The use of superficial heat in the management of low back pain by chiropractors and osteopaths in Australia: an observational cross-sectional survey.

backgroundLow back pain (LBP) is the leading cause of years lived with disability globally and a major contributor to disease burden in Australia. Superficial heat is recognised as a non-pharmacological intervention for LBP. However, its clinical use among chiropractors and osteopaths remains unclear.

objectiveTo examine how chiropractors and osteopaths in Australia use superficial heat in the management of LBP, explore their perceptions of its role and effectiveness, and assess their awareness and application of clinical practice guidelines for LBP.

methodsA cross-sectional survey was conducted between June and October 2022 among registered chiropractors and osteopaths in Australia. The online 43-item questionnaire captured demographic, practice, and clinical data. This included frequency and method of superficial heat use, perceived effectiveness, and awareness of clinical practice guidelines for LBP. Descriptive statistics were used to summarise findings.

resultsA total of 341 practitioners completed the survey (78.3% chiropractors, 21.7% osteopaths). This represents approximately 3.5% of the total registered chiropractic and osteopathic workforce in Australia. Approximately half of all respondents (44.6%) reported using superficial heat for LBP in the preceding 12 months. Among those, chiropractors were more likely to use superficial heat for chronic LBP (44.6%) than for acute LBP (13.8%), whereas osteopaths were more likely to use it for acute LBP (20.3%). Superficial heat was acknowledged by 71.3% of respondents to have a role in LBP management, while 66.0% regarded it as an adjunct to spinal manipulation. In contrast, superficial heat was recommended for self-management by 34.1% of chiropractors and 28.4% of osteopaths. Awareness of LBP clinical guidelines was moderate, with 58.4% of practitioners reporting they knew how and where to access them. Chiropractors most commonly referred to the American College of Physicians (ACP) guidelines, whereas osteopaths more frequently used the UK NICE guidelines.

conclusionDespite its recognised clinical value, the use of superficial heat for LBP was limited, with 44.6% of practitioners reporting its use in practice, and fewer chiropractors (34.1%) and osteopaths (28.4%) recommending it for patient self-management. These findings indicate a gap between awareness and guideline-concordant care, highlighting the need for targeted education and clearer clinical guidance to support its consistent integration within multimodal LBP management.