Acute Low Back Problems Guideline Panel

 Stanley J. Bigos, MD, Chair 
 Orthopedic Surgery 
 Dr. Bigos is Professor of Orthopedic Surgery and Environmental Health at the University of Washington School of Medicine and founder and director of the  Spine Resource Clinic in Seattle. He is the author of numerous articles and book chapters focusing on back problems in industry and the management of back  pain. He has contributed to a new method of spine evaluation included in the American Medical Association's "Guidelines to Evaluate Permanent Impairment,  4th edition, 1993" and also serves as Consultant to the Clinical Standards Advisory Group of the British Department of Health. Among his many honors, Dr.  Bigos received from the American Academy of Orthopaedic Surgeons in 1991 the Kappa Delta Award for Orthopedic Excellence for his sentinel work on  industrial back problems. 

Rev. O. Richard Bowyer 
Rev. Bowyer has experienced low back pain for many years. He is campus minister at Fairmont State College, West Virginia, and also serves on the Board of Directors and Quality Assurance Committee of the Monongahela Valley Association of Health Centers. From 1981-1993 he was a consumer member of   the West Virginia Board of Medicine and served as chairperson of the Board's Complaints Committee. 

G. Richard Braen, MD 
Emergency Medicine 
 Dr. Braen is a practicing emergency physician at Buffalo General Hospital and Professor and Chairman of the Department of Emergency Medicine at State  University of New York, Buffalo. Certified by both the American Board of Emergency Medicine and the American Board of Internal Medicine, he has served on several guideline panels established by the American College of Emergency Physicians. He is currently President of the American Board of Emergency Medicine. 

Kathleen Brown, PhD, RN 
Occupational Health Nursing 
Dr. Brown is Professor in the School of Nursing of the University of Alabama at Birmingham and director of Occupational Health Nursing for the   NIOSH-funded Educational Resource Center for Occupational Health and Safety. Her research and publications have focused on the cst-effectiveness of   back school interventions and the effect of back school education and exercise on back-injured municipal workers. She is principal investigator of an  NIH-funded study of worksite education and exercise to prevent back injuries. 

 Richard Deyo, MD, MPH 
 Internal Medicine 
 Dr. Deyo, a general internist, is Professor in the Departments of Medicine and Health Services at the University of Washington School of Medicine, and staff  physician at the Seattle Veterans Affairs Medical Center. He is principal investigator of the low back pain Patient Outcome Research Team (PORT) and has  published widely on the diagnosis and treatment of low back problems in primary care and on the measurement of quality-of-life and outcomes of surgery for patients with back pain.

Scott Haldeman, DC, MD, PhD 
Dr. Haldeman is trained in chiropractic and is board certified in neurology, neurophysiology and electrodiagnosis. He is an Associate Clinical Professor of  Neurology at the University of California, Irvine, and an Adjunct Professor at Los Angeles Chiropractic College. He is past president of the North American  Spine Society and the North American Academy of Manipulative Medicine and has published widely in the fields of electrodiagnosis, spinal manipulation, and back pain.

John L. Hart, DO 
Rehabilitation Medicine 
Dr. Hart serves as Director of Outpatient Physical Medicine and Rehabilitation at Still Regional Medical Center in Columbia, Missouri. His research interests  include nonoperative treatment of herniated discs and the relationship of employee/employer interactions to the symptoms of low back pain.

Ernest W. Johnson, MD 
Physical Medicine/Rehabilitation 
Dr. Johnson served for 25 years as Chair of the Department of Physical Medicine and Rehabilitation at the Ohio State University College of Medicine before  assuming his present position as Professor and Associate Dean for External Affairs. He is past president of the American Academy of Physical Medicine and Rehabilitation, the Association of Academic Physiatrists, and the American Association of Electrodiagnostic Medicine. The author of numerous articles on electromyography, he serves as Chair of the American Board of Electrodiagnostic Medicine.

