Mini Review
Volume 13 Issue 10 - 2021
Non-Pharmacological Management of Low Back Pain and Root Compression Revisited
Nabil Kitchener*
Professor and Chairman of Neurology, Neuroscience and Neurointervention Department, General Organization for Teaching Hospitals and Institutes, Egypt
*Corresponding Author: Nabil Kitchener, Professor and Chairman of Neurology, Neuroscience and Neurointervention Department, General Organization for Teaching Hospitals and Institutes, Egypt.
Received: July 25, 2021; Published: September 28, 2021


The article discuss low back pain types, causes and mechanisms. It, also, discuss the management of low back pain, which is divided into two major types the first is conservative management, the second is the interventional management, which is subclassified into two sub- types: surgical intervention and non-surgical nonpharmacological intervention.

Keywords: Low Back Pain (LBP); Surgical Intervention; Non-Surgical Nonpharmacological Intervention; Kitchener’s Technique; Single Vertebral Manipulative Therapy (SVMT)


  1. Vrbanic TS. “Low back pain--from definition to diagnosis”. Reumatizam2 (2011): 105-107.
  2. Low back pain, Prepared by: Office of Communications and Public Liaison National Institute of Neurological Disorders and Stroke National Institutes of Health Department of Health and Human Services Bethesda, Maryland 20892-2540 (2020).
  3. Hoy D., et al. “The global burden of low back pain: estimates from the global burden of Disease 2010 study”. Annals of the Rheumatic Diseases6 (2014): 968-974.
  4. Vrbanic TS. “Low back pain--from definition to diagnosis”. Reumatizam2 (2011): 105-107.
  5. Deyo RA and Phillips WR. “Low back pain. A primary care challenge”. Spine24 (1996): 2826-3832.
  6. Childs JD., et al. “A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study”. Annals of Internal Medicine12 (2004): 920-928.
  7. , et al. “BMC Health Services Research 20 (2020): 970.
  8. Couvellaire A., et al. “Pratique médico-chirurgicale, TomeVII. Paris: Masson (1933): 954-963.
  9. Alajouanine TH and Petit-Dutaillis D. “Compression de la queue de cheval par unetumeur du disque intervertébral. Ablation suivie de guérison”. Bulletin of the Botanical Society of France 55 (1929): 937-940.
  10. Mixter WJ and Barr JS. “Rupture of the intervertebral disc with involvement of thespinal canal”. The New England Journal of Medicine 211 (1934): 210-215.
  11. Ehrlich GE and Khaltaev NG. “Low back pain initiative”. Geneva: World Health Organization (1999).
  12. Bigos SJ., et al. “Acute low back pain problems in adults”. Clinical practice guideline no. 14. AHCPR Publication No. 95-0642. Rockville (MD): US Department of Health and Human Services (1994).
  13. Wolfe F., et al. “The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee”. Arthritis and Rheumatology 33 (1990): 160-172.
  14. Von Feldt JM and Ehrlich GE. “Pharmacologic therapies. Low back pain”. Physical Medicine and Rehabilitation Clinics of North America 9 (1998): 473-485.
  15. Cancer, pain relief and palliative care. Geneva: World Health Organization. WHO Technical Report Series No (1990): 408.
  16. Assendelft WJ., et al. “Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies”. Annals of Internal Medicine 138 (2003): 871-881.
  17. Cherkin DC., et al. “A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain”. Annals of Internal Medicine 138 (2003): 898-906.
  18. Guevara-López U., et al. “Practice guidelines for the management of low back pain.Consensus Group of Practice Parameters to Manage Low Back Pain”. Circulation 79 (2011): 264-279.
  19. Blumenthal S., et al. “A prospective, randomized, multicenter Food and Drug Administration investigational device exemptions study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: part I: evaluation of clinical out-comes”. Spine 30 (2005): 1565-1575.
  20. Brox JI., et al. “Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study”. Pain 122 (2006): 145-155.
  21. Brox JI., et al. “Randomized clinical trial of lumbar instrumented fusion and cognitive intervention andexercises in patients with chronic low back pain and disc degeneration”. Spine 28 (2003): 1913-1921.
  22. Fabrizi AP., et al. “Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices”. European Spine Journal 20 (2011): S20-26.
  23. Fairbank J., et al. “Ran-domised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low backpain: the MRC spine stabilisation trial”. British Medical Journal 330 (2005): 1233.
  24. Guyer RD., et al. “Prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of lumbar total disc replacement with the CHARITE artificial disc versus lumbar fusion: five-year follow-up”. The Spine Journal 9 (2009): 374-386.
  25. Kabir SMR., et al. “Lumbar interspinous spacers: a systematic review of clinical and biomechanical evidence”. Spine 35 (2010): E1499-1506.
  26. Kim DH., et al. “Occult spinous process fractures associated with interspinous process spacers”. Spine 36 (2011): E1080-1085.
  27. Kim YS., et al. “Nitinol springrod dynamic stabilization system and Nitinol memory loops in surgical treatment for lumbar disc disorders: short-term follow up”. Neurosurgery Focus 22 (2007): E10.
  28. Korovessis P., et al. “Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radio-logical and clinical analysis of short-term results”. Spine 29 (2004): 735-742.
  29. Mandigo CE., et al. “Posterior dynamic stabilization of the lumbar spine: pedicle based stabilization with the AccuFlex rod system”. Neurosurgery Focus 1 (2007): E9.
  30. Moreno P and Boulot J. “Etude comparative des résultats cliniques à court terme dela prothèse discale lombaire et de l’arthrodèse lombaire antérieure”. Revue de Chirurgie Orthopedique et Reparatrice de L'appareil Moteur 94 (2008): 282-288.
  31. Sasso RC., et al. “Prospective, randomized trial of metal-on-metal artificial lumbar disc replacement: initial results for treatment of discogenicpain”. Spine 33 (2008): 123-131.
  32. Zigler J., et al. “Results of the prospective, randomized, multicenter Food and Drug Administration investigational device exemption study of the ProDisc-L total disc replacement versus circumferential fusion for the treatment of 1-level degenerative disc disease”. Spine 32 (2007): 1155-1162.
  33. Chou R and Huffman LH. “Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline”. Annals of Internal Medicine 147 (2007): 505-514.
  34. Kitchener N. “Single vertebral manipulative therapy (Kitchener’s Technique Description): a new technique for treatment of acute and subacute spinal root compression”. European Journal of Neurology 1 (2016): 111-344.
  35. Kitchener N. “Single vertebral manipulative therapy (Kitchener’s Technique) Clinical Study: a new technique for treatment of acute and subacute spinal root compression”. Journal of Neurology and Stroke 2 (2021): 31-35.
Citation: Nabil Kitchener. “Non-Pharmacological Management of Low Back Pain and Root Compression Revisited”. EC Neurology 13.10 (2021): 87-92.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

December Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the December issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 20, 2021.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to