Nonoperative treatment for low back pain. Rest to restoration

Pain and disability due to disorders of the lumbar spine are endemic in industrialized society. Nonoperative management of low back pain syndromes is most often successful but is complicated by myriad of unproven treatment options. Recent studies have shown that the natural history favors recovery regardless of the type of treatment. With increasing time from onset of symptoms, therapeutic interventions shift from rest and applied therapies to exercise and physical restoration. This also requires an evolution from passive to active participation by the patient. This article outlines current trends and recommendations for the application of various nonoperative treatment methods as low back pain persists through time.