Michael J Schneider

• DC, PhD
• Professor (Full) at University of Pittsburgh

Background Surgical intervention for lumbar spinal stenosis (LSS) is common and associated with high rates of postoperative side effects or complications. Prehabilitation programs aim to reduce postoperative complications and enhance outcomes. However, the clinical effectiveness of prehabilitation programs for patients undergoing LSS surgery has ye...

Objective Chronic low back pain (cLBP) is a common condition that impacts quality of life and function. There are many evidence-based treatments to address cLBP; however, treatment effects are modest, perhaps in part due to individual variation in treatment response. The Biomarkers for Evaluating Spine Treatments (BEST) Trial was designed as the co...

Background There is limited high-quality research examining conservative treatments for back-related leg pain (BRLP). This feasibility study was done in preparation for a full-scale trial comparing a whole-person supported self-management intervention to medical care for chronic BRLP. Methods Participants were randomized to 12 weeks of individuali...

We need a better approach to patients with low back pain (LBP). Current care is plagued by variability, over-medicalization of biopsychosocial problems, inequity, and an overemphasis on interventional and surgical care. Guidelines focused on the short-term management of acute LBP are generally not followed and have limited applicability in clinical...

Objective Entrustable professional activities (EPAs) have seen widespread adoption in medical education and other health professions education. EPAs aim to provide a bridge between competency-based education and clinical practice by translating competencies into fundamental profession-specific tasks associated with clinical practice. Despite the ex...

Purpose Lumbar spinal stenosis (LSS) is common in our aging population resulting in pain and functional impairment. Recent advances in pain research have identified several single nucleotide polymorphisms (SNP) associated with inter-individual symptom and treatment response. The goal of the current study was to investigate the association of SNPs i...

Introduction Lumbar spinal stenosis (LSS) is a leading cause of chronic musculoskeletal pain among older adults. A common and costly intervention for the treatment of LSS is lumbar decompression with or without fusion (LSS surgery), which has mixed outcomes among patients. Prehabilitation is a strategy designed to optimize the consistency of positi...

Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Back Pain Research...

Objective The aim of this study was to explore associations between the utilization of active, passive, and manual therapy interventions for low back pain with one-year escalation-of-care events including opioid prescriptions, spinal injections, specialty care visits, and hospitalizations. Methods This was a retrospective cohort study of 4827 pati...

Background The chiropractic profession in the United States (US) has a long history of intra-professional discourse surrounding ideology and beliefs. Large-scale efforts have evaluated 3 distinctive subgroups of US chiropractors focused on these areas of practice: spine/neuromusculoskeletal, primary care, and vertebral subluxation. To our knowledge...

Background Chiropractors commonly encounter patients who present for spine pain with parallel substance use. There is currently no widespread training within the chiropractic profession to prepare chiropractors to recognize and address substance use in clinical practice. The purpose of this study was to examine chiropractors’ confidence, self-perce...

Objective: Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and depend largely on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider a...

Theoretical models to explain health service utilization are numerous and there is no known literature that has synthesized existing models for health service utilization. Systematic searches were conducted in PubMed, MEDLINE, PsychINFO, Scopus, and CINAHL databases from 1960 through May 2021. Literature theorizing models/frameworks for health serv...

Background Chronic low back pain (cLBP) is widespread, costly, and burdensome to patients and health systems. Little is known about non-pharmacological treatments for the secondary prevention of cLBP. There is some evidence that treatments addressing psychosocial factors in higher risk patients are more effective than usual care. However, most clin...

Background Chronic low back pain (cLBP) is widespread, costly, and burdensome to patients and health systems. Little is known about non-pharmacological treatments for the secondary prevention of cLBP. There is some evidence that treatments addressing psychosocial factors in higher risk patients are more effective than usual care. However, most clin...

We aimed to identify and describe the current interventions used in preoperative programs ("prehabilitation") for spine surgery. Knowledge gaps in approaches, feasibility, timing, patient experience, clinical outcomes, and health care costs were explored while describing their potential benefits on physical and psychological outcomes. An electronic...

Background: Chiropractic is the largest complementary and alternative medicine profession in the United States, with increasing global growth. A preliminary literature review suggests a lack of widespread diversity of chiropractic patient profiles. Objective: There have been no prior studies to comprehensively integrate the literature on chiropr...

