Chou defines non-specific LBP as, “LBP that cannot reliably be attributed to a specific disease or spinal abnormality”; 85% of LBP patients fall into this category.3 Fritz and colleagues concluded, “nonspecific LBP is not a homogenous entity, but instead consists of subtypes, or classifications, that can be identified based on specific signs and symptoms.”5,6
Treatment-Based Classification System
A promising classification system that has gained popularity is the Treatment-Based Classification System (TBC), which is based on the original work of Delitto and colleagues in 1995.6-8 This approach uses information gathered from the physical examination and from patient self-reports of pain (10-point pain scale and pain diagram) and disability (modified Oswestry questionnaire, see Figure 1). This information allows patient subgrouping, which then guides patient treatment.6-9 This system combines and modifies different schools of thought into a more practical, evidence-based system.
Using this system, patients are screened for both red and yellow flags. Red flags are associated with serious medical conditions that can mask as musculoskeletal pain (see Table 1).10-12 Yellow flags are believed to represent psychological barriers that may delay recovery.