Macphail K (2018) Physiotherapy Management of Chronic Low Back Pain Patients with Yellow Flags: A Systematic Review. J Musculoskelet Disord Treat 4:060.


© 2018 Macphail K. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

SYSTEMATIC REVIEW | OPEN ACCESS DOI: 10.23937/2572-3243.1510060

Physiotherapy Management of Chronic Low Back Pain Patients with Yellow Flags: A Systematic Review

Kieran Macphail*

Bowskill Clinic, London, United Kingdom


CLBP is the leading cause of years lived with disability worldwide and patients with yellow flags have the worst outcomes and contribute significantly to the societal cost. Clinicians are aware of the importance of yellow flags but feel undertrained to deal with them. Furthermore there is a lack of clarity for clinicians looking at how to specifically manage these patients from guidelines and an incredibly varied set of approaches available to clinicians. The objective of this review was to review the effectiveness of the physiotherapy interventions for chronic low back pain patients with yellow flags that have been studied. Three approaches were used for retrieving literature. Searches were conducted initially using the terms "physiotherapy", "chronic low back pain", psychosocial and "management or treatment", using the databases PubMed, Embase, PEDro and CINHAL from January 1987 up to February 2017. In addition content experts were consulted to ensure no additional papers were missed and citation tracking was implemented. 39 studies were identified with 20 meeting the selection criteria. Interestingly the term yellow flags is not used in the treatment literature and instead specific psychosocial terms are used. This review tentatively suggests specific exercise and passive interventions are more beneficial for reducing measures of pain, whilst psychological input and general exercise appears more targeted towards psychosocial measures.