[Therapeutic injections and manual medicine in low-back pain : Bimodal synergies between evidence and empiricism].

Background: Oriented towards the therapy planning and management of rheumatic patients, and based on the differentiated therapeutic principles of manual medicine (MM) with knowledge on evidence of therapeutic local infiltration techniques (TLI), the author pleads for the establishment of a structured, mechanism-based therapy concept in the sense of "treat to target" (T2T) for patients with (chronic) degenerative low-back pain (LBP) in outpatient pain therapy care.

Diagnostics: This requires a consistent (primary) diagnosis with pain analysis under the premise that LBP is always specific if it is structurally and functionally conditioned. A broad bio-psycho-social anamnesis and structure-based clinical diagnosis (imaging) with functional differentiation according to MM principles and, if necessary, interventional blocks, should result in the expression of a three-level diagnosis as a prerequisite for a mechanism-based, hierarchic step therapy in LBP. In this article, this is presented in a pragmatic, case-oriented manner, with the implementation of techniques and evidence of TLI and MM.