control group with the Independent T-Test test, getting a p value of <0.05 which has an interpretation of a significant difference. The conclusion obtained after the test and discussion of this study is that the mulligan intervention, namely SNAGS as the latest intervention combined with physiotherapy modalities of ultrasounds, is more effective in improving the functional quality of patients with non-specific low back pain than the combination of conventional stretching interventions with ultrasounds.
 
 Keywords: Mulligan's SNAGS, Ultrasound, Conventional Stretching, Non Specific Low Back Pain, Decreased Functional Activity

An Experimental Study to determine the Impact of Active Release Technique, Core Strengthening on Pain, Muscle Stiffness, Hardness and Quality of Life on Non- Specific Low Back Pain

Introduction: Active Release Technique (ART), works by releasing adhesions and repairing the integrity of soft tissue, thereby extending and restoring functional flexibility entirely. Core stabilization workout (CSE) aims to treat back pain by boosting your muscular strength and stamina, strengthening muscle motor patterns to relieve low-back pain.
 Aim: Aim of the study was to evaluate impact of active release technique and core strengthening on pain, mobility and quality of life on non-specific low-back pain.
 Study Design: Simple random convenient sampling, envelope method
 Place and Duration: A study of 40 people with non-specific low back pain and aging between 18 and 25 years was conducted at Musculoskeletal OPD, Ravi Nair Physiotherapy College, DMIMS(DU), Sawangi (Meghe), and Wardha in the duration of one year.
 Procedure: In this experimental investigation, the influence of active released and impacting non-specific low back pain on suffering, muscular soreness, hardness, strength, ODI, and quality of life was determined. Both groups received hot fomentation and core strengthening, but only the ART group was actively released. The findings have been obtained from NPRS to algometer, durometer, press biofeedback, ODI, and EQ-5D-5L in pre-treatment, post-treatment, and after four weeks of data to analysed impacts.
 Results: in this study both the groups showed reduction in pain, muscle tenderness, muscle hardness as well as increase in core strength and quality of life. When compared ART group shows significant improvement with p value of 0.001.
 Conclusion: In this study we find that the pain threshold, muscular hardness, muscle tenderness, deficiency and quality of life of both groups improved. The ART group was proven to be more effective than the Hpk group when the two groups were compared. In the two groups, the core strength did not change greatly, perhaps after four weeks, from pre- treatment to post- treatment to 4 weeks after.

Impact of Active Release Technique and Core Strengthening on Pain, Muscle Stiffness, Muscle Hardness and Quality of Life on Non- Specific Low Back Pain: An Experimental Study

Background:- Bad posture while working puts excessive stress and strain on low back. These inturn contribute significantly to the development of the spasm–pain–spasm process, which ultimatelyresults in the development of myofascial trigger points(MTrPs) in the muscle fibers. This is due to thereduced blood supply that leads to a decrease in the supply of oxygen and also minerals and vitaminsto the muscle Active release technique(ART), a non-invasive soft tissue restoration procedure includesreducing the scar tissue that induces discomfort, stiffness, muscle weakness and unusual pain likemechanical dysfunction of the myofascial and soft tissue.Methodology:- This experimental study will be conducted with population of 40 aging from 18 to 25dividing them equally into two group with simple random sampling. The participants of one group will begiven active release technique with hot fomentation while the other group will receive hot fomentation. Corestrengthening exercises will be given to both the groups.Conclusion:- This study intends to find the effectiveness of active release technique in reduction of pain,muscle stiffness and muscle hardness in patients with non-specific low back pain and also the resultantimprovement in their quality of life

Comparison of the effects of spinal manipulation and muscle energy techniques on motor control in Non- Specific Chronic Low Back Pain by Beta-band intermuscular pool coherence