Robert Keller, MD 
Orthopedic Surgery 
Dr. Keller serves as Executive Director of the Maine Medical Assessment Foundation and is a member of the Council on Health Policy and Practice of the  American Academy of Orthopaedic Surgeons. He is co-investigator of the Patient Outcomes Research Team (PORT) evaluating low back pain and surgical  outcomes and has published on the subject of small area analysis and physician behavior change. A past president of the Maine Medical Association, he is an Adjunct Professor of Community and Family Medicine and Surgery in the Dartmouth Medical School. 

Daniel Kido, MD, FACR 
Dr. Kido is a Professor of Radiology and Director of the Neuroradiology Section of the Mallinckrodt Institute of Washington University School of Medicine in St. Louis, Missouri. His research and publications have focused on the assessment of imaging techniques to evaluate low back pain, including MRI, CT, and  myelography. He has also compared invasive and noninvasive imaging procedures of the low back, documenting frequency of complications.

Matthew H. Liang, MD, MPH 
Internal Medicine/Rheumatology 
Dr. Liang is an Associate Professor in the Departments of Medicine and Rheumatology at Harvard Medical School. He also serves as medical director of  rehabilitation services at the Brigham and Women's Hospital in Boston. His major research interests include outcome assessment of low back problems, cost-effectiveness of diagnostic procedures, and outcomes of spinal stenosis surgery.

Roger M. Nelson, PT, PhD 
Physical Therapy 
Dr. Nelson is Professor and Chairman of the Department of Physical Therapy at the Thomas Jefferson University College of Allied Health Sciences. His  clinical interests include electromyography and measurements of outcome and satisfaction of low back pain patients. He is a contributor to the National  Institute of Occupational Safety and Health (NIOSH) Low Back Atlas on the subject of tests and measures for the assessment of low back pain.

Margareta Nordin, RPT, DrSci 
Orthopedic Research 
Dr. Nordin is Research Associate Professor and Director of the Occupational and Industrial Orthopaedic Center of the Hospital for Joint Diseases in New York City. Her primary research interest is the prevention of chronicity among patients with low back pain. She has published extensively on the biomechanics, ergonomics, and early care of low back pain. 

Bernice D. Owen, PhD, RN 
Community Health Nursing 
Dr. Owen is a Professor in the School of Nursing of the Center for Health Sciences, University of Wisconsin, Madison. Her work as a teacher and researcher has focused on back stress among health care personnel and the reduction of physical demands on the back in occupational settings. She currently serves as a consultant on back injury reduction programs to hospitals, long-term care facilities, and home care agencies.

Malcolm H. Pope, DrMedSc, PhD 
Orthopedic Research/Biomedical Engineering 
Dr. Pope is Professor of Biomedical Engineering at the University of Iowa and serves as Director of the Iowa Spine Research Center. Before coming to Iowa, he was Director of Orthopaedic Research at the University of Vermont. His research and numerous publications have focused on the biomechanics of   low back pain, ergonomics, and the primary and secondary prevention of low back problems.

Richard K. Schwartz, MS, OTR, FSR 
 Occupational Therapy 
 Mr. Schwartz has treated work-related injuries since 1972. He is currently in private practice as an occupational therapy consultant on injury prevention, ergonomics, and early return-to-work programs. Before 1992 he was Associate Professor and Chairman of Occupational Therapy at the University of Texas  Health Science Center at San Antonio.

Donald H. Stewart, Jr., MD Neurosurgery 
Until his retirement in 1993, Dr. Stewart was in private practice as a neurosurgeon in Syracuse, New York. He also served as Clinical Assistant Professor of  Neurosurgery at the State University of New York, Syracuse. He has published widely on medical economics and medical liability.

Jeff Susman, MD 
Family Practice 
Dr. Susman is Associate Professor, Director of Primary Care, and Vice Chairperson of the Department of Family Practice at the University of Nebraska  Medical Center. A member of the American Academy of Family Physicians' Task Force on Clinical Policies, he is interested in clinical decisionmaking by  physicians and the effects of guidelines on health provider behavior.

