Don’t request imaging for patients with non-specific low back pain and no indicators of a serious cause for low back pain.
Trials have consistently shown that there is no advantage from routine imaging of non-specific low back pain and there are some potential harms. Imaging is instead recommended for cases of low back pain where there is a suspicion of an underlying medically serious disease, like cancer or infection. In people who present to primary care with low back pain, medically serious disease is uncommon. Patients with a higher likelihood of medically serious disease as the cause of their low back pain can be identified by red flags, like a history of cancer. A recent Australian study revealed that most people experiencing acute low back pain expect imaging, believing it will identify the cause of their pain and so is considered a prerequisite for effective care. These views conflict with the available evidence on imaging.
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- 1 Don’t request imaging for patients with non-specific low back pain and no indicators of a serious cause for low back pain.
- 2 Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated decision rule
- 3 Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules (localised bone tenderness or inability to weight-bear as defined in the Rules)
- 4 Don't routinely use incentive spirometry after upper abdominal and cardiac surgery
- 5 Avoid using electrotherapy modalities in the management of patients with low back pain.
- 6 Don’t provide ongoing manual therapy for patients with adhesive capsulitis of the shoulder