Background: Until now, a variety of techniques have been introduced to address the adverse effects of NS-CLBP, including SMT and MET. However, most of these techniques have focused on pain assessment and disability. In other words, the effectiveness of these techniques on the corticospinal tract function was not studied. Therefore, the purpose of this study was to compare the effects of SMT and MET on corticospinal tract function during flexion-extension task phases in NS-CLBP using PC of Bb-IMC. Methods: A cross-sectional study was designed that in which 20 healthy and twenty-four (20–45 years) NS-CLBP patients men voluntarily participated. The patients had continuous or recurrent symptoms for 3 months or more without any referral pain to the lower extremities. The patients were randomly assigned to two equal intervention groups (SMT and MET) and the techniques were applied as described by Greenman. sEMGs from lumbopelvic muscles was recorded for all participants before and after the intervention while they performed three trials of F-ET and the PC for all muscles was calculated using Bb-IMC analysis. Multivariate analysis of variance test was used to compare the differences between the healthy subjects and patient groups before the interventions. Furthermore, in NS-CLBP patients, comparisons were made before and after the interventions in each group (i.e. SMT and MET groups). Results: There were significant differences in A and B muscle cross in the SMT group before and after the intervention in four phases of F-ET (P < 0.05). However, no significant differences were found in the MET group. Conclusion: These results showed that the SMT intervention was more effective than the MET intervention by reducing the PC of Bb-IMC in all phases of FE-T. Therefore, the PC of Bb-IMC could be considered as an approach for clinicians when designing the rehabilitation protocol to ensure optimal treatment.

Ergonomic Assessment of Low Back Loading Pattern During Occupational Lifting Task in a Lower Limb Amputee: Minimizing Injury Risk.

While the relationship between occupational task intensity and repetitive overuse injuries have been well studied and prescription/guidelines to assess and minimize risk of such injuries well established in the general healthy population, these aspects are not well understood in individuals with disabilities. In this practice-oriented paper, we use high a resolution sensor-data driven methodology to track muscle activation patterns and joint kinematics during a common lifting task in a unilateral lower limb amputee to gain a better understanding of the risk of injury during non-optimal lifting postures. The observed data from high resolution sensors are used to recommend optimized prosthetic device tuning. Further the participant specific low back compression loads calculated using Hand-Calculation Back Compressive Force estimation model (HCBCF) and the University of Michigan 3D Static Strength Prediction Program (3DSSPP™) model is used to identify the safe zones of joint loading during the lifting task.

Cognitive Behaviour Assessment in Chronic Non Specific Low Back Pain: A Narrative Review

Cognitive Behaviour Assessment in Chronic Non Specific Low Back Pain: A Narrative Review

Prevalence of Diaphragm Dysfunction in Relation to Breathing Pattern in Non Specific Low Back Pain

Background: Low Back pain is commonly seen clinical condition which is encountered in day to day practice of Physiotherapy. There is lack of studies correlating the relationship between the diaphragm and low back pain. Purpose: The aim of the study was to observe the diaphragm dysfunction with relation to the breathing pattern in individuals with low back pain. Material and Method: The materials used in this study is Pen, pencil and the data collection sheet. An observational study was carried out using a cross sectional study design. The study was carried in Karad city, Maharashtra, India. 80 Participants with low back pain [37:M;43:F] has been participated in the study. The diaphragm weakness and breathing pattern were evaluated at rest as well as after motor task with the help of Manual Assessment of Respiratory Motion and pulmonary Function Test. Result: Observational findings of this study demonstrates partial weakness and altered breathing pattern in patients with low back pain. Conclusion: Partial diaphragm weakness and an altered breathing pattern was found in individuals with low back pain.

A Practical Sensor-Based Methodology for the Quantitative Assessment and Classification of Chronic Non Specific Low Back Patients (NSLBP) in Clinical Settings.

The successful clinical application of patient-specific personalized medicine for the management of low back patients remains elusive. This study aimed to classify chronic nonspecific low back pain (NSLBP) patients using our previously developed and validated wearable inertial sensor (SHARIF-HMIS) for the assessment of trunk kinematic parameters. One hundred NSLBP patients consented to perform repetitive flexural movements in five different planes of motion (PLM): 0° in the sagittal plane, as well as 15° and 30° lateral rotation to the right and left, respectively. They were divided into three subgroups based on the STarT Back Screening Tool. The sensor was placed on the trunk of each patient. An ANOVA mixed model was conducted on the maximum and average angular velocity, linear acceleration and maximum jerk, respectively. The effect of the three-way interaction of Subgroup by direction by PLM on the mean trunk acceleration was significant. Subgrouping by STarT had no main effect on the kinematic indices in the sagittal plane, although significant effects were observed in the asymmetric directions. A significant difference was also identified during pre-rotation in the transverse plane, where the velocity and acceleration decreased while the jerk increased with increasing asymmetry. The acceleration during trunk flexion was significantly higher than that during extension, in contrast to the velocity, which was higher in extension. A Linear Discriminant Analysis, utilized for classification purposes, demonstrated that 51% of the total performance classifying the three STarT subgroups (65% for high risk) occurred at a position of 15° of rotation to the right during extension. Greater discrimination (67%) was obtained in the classification of the high risk vs. low-medium risk. This study provided a smart “sensor-based” practical methodology for quantitatively assessing and classifying NSLBP patients in clinical settings. The outcomes may also be utilized by leveraging cost-effective inertial sensors, already available in today’s smartphones, as objective tools for various health applications towards personalized precision medicine.