John J. Triano, MA, DC 
Dr. Triano is a staff chiropractic physician and a clinical research scientist at the Texas Back Institute in Plano, Texas. He coordinates the work of  interdisciplinary teams in the rehabilitation of patients with spinal pain and conducts research on spine biomechanics and the outcomes of patients treated for  spinal problems. He has served as a consultant to the U.S. Department of Labor and NIOSH training programs and is a Professor at the National College of Chiropractic, Lombard, Illinois.

Lucius C. Tripp, MD, MPH, FACPM 
Industrial Medicine/Neurosurgery 
Dr. Tripp, a neurosurgeon, is board certified in Occupational Medicine and Addiction Medicine. He serves as Medical Director of the General Motors-Henry  Ford Hospital Rehabilitation Center in Warren, Michigan, and is actively involved in research on the prevention of back injury and restoration of function in  patients with back pain. He is a member of the Board of Directors of the American College of Occupational and Environmental Medicine.

Dennis C. Turk, PhD 
Dr. Turk is a Professor in the Departments of Psychiatry and Anesthesiology at the University of Pittsburgh School of Medicine. He serves as Director of the University's Pain Evaluation and Treatment Institute, a large interdisciplinary facility that annually evaluates and treats over 1,500 new patients, the majority of  whom have back pain. His current research is directed toward examination of the role of psychological factors in back pain and the accompanying disability.

Clark Watts, MD, JD 
 Dr. Watts is a Professor of Neurosurgery at the University of Texas Health Science Center at San Antonio. As editor of Neurosurgery from 1982-1987, he  was responsible for evaluating and publishing research on the care of low back problems. His own research has focused on the nature of discogenic pain and the clinical management (operative and nonoperative) of low back problems.

James N. Weinstein, DO 
Orthopedic Surgery 
Dr. Weinstein is a Professor in the Departments of Orthopaedic Surgery and Biomedical Engineering and is Director of the Spine Diagnostic and Treatment Center at the University of Iowa Hospitals and Clinics. His research has focused on the basic mechanisms of pain and aging, the diagnosis and treatment of spinal tumors, and the evaluation of outcomes for patients with low back pain. He is currently Editor-in-Chief of the journal Spine. 

Other Contributors

Project Directors

John P. Holland, MD, MPH 
University of Washington 
Seattle, Washington 
John S. Webster, MD 

Naval Regional Medical Center 
San Diego, California 


Michele C. Battie, PhD, PT 
     Orthopedic Research 
     University of Washington 
     Seattle, Washington 
Claire Bombardier, MD, FRCP 
     Rheumatology/Clinical Epidemiology 
     University of Toronto 
     Toronto, Ontario, Canada 
Nortin M. Hadler, MD 
     University of North Carolina 
     Chapel Hill, North Carolina 
Alf L. Nachemson, MD, PhD 
     Orthopaedic Surgery 
     Göteborg University 
     Göteborg, Sweden 
Gordon Waddell, MD 
     Orthopaedic Surgery 
     Western Infirmary 
     Glasgow, Scotland 


David L. Schriger, MD, MPH 
UCLA Medical School 
Los Angeles, California 

Paul G. Shekelle, MD, MPH 
Department of Veterans Affairs Medical Center 
West Los Angeles, California 

Panel Staff

Mary M. Webster, MA 
Seattle, Washington 
Laura Novell 

St. Louis, Missouri 
Keld Vaegter, MD 
Ralix, Sweden 


David Lanier, MD, MFA 
     Project Officer 
Randie A. Siegel 
     Managing Editor 
Harriet V. Bennett 
Karen Carp 
     Public Affairs Specialists 

Peer Reviewers [1] 

