Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Self-management of chronic low back pain and osteoarthritis

Nature Reviews Rheumatology volume 6, pages 199–209 (2010)Cite this article

Subjects

Abstract

Chronic low back pain and osteoarthritis are two musculoskeletal problems that are highly prevalent in the general population, are frequently episodic and persistent, and are associated with high costs to society, both direct and indirect. This epidemiological picture provides the background that justifies the use of self-management strategies in managing these problems. For this Review, relevant systematic reviews were included that related to effectiveness; other study designs were included that addressed other aspects of the topic. The accepted definition of self-management includes liaison between health professionals and individuals with these problems, as well as independent health-promotion activities. Independent self-management strategies, such as exercise and self-medication, are practiced by individuals in the general population. Consistent evidence shows that self-management programs for osteoarthritis are effective in addressing pain and function, but effect sizes are small and might be clinically negligible. Educational programs for patients with back pain are effective in an occupational setting and if combined with an exercise program. Exercise is an effective strategy in the management of both chronic low back pain and osteoarthritis, although it is unclear what the optimum exercise is. Exercise, supported by advice and education, should be at the core of self-management strategies for chronic low back pain and osteoarthritis.

Key Points

  • Given the high prevalence and associated costs of common chronic musculoskeletal conditions such as chronic low back pain and osteoarthritis, self-management should be a key strategy

  • Self-management is practiced by individuals with these conditions in the general population

  • Barriers to self-management can come from both patients and healthcare professionals

  • Self-management programs have a small but positive effect for osteoarthritis; the efficacy of back education programs is not as clear

  • Exercise programs are effective for the improvement of pain and function in both chronic low back pain and osteoarthritis

  • Exercise, supported by advice and education, should be at the core of self-management strategies

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Bennett, N., Jarvis, L., Rowlands, O., Singleton, N. & Haselden, L. Living in Britain: results from the 1994 General Household survey: an inter-departmental survey carried out by OPCS between April 1994 and March 1995. Great Britain Office of Population Censuses and Surveys Social Survey Division, (Her Majesty's Stationary Service, London, 1996).

    Google Scholar 

  2. Rekola, K. E., Keinänen-Kiukaanniemi, S. & Takala, J. Use of primary health services in sparsely populated country districts by patients with musculoskeletal symptoms: consultations with a physician. J. Epidemiol. Community Health 47, 153–157 (1993).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Picavet, H. S. & Schouten, J. S. Musculoskeletal pain in the Netherlands: prevalences, consequences and risk groups, the DMC(3)-study. Pain 102, 167–178 (2003).

    Article  CAS  PubMed  Google Scholar 

  4. Urwin, M. et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann. Rheum. Dis. 57, 649–655 (1998).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Abbott, J. H. & Mercer, S. R. The natural history of acute low back pain. N. Z. J. Physiother. 30, 8–16 (2002).

    Google Scholar 

  6. Hestbaek, L., Leboeuf-Yde, C. & Manniche, C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur. Spine J. 12, 149–165 (2003).

    PubMed  PubMed Central  Google Scholar 

  7. Pengel, L. H., Herbert, R. D., Maher, C. G. & Refshauge, K. M. Acute low back pain: systematic review of its prognosis. BMJ 327, 323 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  8. van Tulder, M. W., Koes, B. W. & Bouter, L. M. A cost-of-illness study of back pain in the Netherlands. Pain 62, 233–240 (1995).

    Article  CAS  PubMed  Google Scholar 

  9. Maniadakis, N. & Gray, A. The economic burden of back pain in the UK. Pain 84, 95–103 (2000).

    Article  CAS  PubMed  Google Scholar 

  10. Dagenais, S., Caro, J. & Haldeman, S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 8, 8–20 (2008).

    Article  PubMed  Google Scholar 

  11. Bijlsma, J. W. & Knahr, K. Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Pract. Res. Clin. Rheumatol. 21, 59–76 (2007).

    Article  CAS  PubMed  Google Scholar 

  12. Hurley, M. An exercise in knee pain self-management. Reports on the Rheumatic Disease Series 5. Hands on. Practical advice on management of rheumatic disease. (Arthritis Research Council, Chesterfield, 2005).

    Google Scholar 

  13. Cooper, K., Smith, B. H. & Hancock, E. Patients' perceptions of self-management of chronic low back pain: evidence for enhancing patient education and support. Physiotherapy 95, 43–50 (2009).