As a member of the Back Pain Consortium (BACPAC), the University of Pittsburgh Mechanistic Research Center's research goal is to phenotype chronic low back pain using biological, biomechanical, and behavioral domains using a prospective, observational cohort study. Data will be collected from 1,000 participants with chronic low back pain according...

Background Low back pain (LBP) is a common musculoskeletal condition and a major cause of disability worldwide. Previous studies have found associations of biomarkers with pain and pain-related disability in LBP patients. This study aimed to explore the association between serum biomarkers and pain and disability in patients with acute or subacute...

Background In an article published in 2011, we discussed the need for a new role in health care systems, referred to as the Primary Spine Practitioner (PSP). The PSP model was proposed to help bring order to the chaotic nature of spine care. Over the past decade, several efforts have applied the concepts presented in that article. The purpose of th...

The Biobehavioral Working Group of BACPAC was charged to evaluate a range of psychosocial, psychophysical, and behavioral domains relevant to chronic low back pain, and recommend specific assessment tools and procedures to harmonize biobehavioral data collection across the consortium. Primary references and sources for measure selection were the In...

The worldwide outbreak of SARS-COV2 has fueled a renewed interest in virtual delivery of healthcare services. Care for musculoskeletal disorders, specifically low back pain (LBP) is no different. Questions remain however regarding safety and efficacy, as well as satisfaction of patients and providers. The objective of this systematic review was to...

Introduction: Chronic low back pain (cLBP) is highly prevalent in the United States and globally, resulting in functional impairment and lowered quality of life. While many treatments are available for cLBP, clinicians have little information about which specific treatment(s) will work best for individual patients or subgroups of patients. The Bac...

BACKGROUND CONTEXT Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. Our 2013 Cochrane systematic review assessing the effectiveness of nonoperative treatments for neurogenic claudication found only low and very low-quality evidence. Therefore, no conclusions could be made on the effectiveness...

BACKGROUND CONTEXT Lumbar spinal stenosis (LSS) is a prevalent condition associated with limited walking capacity, reduced physical function and increased disability. While many patients with LSS potentially benefit from nonsurgical interventions, it is critical to have sensitive assessment tools to detect changes in these domains over time to guid...

Background Lumbar spinal stenosis (LSS) is a common degenerative spinal condition in older adults associated with disability, diminished quality of life, and substantial healthcare costs. Individual symptoms and needs vary. With sparse and sometimes inconsistent evidence to guide clinical decision-making, variable clinical care may lead to unsatisf...

Background The uptake of Self-Management Support (SMS) among clinicians is suboptimal. To date, few studies have tested knowledge translation (KT) interventions to increase the application of SMS in chiropractic teaching clinics. Study objective Evaluate the feasibility of implementing a KT intervention to promote the use of a SMS strategy among c...

Objectives Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication. Design A systematic review. Data sources CENTRAL, MEDLINE, EMBASE, CINAHL and Index to Chi...

Background Lumbar spinal stenosis (LSS) is a common degenerative spinal condition in older adults associated with disability, diminished quality of life, and substantial healthcare costs. Individual symptoms and needs vary. With sparse and sometimes inconsistent evidence to guide clinical decision-making, variable clinical care may lead to unsatisf...

Objective The objective of this study was to establish the level of inter-examiner reliability for six common cervical manual and physical examination procedures used to assess the cervical spine. Materials Reliability study that used a convenience sample of 51 patients between the ages of 16–70 years presenting with a chief complaint of neck pain...

Low back pain (LBP) remains a musculoskeletal condition with an adverse societal impact. Globally, LBP is highly prevalent and a leading cause of disability. This is an update to the 2012 Academy of Orthopaedic Physical Therapy (AOPT), formerly the Orthopaedic Section of the American Physical Therapy Association (APTA), clinical practice guideline...

Background Professional subgroups are common and may play a role in aiding professional maturity or impeding professional legitimization. The chiropractic profession in the United States has a long history of diverse intra-professional subgroups with varying ideologies and practice styles. To our knowledge, large-scale quantification of chiropracti...

Objective Cervical artery dissection (CAD) has been associated with spinal manipulative therapy (SMT). Although uncommonly reported, SMT-associated CADs hold devastating neurological consequences, warranting further exploration. We endeavored to investigate this association through the comparison of all CAD etiologies at a single academic medical c...

Background Many patients with acute low back pain (LBP) first seek care from primary care physicians. Evidence is lacking for interventions to prevent transition to chronic LBP in this setting. We aimed to test if implementation of a risk-stratified approach to care would result in lower rates of chronic LBP and improved self-reported disability....

Lumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is increasingly common with an aging population and can be associated with significant symptoms and functional limitations. We developed this guideline to present the evidence and provide clinical recommendations on non-surgical management of patients with LSS causing NC. Using the G...

Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups f...

Study Design: Secondary analysis from a randomized clinical trial on non-surgical interventions for patients with lumbar spinal stenosis (LSS). Objective: To assess responsiveness of the Self-Paced Walking Test (SPWT), Swiss Spinal Stenosis Questionnaire (SSS) and, Oswestry Disability Index (ODI) and determine their Minimal Clinically Important Di...

Background Physical therapy (PT) is frequently used for the management of low back pain (LBP) within the US Departments of Defense (DOD) and Veterans Affairs (VA). However, variations in PT practice patterns and use of ineffective interventions lower the quality and increase the cost of care. Although adherence to the clinical practice guidelines (...

Background: In the midst of the coronavirus pandemic, the International Chiropractors Association (ICA) posted reports claiming that chiropractic care can impact the immune system. These claims clash with recommendations from the World Health Organization and World Federation of Chiropractic. We discuss the scientific validity of the claims made i...

Background: Following head and neck trauma, the involvement of the cranio-cervical junction (CCJ) and its contribution to a patients transition to chronic pain, is poorly understood. The detection of hypermobility in this region is dependent on clinical examination and static imaging modalities such as x-ray, CT and MRI. Sagittal plane hypermobili...

BACKGROUND The COVID-19 pandemic has greatly limited the access of patients to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic lockdown. In most low- and middle-income countries, as well as many underserv...

BACKGROUND The COVID-19 pandemic has greatly limited the access of patients to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic lockdown. In most low- and middle-income countries, as well as many underser...

Background Taping is a common treatment modality used by many rehabilitation providers. Several types of tapes and taping methods are used in the treatment of musculoskeletal dysfunction and pain. Purpose To summarize and map the evidence related to taping methods used for various joints and conditions of the musculoskeletal system, and to provide...

Acute and chronic whiplash-associated disorders pose a significant healthcare burden due to chronic pain, which is associated with upper cervical instability resulting from ligamentous injury. No standard measure exists for diagnosing alar ligament injury and imaging findings vary widely. Multiple physical examination maneuvers are used to diagnose...

Study design: Qualitative focus group study. Background and objectives: Lumbar spinal stenosis (LSS) is a common degenerative disease among older adults. Currently, protocols to prepare patients for LSS surgery are widely varied. The purpose of this study was to gain the perspectives of patients who underwent LSS surgery and physical therapists...

Background: The literature supports the effectiveness of self-management support (SMS) to improve health outcomes of patients with chronic spine pain. However, patient engagement in SMS programs is suboptimal. The objectives of this study were to: 1) assess participation in self-care (i.e. activation) among patients with spine pain, 2) identify pa...

Background context: Lumbar spinal stenosis (LSS) leads to diminished blood flow to the spinal nerves causing neurogenic claudication and impaired walking ability. Animal studies have demonstrated increased blood flow to the spinal nerves and spinal cord with superficial para-spinal electrical stimulation of the skin. Purpose: The aim of this stu...

Background Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically informed physical therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduc...

Background: Low back pain (LBP) is one of the most prevalent and potentially disabling conditions for which people seek health care. Patients, providers, and payers agree that greater effort is needed to prevent acute LBP from transitioning to chronic LBP. Methods and study design: The TARGET (Targeted Interventions to Prevent Chronic Low Back P...

Background: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically Informed Physical Therapy (PIPT) is a secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to redu...

Background Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically Informed Physical Therapy (PIPT) is secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce...

Importance: Several functional limitations persist after total knee replacement (TKR). Intensive exercise programs could resolve these limitations but are not well tolerated by many patients until a later stage (>2 months) after surgery. Evidence for exercise at a later stage after TKR is limited. Objectives: To compare the effectiveness of late...

Importance Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. Objective To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. Design, Setting, and Participants Three-arm randomized clinical...

eAppendix. Trial baseline adaptive randomization methodology

Background: Low back pain (LBP) is a public health concern because it is highly prevalent and the leading cause of disability worldwide. Psychologically Informed Physical Therapy (PIPT) is secondary prevention approach that first aims to identify individuals at high risk for transitioning to chronicity and then provides tailored treatment to reduce...