Lucien Abenhaim, MD, MSc, ScD 
     McGill University 
     Montreal, Quebec, Canada 
Gad Alon, PhD, PT 
     University of Maryland 
     Department of Physical Therapy 
     Baltimore, Maryland 
Michael Andary, MD 
     Michigan State University 
     College of Osteopathic Medicine 
     East Lansing, Michigan 
Gunnar B.J. Andersson, MD, PhD 
     Rush-Presbyterian-St. Luke's Medical Center 
     Chicago, Illinois 
Howard A. Balduc, DC 
     American Chiropractic Association 
     Arlington, Virginia 
Judith C. Bautch, PhD, RN, CS 
     University of Wisconsin School of Nursing 
     Madison, Wisconsin 
James R. Bean, MD 
     Neurosurgical Associates 
     Lexington, Kentucky 
Alfred O. Berg, MD, MPH 
     University of Washington 
     Seattle, Washington 
Stephen Blood, DO 
     American Academy of Osteopathy 
     Indianapolis, Indiana 
Wilbur J. Boike, MD 
     Center for Comprehensive Back Care 
     Flint, Michigan 
Richard H. Borman, MD 
     University of California 
     San Diego, California 
Albert M. Brady, MD 
     Harris Methodist Health System 
     Fort Worth, Texas 
Phillip O. Bridenbaugh, MD 
     University of Cincinnati Medical Center 
     Cincinnati, Ohio 
Jerry M. Calkins, PhD, MD 
     University of Arizona Department of Anesthesiology 
     Phoenix, Arizona 
J. David Cassidy, DC, PhD 
     Royal University Hospital Department of Orthopaedics 
     Saskatoon, Saskatchewan, 
C. Richard Chapman, PhD 
     University of Washington Department of Anesthesiology 
     Seattle, Washington 
Steven G. Charapata, MD 
     Pain Management Associates 
     Kansas City, Missouri 
Joy White Danches, MOT, OTR 
     Visionary Management, Inc. 
     Dallas, Texas 
Marsha Courville Davis, MSN, RN, CRRN 
     Association of Rehabilitation Nurses 
     Jackson, Mississippi 
Douglas E. DeGood, PhD 
     University of Virginia Health Sciences Center 
     Charlottesville, Virginia 
Anthony Delitto, PT, PhD 
     University of Pittsburgh 
     Pittsburgh, Pennsylvania 
Mark A. Doyne, MD, FACPE 
     Texas Back Institute 
     Dallas, Texas 
Daniel A. Dyrek, MS, PT 
     Massachusetts General Hospital 
     Boston, Massachusetts 
Frank Eismont, MD 
     University of Miami School of Medicine 
     Miami, Florida 
Maury R. Ellenberg, MD, FACP 
     Wayne State University School of Medicine 
     Detroit, Michigan 
Julia Faucett, RN, PhD 
     University of California 
     San Francisco, California 
Morris A. Fisher, MD 
     Loyola University Stritch School of Medicine 
     Chicago, Illinois 
Gary M. Franklin, MD, MPH 
     University of Washington Occupational Epidemiology 
     Seattle, Washington 
Todd D. Gastaldo, DC 
     Private Chiropractic Research 
     Sunnyvale, California 
Sharon J. Gates 
     The Graduate Hospital 
     Philadelphia, Pennsylvania 
Michael Goertz, MD, MPH 
     Airport Medical Clinic 
     Minneapolis, Minnesota 
Michael K. Greenberg, MD 
     Uniformed Services University of the Health Sciences 
     Bethesda, Maryland 
J. Eric Griffiths, DC 
     Wheat Ridge Chiropractic Center 
     Denver, Colorado 
Daniel T. Hansen, DC, FICC 
     Private Practice of Chiropractic 
     Olympia, Washington 
Dennis L. Hart, PhD, PT 
     Rehability Corporation 
     Falls Church, Virginia 
Jodie K. Haselkorn, MD, MPH 
     Veterans Affairs Medical Center 
     Seattle, Washington 
Stanley A. Herring, MD 
     Puget Sound Sports and Spine Physicians 
     Seattle, Washington 
Paul D. Howard, PhD, PT 
     Thomas Jefferson University 
     Philadelphia, Pennsylvania 
Thomas E. Hyde, DC, CCSP 
     American Chiropractic Association Sports Council 
     North Miami Beach, Florida 
Susan J. Isernhagen, PT 
     Isernhagen & Associates, Inc. 
     Duluth, Minnesota 
Manucher J. Javid, MD 
     University of Wisconsin 
     Department of Neurosurgery 
     Madison, Wisconsin 
John H. Juhl, DO 
     American Academy of Osteopathy 
     New York, New York 
Neil Kahanovitz, MD 
     Anderson Clinic 
     Arlington, Virginia 
Robert D. Kerns, PhD 
     West Haven VA Medical Center 
     Yale University 
     West Haven, Connecticut 
Myron M. LaBan, MD, FACP 
     William Beaumont Hospital Department of Physical Medicine and Rehabilitation 
     Royal Oak, Michigan 
Ruth A. Larkin, RN 
     North Colorado Medical Center 
