For low back pain, with or without sciatica, NICE revised (draft) guidance recommends risk stratification and a multimodal treatment package comprising exercise alongside at least one of:
– Manual therapy [manipulation, mobilisation or soft tissue techniques (for example, massage)]
– Psychological therapy (for example, cognitive behavioural therapy)
It is noted that mobilisation and soft tissue techniques are performed by a wide variety of practitioners; whereas manipulation is usually performed by chiropractors or osteopaths, and by doctors or physiotherapists who have undergone additional training in manipulation. Manual therapists often combine a range of techniques in their approach and may also include exercise interventions and advice about self-management.