Proprioceptive Weighting Ratio for Balance Control in Static Standing Is Reduced in Elderly Patients With Non-Specific Low Back Pain: Erratum.

Proprioceptive Weighting Ratio for Balance Control in Static Standing Is Reduced in Elderly Patients With Non-Specific Low Back Pain: Erratum.

Commentary on "Cognitive Functional Therapy in Patients with Non-Specific Chronic Low Back Pain".

In this issue, you will find a paper by Vibe Fersum et al., entitled “Cognitive Functional Therapy in Patients with Non Specific Chronic Low Back Pain: A Randomized Controlled Trial 3-year Follow Up” (Vibe Fersum et al., 2019). This interesting and well done paper reports on 3 year outcomes from a previously reported randomized trial. The primary findings are lower self-reported disability for those randomized to receive cognitive functional therapy instead of manual therapy and exercise. This is a strong contribution to the literature as there is growing interest in psychologically informed approaches to managing musculoskeletal pain. In particular, the authors are to be commended for reporting 3-year data, as follow up beyond 12 or 24 months is rare in conservative treatment trials for low back pain. This commentary will introduce some issues for readers to consider when interpreting the results of this study. The primary issue when reading this paper is to consider the potential impact that loss to follow up has on the long-term effects of cognitive functional therapy. This issue is mentioned by the authors as a primary limitation in the paper, and I will expand on it briefly. Only 52% (63/121) of those from the original trial provided follow up data at 3 years. The authors have taken appropriate care statistically in accounting for this loss to follow up via sensitivity analyses using mixed models and multiple imputation. However, the fact remains that this was a relatively small trial to begin with and the 3-year attrition rate has substantially eroded the original sample size. The absolute number of subjects providing follow up data is small enough (n< 50 per treatment group) that the precision of reported treatment effects is limited. Further drawing attention to this issue is the evidence of differential loss to follow up that suggests those providing 3-year data had lower psychosocial distress. This is a clinical relevant baseline difference because psychological distress is often an important mediator of treatment outcome. The authors do account for this by adjusting analyses for baseline scores. While that is an acceptable statistical solution, it doesn’t entirely account for the impact selective follow-up could have on the 3-year results. Another issue to consider when reading this paper is the timing of the treatment effects. At 3-years group differences still exist for disability and most of this gain appears to have much earlier (i.e. at 3 month follow up). This is evidence supporting that after an initial period of receiving a treatment a favourable trajectory is established. Statistically the treatment effect was sustained at 3 years but the size of the effect is cut in half from when the benefit was largest (i.e. 3 month follow up). Even with a smaller absolute effect at 3 years, the effect sizes reported remain large when compared to others in this field. This deserves mention both in the “good news” category (i.e. even at 3 years these effect sizes are larger than what you see in the typical trial) but also in the “need more studies” category (i.e. can these effect sizes be replicated when the treatment is delivered by others in different settings). Several of the next steps one could take from this clinical trial are well aligned with recent research priorities identified for psychological informed practice. For example, cognitive functional therapy was associated with improved self-reported disability but identifying specific factors involved in the process of achieving better outcomes were not part of these analyses. Future studies could consider measures of pain intensity, self-efficacy, fear of pain and catastrophizing and identify which are key mediators of favourable outcomes when receiving cognitive functional therapy. Another seemingly informative study would be to investigate the impact of “booster sessions” for cognitive functional therapy that could be delivered as part of group sessions or tele-health. Use of such post-treatment booster sessions could help determine if the size of treatment effects initially obtained able to be maintained at later follow up times. I appreciate the chance to provide additional insight into this article. The authors are to be congratulated for presenting work that provides valuable information on longer term effects of cognitive functional therapy and also helps to plan future clinical research. None declared.

Proprioceptive Weighting Ratio for Balance Control in Static Standing Is Reduced in Elderly Patients With Non-Specific Low Back Pain.