    Article  PubMed  Google Scholar 

  14. Lorig, K. R. et al. Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Med. Care 37, 5–14 (1999).

    Article  CAS  PubMed  Google Scholar 

  15. Lorig, K. Partnership between expert patients and physicians. Lancet 359, 814–815 (2002).

    Article  PubMed  Google Scholar 

  16. Lorig, K. Self-management education: more than a nice extra. Med. Care 41, 699–701 (2003).

    PubMed  Google Scholar 

  17. Newman, S., Mulligan, K. & Steed, L. What is meant by self-management and how can its efficacy be established? Rheumatology 40, 1–4 (2001).

    Article  CAS  PubMed  Google Scholar 

  18. Osborne, R. H., Spinks, J. M. & Wicks, I. P. Patient education and self-management programs in arthritis. Med. J. Aust. 180 (Suppl. 5), S23–S26 (2004).

    PubMed  Google Scholar 

  19. Von Korff, M., Gruman, J., Schaefer, J., Curry, S. J. & Wagner, E. H. Collaborative management of chronic illness. Ann. Intern. Med. 127, 1097–1102 (1997).

    Article  CAS  PubMed  Google Scholar 

  20. Bodenheimer, T., Lorig, K., Holman, H. & Grumbach, K. Patient self-management of chronic disease in primary care. JAMA 288, 2469–2475 (2002).

    Article  PubMed  Google Scholar 

  21. Bodenheimer, T., Wagner, E. H. & Grumbach, K. Improving primary care for patients with chronic illness. JAMA 288, 1775–1779 (2002).

    Article  PubMed  Google Scholar 

  22. Woolf, A. D. et al. Musculoskeletal pain in Europe: its impact and a comparison of population and medical perceptions of treatment in eight European countries. Ann. Rheum. Dis. 63, 342–347 (2004).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Jinks, C., Ong, B. N. & Richardson, J. A mixed methods study to investigate needs assessment for knee pain and disability: population and individual perspectives. BMC Musculoskelet. Disord. 8, 59 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  24. Enthoven, P., Skargren, E. & Oberg, B. Clinical course in patients seeking primary care for back or neck pain: a prospective 5-year follow-up of outcome and health care consumption with subgroup analysis. Spine 29, 2458–2465 (2004).

    Article  PubMed  Google Scholar 

  25. Hillman, M., Wright, A., Rajaratnam, G., Tennant, A. & Chamberlain, M. A. Prevalence of low back pain in the community: implications for service provision in Bradford, UK. J. Epidemiol. Community Health 50, 347–352 (1996).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Linton, S. J., Hellsing, A. L. & Halldén, K. A population-based study of spinal pain among 35–45-year-old individuals. Prevalence, sick leave, and health care use. Spine 23, 1457–1463 (1998).

    Article  CAS  PubMed  Google Scholar 

  27. Santos-Eggimann, B., Wietlisbach, V., Rickenbach, M., Paccaud, F. & Gutzwiller, P. One-year prevalence of low back pain in two Swiss regions: estimates from the population in the 1992–1993 MONICA project. Spine 25, 2473–2479 (2000).

    Article  CAS  PubMed  Google Scholar 

  28. Walsh, K., Cruddas, M. & Coggon, D. Low back pain in eight areas in Britain. J. Epidemiol. Community Health 46, 227–230 (1992).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Blyth, F. M., March, L. M., Branbic, A. J. & Cousins, M. J. Chronic pain and frequent use of health care. Pain 111, 51–58 (2004).

    Article  PubMed  Google Scholar 

  30. Eriksen, J., Jensen, M. K., Sjøgren, P., Ekholm, O. & Rasmussen, N. K. Epidemiology of chronic non-malignant pain in Denmark. Pain 106, 221–228 (2003).

    Article  PubMed  Google Scholar 

  31. Jzelenberg, W. I. & Burdorf, A. Patterns of care for low back pain in a working population. Spine 29, 1362–1368 (2004).

    Article  Google Scholar 

  32. Lim, K. L., Jacobs, P. & Klarenbach, S. A population-based analysis of healthcare utilization of persons with back disorders; results from the Canadian Community Health Survey 2000–2001. Spine 31, 212–218 (2006).