     Greeley, Colorado 
Casey K. Lee, MD 
     New Jersey Medical School Department of Orthopaedics 
     Newark, New Jersey 
Daniel Lessard 
     Back Health Medical Centers 
     Seattle, Washington 
Stephen M. Levin, MD 
     American Academy of Orthopaedic Medicine 
     Vienna, Virginia 
Philipp M. Lippe, MD, FACS, FACPM 
     American Academy of Pain Medicine 
     Skokie, Illinois 
Michael D. Lockshin, MD 
     National Institute of Arthritis and Musculoskeletal and Skin Diseases 
     National Institutes of Health 
     Bethesda, Maryland 
John D. Loeser, MD 
     University of Washington 
     Seattle, Washington 
Don M. Long, MD, PhD 
     Johns Hopkins University School of Medicine 
     Baltimore, Maryland 
Sally L. Lusk, PhD, RN, FAAN 
     University of Michigan School of Nursing 
     Ann Arbor, Michigan 
Norman J. Marcus, MD 
     New York Pain Treatment Program 
     Lenox Hill Hospital 
     New York, New York 
Stephen C. Marini, MS, DC, PhD 
     Pennsylvania College of Chiropractic 
     Philadelphia, Pennsylvania 
Tom G. Mayer, MD 
     Southwestern Medical School Department of Orthopedics 
     Dallas, Texas 
George B. McClelland, DC 
     Foundation for Chiropractic Education and Research 
     Arlington, Virginia 
William A. McIlwain, MD, FACS 
     Bristol Regional Medical Center 
     Bristol, Tennessee 
William C. Meeker, DC, MPH 
     Palmer College of Chiropractic-West 
     San Jose, California 
Christine Miaskowski, RN, PhD 
     University of California 
     San Francisco, California 
Edward H. Mills, MD 
     U.S. Department of Labor 
     Seattle, Washington 
Michael Mittelmann, MD 
     Aetna Life and Casualty 
     Hartford, Connecticut 
Vert Mooney, MD 
     University of California 
     San Diego, California 
Mary T. Muffroid, PhD, PT 
     University of Vermont 
     Burlington, Vermont 
Albert M. Murtland, MD 
     Guthrie Clinic 
     Sayre, Pennsylvania 
David E. Nestor, MS, PT, ECS 
     U.S. Public Health Service 
     Rochester, Minnesota 
E.J. Nordby, MD 
     University of Wisconsin Medical School 
     Madison, Wisconsin 
Jane E. Parker-Conrad, PhD, RN 
     Walters State College 
     Morristown, Tennessee 
Richard Payne, MD 
     University of Texas M.D. Anderson Cancer Center 
     Houston, Texas 
Reed B. Phillips, DC, PhD 
     Los Angeles College of Chiropractic 
     Whittier, California 
William R. Phillips, MD, MPH 
     University of Washington 
     Seattle, Washington 
Vern Putz-Anderson, PhD 
     National Institute for Occupational Safety and Health 
     Cincinnati, Ohio 
Jan K. Richardson, PT, PhD 
     Slippery Rock University School of Physical Therapy 
     Pittsburgh, Pennsylvania 
Hubert L. Rosomoff, MD, DMedSc 
     University of Miami School of Medicine 
     Department of Neurological Surgery 
     Miami, Florida 
Renee Steele Rosomoff, RN, MBA, CRC 
     University of Miami Comprehensive Pain and Rehabilitation Center 
     Miami Beach, Florida 
Michel Rossignol, MD, FRCPC 
     McGill University 
     Montreal, Quebec, Canada 
Donald Sheffel, MD 
     Memorial Hospital Division of Neurosurgery 
     Hollywood, Florida 
Dennis Shubert, MD, PhD 
     Neurosurgical Associates 
     Bangor, Maine 
Stover H. Snook, PhD 
     Liberty Mutual Insurance Company 
     Hopkinton, Massachusetts 
Jody L. Snow, PT 
     Sacred Heart Medical Center 
     The Rehabilitation Center 
     Spokane, Washington 
Dan M. Spengler, MD 
     Vanderbilt University Medical Center Department of Orthopaedics and Rehabilitation 
     Nashville, Tennessee 
Richard L. Stieg, MD 
     University of Colorado Health Sciences Center Department of Neurology 
     Denver, Colorado 
Rand S. Swenson, DC, MD, PhD 
     Dartmouth Medical School 
     Hanover, New Hampshire 
Robert L. Swezey, MD, FACP, FACR 
     Arthritis & Back Pain Center 
     Santa Monica, California 
Peter J. Vicente, PhD 
     Good Samaritan Hospital Pain Rehabilitation Center 
     Cincinnati, Ohio 
Nicholas E. Walsh, MD 
     University of Texas Health Science Center 
     San Antonio, Texas 
Barbara S. Webster, RPT, PA-C 
     American Academy of Physician Assistants 
     Alexandria, Virginia 
Debra Weiner, MD 
     Duke University Medical Center 
     Durham, North Carolina 
Arthur H. White, MD 

