NICE guideline approaches to managing low back pain differ depending on whether sciatica is present.15,17

A formal exercise programme may be helpful for a bout of low back pain without sciatica. This can be combined with a psychological intervention using a cognitive behavioural approach, preferably within a group context. Cognitive behavioural therapy (CBT) alongside exercise has been shown to be cost-effective in managing low back pain.4,15

Manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage) can be also considered within a treatment package that includes exercise. Local heat application is also indicated for low back pain and for sciatica.11,15,18

However, NICE does not support the use of electrotherapies such as transcutaneous electrical nerve simulation (TENS), percutaneous electrical nerve simulation (PENS), ultrasound or interferential therapy for managing low back pain with or without sciatica.15

NICE also advises against the use of ‘support’ belts or corsets, foot orthotics/shoe inserts or rocker soles. Nor does it recommend traction for managing low back pain with or without sciatica.15