A cross-sectional, observational study. The aim of this study was to determine a specific proprioceptive control strategy during postural balance in elderly patients with non-specific low back pain (NSLBP) and non-LBP (NLBP). Proprioceptive decline is an important risk factor for decreased balance control in elderly patients with NSLBP. The resulting reduction in proprioception in the trunk or lower legs may contribute to a reduction in postural sway. This study aims to determine the specific proprioceptive control strategy used during postural balance in elderly patients with NSLBP and NLBP and to assess whether this strategy is related to proprioceptive decline in NSLBP. Pressure displacement centers were determined in 28 elderly patients with NSLBP and 46 elderly patients with NLBP during upright stances on a balance board without the benefit of vision. Gastrocnemius and lumbar multifidus muscle vibratory stimulations at 30, 60, and 240 Hz, respectively, were applied to evaluate the relative contributions of the different proprioceptive signals (relative proprioceptive weighting ratio, RPW) used in postural control. Compared to elderly patients with NLBP, those with NSLBP had a lower RPW at 240 Hz and significantly higher RPW at 30 Hz. A logistic regression analysis showed that RPW at 240 Hz was independently associated with NSLBP after controlling for confounding factors. Elderly patients with NSLBP decreased their reliance on ankle strategy (RPW at 240 Hz) and hip strategy (RPW at 30 Hz) proprioceptive signals during balance control. The inability to control hip and ankle strategies indicates a deficit of postural control and is hypothesized to result from proprioceptive impairment. Moreover, elderly patients with NSLBP are at higher risk for lower leg proprioceptive decrease (240 Hz) through the NSLBP exacerbation. 4.

Development of APLAR-COPCORD Core Questionnaire for Identification of Risk Factors for Non Specific Low Back Pain

Background: Non specific low back pain (NSLBP) has been identified as one of the commonest rheumatic disorders in prevalence surveys in Asia-PacificObjective: Development of a core questionnaire for identification of risk factors of NSLBP at community level.Methods: Following steps were followed: 1) item generation from literature survey, existing Nordic questionnaires and patient focus group discussions, 2) development of a preliminary APLAR-COPCORD English questionnaire, 3) translation into target language, back translation and development of a synthetic target language version, 4) adaptation of the synthetic target language version through tests of comprehensibility, content validity test-retest reliability, and 5) finalization of the English questionnaire. .Results: 45 items were generated. A preliminary English questionnaire was developed.Conclusion: The developed English questionnaire will serve as an efficient tool for identification of risk factors of NSLBP in Asia-Pacific communities.TAJ 2011; 24(2): 85-90

Spinal Injections, Epidural Neurolysis and Denervation for Specific Low Back Pain and Sciatica.

Many members of the adult population suffer acute low back pain at some stage in life. A specific cause is found in only a rather small number of these patients. Some of the patients develop chronic low back pain and this is a major source of disability. On the other hand, there has been a great increase in Germany in the number of spinal operations due to degenerative spine disease and, in turn, unnecessary surgery on the spine is under debate. This is a narrative review of different minimally invasive spine procedures in the treatment of specific low back pain. The effectiveness of spinal injections, radiofrequency of the facet joints as well as epidural adhesiolysis/neurolysis are described. An analysis of the literature was performed via PubMed, Medline and the Cochrane Database. Facet-, epidural and intradiscal steroid injections for specific pain generators in the degenerative spine show different short- and long-term results; they are able to improve low back pain in specific patients with chronic low back pain and may be able to prevent some of these patients from having to undergo open surgery. Furthermore, there are promising results from interventions such as epidural neurolysis for sciatica and radiofrequency of the medial branch of the dorsal root for the treatment of axial facet-related back pain. Facet and intradiscal steroid injections give only short-term effects in axial low back pain and should therefore only be considered reluctantly, whereas the different forms of epidural steroid injections in patients with sciatica due to radicular compression offer a well proven adjuvant treatment option within a conservative therapeutic regimen. The overview of the literature with the use of different steroids has shown that use of non-particulate steroids show better results with respect to the safety and avoidance of major complications, especially when used at the cervical spine. However, in Germany the use of these steroids is still off label and patients have to give informed consent prior to injection. In summary, careful use of spinal injections and interventions within a conservative physiotherapeutic regimen seem to improve chronic back pain and, in turn, to be able to prevent some patients from having to undergo spine surgery.