    Article  PubMed  Google Scholar 

  33. Walker, B. F., Muller, R. & Grant, W. D. Low back pain in Australian adults. Health provider utilization and care seeking. J. Manipulative Physiol. Ther. 27, 327–335 (2004).

    Article  PubMed  Google Scholar 

  34. Albert, S. M., Musa, D., Kwoh, C. K., Hanlon, J. T. & Silverman, M. Self-care and professionally guided care in osteoarthritis: racial differences in a population-based sample. J. Aging Health 20, 198–216 (2008).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Blyth, F. M., March, L. M., Nicholas, M. K. & Cousins, M. J. Self-management of chronic pain: a population based study. Pain 113, 285–292 (2005).

    Article  PubMed  Google Scholar 

  36. Barlow, J., Wright, C., Sheasby, J., Turner, A. & Hainsworth, J. Self-management approaches for people with chronic conditions: a review. Patient Educ. Couns. 48, 177–187 (2002).

    Article  PubMed  Google Scholar 

  37. Berzins, K., Reilly, S., Abell, J., Hughes, J. & Challis, D. UK self-care support initiatives for older patients with long-term conditions: a review. Chronic Illn. 5, 56–72 (2009).

    Article  CAS  PubMed  Google Scholar 

  38. Chodosh, J. et al. Meta-analysis: chronic disease self-management programs for older adults. Ann. Intern. Med. 143, 427–438 (2005).

    Article  PubMed  Google Scholar 

  39. Conn, V. S., Hafdahl, A. R., Brown, S. A. & Brown, L. M. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Educ. Couns. 70, 157–172 (2008).

    Article  PubMed  Google Scholar 

  40. Foster, G., Taylor, S. J., Eldridge, S., Ramsay, J. & Griffiths, C. J. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD005108. doi:10.1002/14651858.CD005108.pub2 (2007).

    Google Scholar 

  41. Newman, S., Steed, L. & Mulligan, K. Self-management interventions for chronic illness. Lancet 364, 1523–1532 (2004).

    Article  PubMed  Google Scholar 

  42. Warsi, A., Wang, P. S., LaValley, M. P., Avorn, J. & Solomon, D. H. Self-management education programs in chronic disease: a systematic review and methodological critique of the literature. Arch. Intern. Med. 164, 1641–1649 (2004).

    Article  PubMed  Google Scholar 

  43. Weingarten, S. R. et al. Interventions used in disease management programmes for patients with chronic illness—which ones work? Meta-analysis of published reports. BMJ 325, 925 (2002).

    Article  PubMed  PubMed Central  Google Scholar 

  44. Devos-Comby, L., Cronan, T. & Roesch, S. C. Do exercise and self-management interventions benefit patients with osteoarthritis of the knee? A metaanalytic review. J. Rheumatol. 33, 744–756 (2006).

    PubMed  Google Scholar 

  45. Hawley, D. J. Psycho-educational interventions in the treatment of arthritis. Ballieres Clin. Rheumatol. 9, 803–823 (1995).

    Article  CAS  Google Scholar 

  46. Hirano, P. C., Laurent, D. D. & Lorig, K. Arthritis patient education studies, 1987–1991: a review of the literature. Patient Educ. Couns. 24, 9–54 (1994).

    Article  PubMed  Google Scholar 

  47. Mullen, P. D., Laville, E. A., Biddle, A. K. & Lorig, K. Efficacy of psychoeducational interventions on pain, depression, and disability in people with arthritis: a meta-analysis. J. Rheumatol. 14, Suppl. 15, 33–39 (1987).

    Google Scholar 

  48. Reid, M. C. et al. Self-management strategies to reduce pain and improve function among older adults in community settings: a review of the evidence. Pain Med. 9, 409–424 (2008).

    Article  PubMed  Google Scholar 

  49. Superio-Cabuslay, E., Ward, M. W. & Lorig, K. R. Patient education interventions in osteoarthritis and rheumatoid arthritis: a meta-analytic comparison with nonsteroidal antiinflammatory drug treatment. Arthritis Care Res. 9, 292–301 (1996).

    Article  CAS  PubMed  Google Scholar 

  50. Warsi, A., LaValley, M. P., Wang, P. S., Avorn, J. & Solomon, D. H. Arthritis self-management education programs: a meta-analysis of the effect on pain and disability. Arthritis Rheum. 48, 2207–2213 (2003).

