Table 1 Definitions of interventions based on the general base of treatment

Exercise therapy (ET)

Strengthening/resistance

Exercise training designed to improve the strength, power, endurance, and size of skeletal muscles

Stretching

Exercise training including muscle lengthening using any of the following methods: passive, static, isometric, ballistic, or proprioceptive neuromuscular facilitation

Stabilization/motor control

Exercise training targeting specific trunk/neck muscles to improve control and coordination of neck and related structures

Proprioception

Exercises to increase the proprioceptive and kinaesthetic control

Pilates

Exercise training following traditional Pilates’s principles such as centring, concentration, control, precision, flow, and breathing

Yoga/Tai Chi/Qigong

Exercise training following traditional yoga/Tai Chi/Qigong principles with a physical component

Aerobic supervised training

Exercise’s training such as walking, cycling, and jogging in any land-based mode that is designed to improve the efficiency and capacity of the cardiorespiratory system guided by a health professional and conducted generally in a clinical setting

Water-based

Exercise training performed in deep or shallow water

Prescribed physical activity

General recommendation to perform exercises such as walking, cycling, and rowing, aimed at improving overall physical activity. These recommendations are not supervised and are carry out by the participants on their own

Balance

Exercises aimed at improving postural balance

Relaxation

Techniques that reduce stress and promote calm (i.e., deep breathing, muscle relaxation, and meditation)

Respiratory exercises

Exercises focus on improving the function of the lungs and respiratory muscles by controlling breathing patterns (i.e., diaphragmatic breathing, pursed-lip breathing, and controlled breath holding)

Postural exercises

Movements that strengthen the muscles involved in maintaining proper postural alignment (such as the core, back, and pelvic muscles), while also increasing flexibility and balance

Ergonomic

Ergonomic exercises are specific physical activities aimed at preventing and alleviating musculoskeletal complains and repetitive stress injuries by improving body mechanics and promoting proper alignment. They focus on enhancing flexibility, strength, and posture of muscles and joints, particularly those most affected by prolonged sitting, typing, or repetitive motions

Multimodal

Two or more of the specific types of exercise training mentioned above (not deemed multimodal if only part of warm up or cool down)

Active exercise

Voluntary contraction and movement of muscles to perform physical activities, typically against gravity or resistance, without external help

Assistive exercise

Partially active movements in which the individual engages their muscles but requires assistance—either from a therapist, a device, or equipment—to complete the movement

Supervised exercise

Structured physical activity programs conducted with the direct supervision of a health practitioner who monitors the participant’s form, intensity, and progress

Not supervised exercise

Exercise not supervised by a health practitioner

Other

Exercise training that does not meet any of the specific types of exercise training mentioned above

Manual therapy (MT)

Manual therapy: spinal manipulation

High velocity thrust techniques at or near the end of the passive or physiologic range of motion

Manual therapy: spinal mobilization

Low-grade velocity movement techniques within the patient’s range of motion and control

Neural mobilization

Techniques designed to facilitate the movement of neural tissue within its surrounding anatomical structures, such as muscles and fascia

Massage

Soft tissue massage, acupressure

Trigger point therapy

Soft tissue technique including only techniques associated with trigger point deactivation

Myofascial release

Movements applied gently with a sustained pressure to specific areas of the fascia to release restrictions and improve the body’s movement patterns

Maitland mobilization

Treatment of joints and soft tissues through skilled manual therapy techniques, which includes rolling, rotating, sliding, and separation traction

Mobilization with movement (MWM)

Mobilization with movement (MWM) is a manual therapy technique that integrates passive joint mobilization by the therapist with active movement performed by the patient. This method aims to immediately reduce pain and restore normal movement by applying a sustained, pain-free accessory glide to the joint while the patient actively moves through the impaired range of motion

Sustained natural apophyseal glides (SNAGs)

The application of an MWM in the spine is referred to as a SNAG. This manual therapy technique applied to the spine involves the combination of a sustained passive accessory glide (or joint mobilization) applied in the plane of the facet joints by the physiotherapist to the spine (specific motion segment) with active movement from the patient. SNAGs can be applied centrally on the spinous process or laterally on the articular pillar

Natural apophyseal glides (NAGs)

Painless oscillatory mid- to end-range mobilization applied in the plane of the facet joints on the spinous process or articular pillar applied between C2 and C7

Reverse NAGs

Painless oscillatory mid- to end-range mobilization is applied in the plane of the facet joints on the spinous process or articular pillar. This technique can be applied between C6 and the upper thoracic spine

High-velocity low amplitude (HVLA) technique

Rapid use of force over a short duration, distance, and/or rotational area within the anatomical range of motion of a joint to engage the restrictive barrier in one or more planes of motion to elicit the release of restriction

Passive accessory intervertebral movements (PAIVMS)

Passive accessory intervertebral movement to produce movements in directions that cannot be produced actively in isolation

Multimodal MT

Two or more of the specific types of MT techniques mentioned above

Patient education

Pain neuroscience education (PNE)

Educational sessions that describe the neurobiology and neurophysiology of pain by the nervous system

Education

Educational intervention, advice on importance of staying active, reassurance among others

Behavioral graded activity (BGA)

Behavioral treatment integrating the concept of operant conditioning with exercise therapy comprising booster sessions

Pharmacological

NSAIDs

Ibuprofen, naproxen, sulindac, ketoprofen, tolmetin, etodolac, fenoprofen, diclofenac, flurbiprofen, piroxicam, ketorolac, Indomethacin, meloxicam, nabumetone, oxaprozin, mefenamic acid, diflunisal, fenoprofen

Opioids (strong)

Morphine, hydromorphone, oxycodone, fentanyl, methadone, buprenorphine, diamorphine, tapentadol

Opioids (weak)

Codeine, hydrocodone, tramadol, pentazocine, tilidine

Muscle relaxants: benzodiazepines

Diazepam, estazolam, quazepam, alprazolam, chlordiazepoxide, clorazepate, lorazepam, flurazepam, clonazepam, temazepam, midazolam

Muscle relaxants: skeletal

Flupirtine, orphenadrine, dantrolene, carisoprodol, tizanidine, incobotulinumtoxinA, cyclobenzaprine, metaxalone, baclofen, methocarbamol, chlorzoxazone

Antidepressants

Duloxetine, desvenlafaxine, levomilnacipran, fluoxetine, fluvoxamine, paroxetine, escitalopram, citalopram, sertraline, amitriptyline, amoxapine, desipramine, imipramine, doxepin, clomipramine, trimipramine, protriptyline, imipramine, nortriptyline, doxepin, nortriptyline

Paracetamol

Topical agents (non-opioid)

Diclofenac, capsaicin, lidocaine

Main comparators

Control

No active treatment, no prescribed physical exercise, no physical/manual therapy. The waiting list is a good example of a control intervention

Oral placebo

Any treatment that has no active properties and is applied via oral (e.g., sugar pills)

Topical placebo

Any treatment that has no active properties and is applied on the skin (e.g., creams)

Sham therapy

An inactive procedure designed to mimic the active procedure as closely as possible (e.g., sham acupuncture, sham manual therapy)

Usual care

Any treatment that the targeted patient population would be expected to receive as part of the normal practice

Usual care intervention may include information or general advice to stay active (without specific exercise instructions) or keep doing the treatment delivered by clinicians without study goals or protocolized treatments