     San Francisco Spine Institute 
     San Francisco, California 
John W. Wickenden, MD 

     Penobscot Bay Medical Center 
     Rockport, Maine 
Sam W. Wiesel, MD 
     Georgetown University Medical Center Department of Orthopaedics 
     Washington, DC 
Arthur Winter, MD, FICS 
     University of Medicine and Dentistry of New Jersey 
     New Jersey Neurological Institute 
     Livingston, New Jersey 
Hansen A. Yuan, MD 
     State University of New York 
     Syracuse, New York 

Pilot Reviewers

Douglas A. Benner, MD 
     Kaiser Permanente 
     Oakland, California 
James E. Blessman, Jr., MD, MPH 
     Wayne State University 
     Detroit, Michigan 
Michael Erdil, MD 
     Industrial Medical Care Center 
     Hartford, Connecticut 
Don C. Fisher, MD, MS 
     Presbyterian Occupational Health Network 
     Albuquerque, New Mexico 
Garry A. Goldstein, MD 
     General Motors Corporation 
     Wilmington, Delaware 
Robert J. Gorman, MD, MPH 
     Park Nicollet Medical Center 
     Minneapolis, Minnesota 
Rowland G. Hazard, MD 
     University of Vermont 
     Burlington, Vermont 
Timothy J. Key, MD, MPH 
     University of Alabama School of Medicine 
     Birmingham, Alabama 
Ron R. Loeppke, MD, MPH 
     Corporate Health and Medical Programs, Inc. 
     Greeley, Colorado 
Christel Mottur-Pilson, PhD 
     Internal Medicine Center to Advance Research & Education (IMCARE) 
     Washington, DC 
Julie Graves Moy, MD, MPH 
     Baylor College of Medicine 
     Houston, Texas 
Dennis A. Plante, MD 
     University of Vermont 
     Burlington, Vermont 
Louis Sportelli, DC 
     Private Practice
     Palmerton, Pennsylvania