Assuming other conditions have been excluded, patients with low back pain and sciatica should be assessed using a prognostic questionnaire to help identify modifiable risk factors – biomedical, psychological and social – for disability. An example of this is the STarT Back Screening Tool. The resulting score determines whether a patient is regarded as low, medium or high risk, and their treatment package matched accordingly.

• Low risk patients are very likely to improve, so the primary aims of management are to address concerns, provide information and enable self care
• Medium risk patients require the above but with the aim of restoring everyday functioning, including being able to work, and minimising disability even if pain remains present, for example, by using physiotherapy interventions
• High risk patients should be given a plan that aims to reduce pain and disability, and improve psychological functioning. Those delivering care to this group should have undergone additional training so that they are able to address more complex issues, as these patients often have significant psycho-social barriers to recovery. An example of an appropriate strategy is to bring elements of CBT into physiotherapy sessions.