    Article  PubMed  Google Scholar 

  51. Cohen, J. Statistical Power Analysis for the Behavioral Sciences, 2nd edn (Lawrence Erlbaum, Hillsdale, NJ, 1988).

    Google Scholar 

  52. Brox, J. I. et al. Systematic review of back schools, brief education, and fear-avoidance training for chronic low back pain. Spine J. 8, 948–958 (2008).

    Article  CAS  PubMed  Google Scholar 

  53. Cohen, J. E. et al. Group education interventions for people with low back pain. An overview of the literature. Spine 19, 1214–1222 (1994).

    Article  CAS  PubMed  Google Scholar 

  54. Di Fabio, R. P. Efficacy of comprehensive rehabilitation programs and back schools for patients with low back pain: a meta-analysis. Phys. Ther. 75, 865–878 (1995).

    Article  CAS  PubMed  Google Scholar 

  55. Henrotin, Y. E., Cedraschi, C., Duplan, B., Bazin, T. & Duquesnoy, B. Information and low back pain management: a systematic review. Spine 31, E326–E334 (2006).

    Article  PubMed  Google Scholar 

  56. Heymans, M. W., van Tulder, M. W., Esmail, R., Bombardier, C. & Koes, B. W. Back schools for non-specific low back pain. A systematic review within the framework of the Cochrane Collaboration Back Pain Review Group. Spine 30, 2153–2163 (2005).

    Article  CAS  PubMed  Google Scholar 

  57. Keijsers, J. F., Bouter, L. M. & Meertens, R. M. Validity and comparability of studies on the effects of back schools. Physiotherapy: Theory and Practice 7, 177–184 (1991).

    Google Scholar 

  58. Koes, B. W., van Tulder, M. W., van der Windt, W. M. & Bouter, L. M. The efficacy of back schools: a review of randomized clinical trials. J. Clin. Epidemiol. 47, 851–862 (1994).

    Article  CAS  PubMed  Google Scholar 

  59. Liddle, S. D., Gracey, J. H. & Baxter, G. D. Advice for the management of low back pain: a systematic review of randomised controlled trails. Man. Ther. 12, 310–327 (2007).

    Article  PubMed  Google Scholar 

  60. Linton, S. J. & Kamwendo, K. Low back schools. A critical review. Phys. Ther. 67, 1375–1383 (1987).

    Article  CAS  PubMed  Google Scholar 

  61. van Tulder, M. W., Esmail, R., Bombardier, C. & Koes. B. W. Back schools for non-specific low back pain. Cochrane Database of Systematic Reviews. Issue 3, Art. No:CD000261. doi:10.1002/14651858.CD000261.pub2 (1999).

    Google Scholar 

  62. Mazières, B., Bannwarth, B., Dougados, M. & Lequesne, M. EULAR recommendations for the management of knee osteoarthritis. Report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trails. Joint Bone Spine 68, 231–240 (2001).

    Article  PubMed  Google Scholar 

  63. [No authors listed] Ottawa panel evidence-based clinical practice guidelines for therapeutic exercises and manual therapy in the management of osteoarthritis. Phys. Ther. 85, 907–971 (2005).

  64. Petrella, R. J. Is exercise effective treatment for osteoarthritis of the knee? Br. J. Sports Med. 34, 326–331 (2000).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Moe, R. H. et al. Effectiveness of nonpharmacological and nonsurgical interventions for hip osteoarthritis: an umbrella review of high-quality systematic reviews. Phys. Ther. 87, 1716–1727 (2007).

    Article  PubMed  Google Scholar 

  66. Brosseau, L., MacLeay, L., Welch, V., Tugwell, P. & Wells, G. A. Intensity of exercise for the treatment of osteoarthritis. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD004259. doi:10.1002/14651858.CD004259 (2003).

    Google Scholar 

  67. Brosseau, L. et al. Efficacy of aerobic exercises for osteoarthritis (Part II): A meta-analysis. Phys. Ther. Rev. 9, 125–145 (2004).

    Article  Google Scholar 

  68. Brosseau, L. et al. Ottawa panel evidence-based clinical practice recommendations for therapeutic exercises and manual therapy in the management of osteoarthritis. Phys. Ther. 85, 907–971 (2005).

    Google Scholar 

  69. Focht, B. C. Effectiveness of exercise interventions in reducing pain symptoms among older adults with knee osteoarthritis: a review. J. Aging Phys. Act. 14, 212–235 (2006).