Background Previous systematic reviews have concluded that lumbar traction is not effective for patients with low back pain (LBP), yet many clinicians continue to assert its clinical effectiveness. Objective To systematically identify randomized controlled trials (RCTs) of traction and explore the variability of traction interventions used in each...

Background: One proposed mechanism of chronic low back pain might be paraspinal muscle impairment. Commonly, this impairment is treated with stabilization exercises. However, the effect size of stabilization exercises has been previously reported to be small. Design: Randomized controlled trial. Objective: To investigate the clinical benefit o...

Background: Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at th...

Background context: Lumbar spinal stenosis (LSS) can impair blood flow to the spinal nerves giving rise to neurogenic claudication and limited walking ability. Reducing lumbar lordosis can increases the volume of the spinal canal and reduce neuro-ischemia. We developed a prototype LSS belt aimed at reducing lumbar lordosis while walking. Purpose:...

Objectives: To compare the effectiveness of a comprehensive non-surgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis. Design: Randomized controlled trial. Setting: Academic hospital outpatient clinic. Participants: A total of 104 participants with neurogenic claudication and imaging con...

The variability and delay in utilizing evidence in clinical practice are barriers to improving care, quality, and cost in health care, as charged by the "triple aim" framework. Scientific research provides an avenue not only to further the field of pain research, but also to study and change the patterns and processes that drive systemic and indivi...

Background Lumbar spinal stenosis (LSS) is commonly caused by degenerative arthritis of the spine and is characterized by narrowing of the spinal canal and/or neural foraminae. It is prevalent in older adults and leads to limitations in physical function and activities of daily living. Insulin‐like growth factor I (IGF‐I) and insulin‐like growth fa...

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumba...

Background context: The effectiveness of treatments for chronic, degenerative conditions of the lumbar spine can be influenced by patient perceptions and expectations regarding treatment. Purpose: The primary purpose of this study was to understand the factors that are important to individuals with lumbar spinal stenosis (LSS) regarding differen...

Background context: Lumbar spinal stenosis (LSS) is a highly prevalent disease in older adults that causes significant limitations in walking and other daily activities. There is a lack of research into optimal nonsurgical treatment approaches for LSS. Purpose: The purpose of this qualitative study is to assess the opinions of participants in a...

We present the movement control approach as part of the treatment-based classification system. This approach proposes a movement control schema that clarifies that movement control is a product of the interplay among multiple biopsychosocial components. The schema illustrates that for movement to occur in a dynamically controlled fashion, the lumba...

Low back pain is a common secondary health condition after lower limb amputation with important implications related to functional capabilities and overall quality of life. Despite the high prevalence of low back pain after lower limb amputation, the underlying etiologies of the disorder remain unknown. This hypothesis-driven communication provides...

There is an increasing awareness, interest and acceptance of the biopsychosocial (BPS) model by all health care professionals involved with patient care. The areas of spine care and pain medicine are no exception, and in fact, these areas of health care are a major centerpiece of the movement from the traditional biomedical model to a BPS model of...

Background: Nontraumatic knee pain (NTKP) is highly prevalent in adults 65 years of age and older. Evidence-based guidelines recommend early use of rehabilitation; however, there is limited information comparing differences in health care utilization when rehabilitation is included in the management of NTKP. Objectives: To describe the overall h...

Objective: The purpose of this study was to update evidence-based recommendations on the best practices for chiropractic care of older adults. Methods: The project consisted of a systematic literature review and a consensus process. The following were searched from October 2009 through January 2016: MEDLINE, Index to Chiropractic Literature, CIN...

Background: The patient perspective regarding the impact of neurogenic claudication (NC) has not been well studied. The objectives of this study were to determine what is most bothersome among patients with NC and how it impacts their lives and expectations with surgical and non-surgical treatment. Methods: Semi-structured telephone interviews w...

Background The purported relationship between cervical manipulative therapy (CMT) and stroke related to vertebral artery dissection (VAD) has been debated for several decades. A large number of publications, from case reports to case–control studies, have investigated this relationship. A recent article suggested that case misclassification in the...

Objective The purpose of this commentary is to provide an argument for the role and identity of chiropractors as spine care providers within the context of the greater health care system. Discussion Surveys of the general public and chiropractors indicate that the majority of patients seek chiropractic services for back and neck pain. Insurance co...