    Article  PubMed  Google Scholar 

  70. Fransen, M., McConnell, S. & Bell, M. Therapeutic exercise for people with osteoarthritis of the hip or knee. A systematic review. J. Rheumatol. 29, 1737–1745 (2002).

    PubMed  Google Scholar 

  71. Fransen, M. & McConnell, S. Exercise for osteoarthritis of the knee. Cochrane Database of Systematic Reviews, Issue 4. Art. No.: CD004376. doi:10.1002/14651858.CD004376.pub2 (2008).

    Google Scholar 

  72. Jamtvedt, G. et al. Physical therapy interventions for patients with osteoarthritis of the knee: an overview of systematic reviews. Phys. Ther. 88, 123–136 (2008).

    Article  PubMed  Google Scholar 

  73. Marks, R. & Allegrante, J. P. Chronic osteoarthritis and adherence to exercise: a review of the literature. J. Aging Phys. Act. 13, 434–460 (2005).

    Article  PubMed  Google Scholar 

  74. McCarthy, C. J. & Oldham, J. A. The effectiveness of exercise in the treatment of osteoarthritic knees: a critical review. Phys. Ther. Rev. 4, 241–250 (1999).

    Article  Google Scholar 

  75. Pelland, L. et al. Efficacy of strengthening exercises for osteoarthritis (Part I): a meta-analysis. Phys. Ther. Rev. 9, 77–108 (2004).

    Article  Google Scholar 

  76. Puett, D. W. & Griffin, M. R. Published trials of nonmedicinal and noninvasive therapies for hip and knee osteoarthritis. Ann. Intern. Med. 121, 133–140 (1994).

    Article  CAS  PubMed  Google Scholar 

  77. Roddy, E., Zhang, W. & Doherty, M. Aerobic walking or strengthening exercise for osteoarthritis of the knee. A systematic review. Ann. Rheum. Dis. 64, 544–548 (2005).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Roddy, E. et al. Evidence-based recommendations for the role of exercise in the management of osteoarthritis in the hip or knee—the MOVE consensus. Rheumatology 44, 67–73 (2005).

    Article  CAS  PubMed  Google Scholar 

  79. Smidt, N. et al. Effectiveness of exercise therapy: a best-evidence summary of systematic reviews. Aust. J. Physiother. 51, 71–85 (2005).

    Article  PubMed  Google Scholar 

  80. van Baar, M. E., Assendelft, W. J., Dekker, J., Oostendorp, R. A. & Bijlsma, J. W. Effectiveness of exercise therapy in patients with osteoarthritis of the hip or knee: a systematic review of randomized clinical trials. Arthritis Rheum. 42, 1361–1369 (1999).

    Article  CAS  PubMed  Google Scholar 

  81. Walsh, N. E., Mitchell, H. L., Reeves, B. C. & Hurley, M. V. Integrated exercise and self-management programmes in osteoarthritis of the hip and knee: a systematic review of effectiveness. Phys. Ther. Rev. 11, 289–297 (2006).

    Article  Google Scholar 

  82. Christensen, R., Bartels, E. M., Astrup, A. & Bliddal, H. Effect of weight reduction in obese patients diagnosed with knee osteoarthritis: a systematic review and meta-analysis. Ann. Rheum. Dis. 66, 433–439 (2007).

    Article  PubMed  PubMed Central  Google Scholar 

  83. Airaksinen, O. et al. European guidelines for the management of chronic non-specific low back pain [online], (2004).

    Google Scholar 

  84. Arnau, J. M. et al. A critical review of guidelines for low back pain treatment. Eur. Spine J. 15, 543–553 (2006).

    Article  PubMed  Google Scholar 

  85. Clare, H. A., Adams, R. & Maher, C. G. A systematic review of efficacy of McKenzie therapy for spinal pain. Aust. J. Physiother. 50, 209–216 (2004).

    Article  PubMed  Google Scholar 

  86. Cook, C., Hegedus, E. J. & Ramey, K. Physical therapy exercise intervention based on classification using the patient response method: a systematic review of the literature. J. Manual Manip. Ther. 13, 152–162 (2005).

    Article  Google Scholar 

  87. Ferreira, P. H., Ferreira, M. L., Maher, C. G., Herbert, R. D. & Refshauge, K. Specific stabilisation exercise for spinal and pelvic pain: a systematic review. Aust. J. Physiother. 52, 79–88 (2006).

    Article  PubMed  Google Scholar 

  88. Hayden, J. A., van Tulder, M. W., Malmivaara, A. V. & Koes, B. W. Meta-analysis: exercise therapy for nonspecific low back pain. Ann. Intern. Med. 142, 765–775 (2005).

    Article  PubMed  Google Scholar 

  89. Hayden, J. A., van Tulder, M. W. & Tomlinson, G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Ann. Intern. Med. 142, 776–785 (2005).

    Article  PubMed  Google Scholar 

  90. Hettinga, D. M. et al. A systematic review and synthesis of higher quality evidence of the effectiveness of exercise interventions for non-specific low back pain of at least 6 weeks' duration. Phys. Ther. Rev. 12, 221–232 (2007).

    Article  Google Scholar 

  91. Hubley-Kozey, C. L., McCulloch, T. A. & McFarland, D. H. Chronic low back pain: A critical review of specific therapeutic exercise protocols on musculoskeletal and neuromuscular parameters. J. Manual Manip. Ther. 11, 78–87 (2003).

    Article  Google Scholar 

  92. Kool, J. et al. Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis. J. Rehabil. Med. 36, 49–62 (2004).

    Article  PubMed  Google Scholar 

  93. Liddle, S. D., Baxter, G. D. & Gracey, J. H. Exercise and chronic low back pain: what works? Pain 107, 176–190 (2004).

    Article  PubMed  Google Scholar 

  94. Machado, L. A., de Souza, M. S., Ferreira, P. H. & Ferreira, M. L. The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach. Spine 31, E254–E262 (2006).

    Article  PubMed  Google Scholar 

  95. Macedo, L. G., Maher, C. G., Latimer, J. & McAuley, J. H. Motor control exercises for persistent, nonspecific low back pain: a systematic review. Phys. Ther. 89, 9–25 (2009).

    Article  PubMed  Google Scholar 

  96. May, S. & Johnson, R. Stabilisation exercises for low back pain: a systematic review. Physiotherapy 94, 179–189 (2008).

    Article  Google Scholar 

  97. Rackwitz. B. et al. Segmental stabilizing exercises and low back pain. What is the evidence? A systematic review of randomized controlled trials. Clin. Rehabil. 20, 553–567 (2006).

    Article  PubMed  Google Scholar 

  98. Slade, S. C. & Keating, J. L. Trunk-strengthening exercises for chronic low back pain: a systematic review. J. Manipulative Physiol. Ther. 29, 163–173 (2006).

    Article  PubMed  Google Scholar 

  99. Slade, S. C. & Keating, J. Unloaded movement facilitation exercise compared to no exercise or alternative therapy on outcomes for people with nonspecific chronic low back pain: a systematic review. J. Manipulative Physiol. Ther. 30, 301–311 (2007).

    Article  PubMed  Google Scholar 

  100. Standaert, C. J., Weinstein, S. M. & Rumpeltes, J. Evidence-informed management of chronic low back pain with lumbar stabilization exercises. Spine J. 8, 114–120 (2008).

    Article  PubMed  Google Scholar 

  101. van Tulder, M. W., Malmivaara, A., Esmail, R. & Koes, B. Exercise therapy for low back pain. A systematic review with the framework of the Cochrane Collaboration Back Review Group. Spine 25, 2784–2796 (2000).

    Article  CAS  PubMed  Google Scholar 

  102. Axford, J., Heron, C., Ross, F. & Victor, C. R. Management of knee osteoarthritis in primary care: pain and depression are the major obstacles. J. Psychosom. Res. 64, 461–467 (2008).

    Article  PubMed  Google Scholar 

  103. Damush, T. M., Wu, J., Bair, M. J., Sutherland, J. M. & Kroenke. K. Self-management practices among primary care patients with musculoskeletal pain and depression. J. Behav. Med. 31, 301–307 (2008).

    Article  PubMed  Google Scholar 

  104. Krein, S. L., Heisler, M., Piette, J. D., Butchart, A. & Kerr, E. A. Overcoming the influence of chronic pain on older patients' difficulty with recommended self-management activities. Gerontologist 47, 61–68 (2007).

    Article  PubMed  Google Scholar 

  105. May, S. Patients' attitudes and beliefs about back pain and its management after physiotherapy for low back pain. Physiother. Res. Int. 12, 126–135 (2007).

    Article  PubMed  Google Scholar 

  106. McCracken, L. M. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain 74, 21–27 (1998).

    Article  CAS  PubMed  Google Scholar 

  107. May, S. J. Patients' satisfaction with management of back pain. Part 1: What is satisfaction? Review of satisfaction with medical management. Physiotherapy 87, 4–9 (2001).

    Article  Google Scholar 

  108. May, S. J. Patients' satisfaction with management of back pain. Part 2: An explorative, qualitative study into patients' satisfaction with physiotherapy. Physiotherapy 87, 10–20 (2001).

    Article  Google Scholar 

  109. Morris, A. L. Patients' perspectives on self-management following a back rehabilitation programme. Musculoskeletal Care 2, 165–179 (2004).

    Article  PubMed  Google Scholar 

  110. Goubert, L., Crombez, G. & de Bourdeaudhuij, I. Low back pain, disability and back pan myths in a community sample: prevalence and interrelationship. Eur. J. Pain. 8, 385–394 (2004).

    Article  PubMed  Google Scholar 

  111. Keen, S. et al. Individuals with low back pain: how do they view physical activity? Fam. Pract. 16, 39–45 (1999).

    Article  CAS  PubMed  Google Scholar 

  112. Klaber Moffett, J. A., Newbronner, E., Waddell, G., Croucher, K. & Spear, S. Public perceptions about low back pain and its management: a gap between expectations and reality? Health Expect. 3, 161–168 (2000).

    Article  PubMed  Google Scholar 

  113. Blakeman, T., Macdonald, W., Bower, P., Gately, C. & Chew-Graham, C. A qualitative study of GPs' attitudes to self-management of chronic disease. Br. J. Gen. Pract. 56, 407–414 (2006).

    PubMed  PubMed Central  Google Scholar 

  114. Jamison, J. R. Patient-practitioner perceptions: can chiropractors assume congruence. J. Manipulative Physiol. Ther. 23, 409–413 (2000).

    Article  CAS  PubMed  Google Scholar 

  115. Lansbury, G. Chronic pain management: a qualitative study of elderly people's preferred coping strategies and barriers to management. Disabil. Rehabil. 22, 2–14 (2000).

    Article  CAS  PubMed  Google Scholar 

  116. Potts, M., Weinberger, M. & Brandt, K. D. Views of patients and providers regarding the importance of various aspects of an arthritis treatment program. J. Rheumatol. 11, 71–75 (1984).

    CAS  PubMed  Google Scholar 

  117. Victor, C. R., Ross, F. & Axford, J. Capturing lay perspectives in a randomized control trial of a health promotion intervention for people with osteoarthritis of the knee. J. Eval. Clin. Pract. 10, 63–70 (2004).

    Article  PubMed  Google Scholar 

  118. Wilson, P. M., Kendall, S. & Brooks, F. Nurses' responses to expert patients: the rhetoric and reality of self-management in long-term conditions: a grounded theory study. Int. J. Nurs. Stud. 43, 803–818 (2006).

    Article  PubMed  Google Scholar 

  119. McAuley, E. et al. Physical activity and functional limitations in older women: influence of self-efficacy. J. Gerontol. B Psychol. Sci. Soc. Sci. 61, P270–P277 (2006).

    Article  PubMed  Google Scholar 

  120. McAuley, E., Jerome, G. J., Elavsky, S. Marquez, D. X. & Ramsey, S. N. Predicting long-term maintenance of physical activity in older adults. Prev. Med. 37, 110–118 (2003).

    Article  PubMed  Google Scholar 

  121. Rejeski, W. J., Miller, M. E., Foy, C., Messier, S. & Rapp, S. Self-efficacy and the progression of functional limitations and self-reported disability in older adults with knee pain. J. Gerontol. B Psychol. Sci. Soc. Sci. 56, S261–S265 (2001).

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Health and Wellbeing, Sheffield Hallam University, Broomhall Road, Sheffield, S10 2BP, UK

    Stephen May

Authors
  1. Stephen May
    View author publications

    You can also search for this author in PubMed Google Scholar

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

May, S. Self-management of chronic low back pain and osteoarthritis. Nat Rev Rheumatol 6, 199–209 (2010). https://doi.org/10.1038/nrrheum.2010.26

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrrheum.2010.26

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing