Lifestyle Medicine and Chronic Low Back Pain in Viet Nam: Exercise Therapy, Red-Flag Assessment, and Avoiding Low-Value Care

Lifestyle Medicine and Chronic Low Back Pain in Viet Nam: Exercise Therapy, Red-Flag Assessment, and Avoiding Low-Value Care

Primary category: Evidence & Clinical Practice

Secondary category: Lifestyle Medicine in Viet Nam

Article type: VLMA Perspective

Last reviewed: October 30, 2026

A person with persistent low back pain may have tried several treatments without lasting improvement. A magnetic resonance imaging scan shows disc degeneration or a small disc protrusion, and they begin to worry that their spine has been permanently damaged. Another person with similar symptoms has never undergone imaging but has gradually stopped exercising, reduced working hours, and become increasingly concerned that movement could make the pain worse.

Both situations illustrate a common challenge in chronic low back pain care. The problem is not always a lack of available treatments. It may be uncertainty about what is causing the pain, whether further investigation is necessary, and which interventions are most likely to help someone return to everyday activities.

Evidence-based Lifestyle Medicine can contribute through appropriate physical activity, patient education, and support for sustainable rehabilitation. However, not all persistent back pain has the same cause. Before recommending an intervention, healthcare professionals need to consider whether the person has a condition requiring further investigation or specific treatment.

For Viet Nam, the opportunity is to connect appropriate clinical assessment with evidence-based rehabilitation while avoiding investigations and treatments that offer little meaningful benefit. The aim is not simply to reduce pain, but to help people regain function, maintain activity, and participate more confidently in daily life.

Chronic Low Back Pain Is Not a Single Diagnosis

Low back pain generally refers to pain located between the lower ribs and the buttocks, sometimes accompanied by symptoms extending into one or both legs. It is commonly classified as chronic when symptoms persist or recur for more than three months.

The World Health Organization's 2023 guideline specifically addresses chronic primary low back pain in adults, including older people, in primary and community care settings. This refers to persistent or recurrent pain that cannot be adequately explained by an underlying disease or another identifiable condition. [1]

Chronic low back pain, however, is a broader clinical presentation rather than a single diagnosis.

Some patients have pain associated with lumbar radiculopathy, spinal stenosis, vertebral fractures, inflammatory spinal disease, infection, malignancy, or other identifiable disorders. Occasionally, pain perceived in the lower back may originate outside the spine, including from abdominal, pelvic, or urinary conditions.

These possibilities require appropriate clinical consideration rather than automatically classifying everyone with persistent symptoms as having chronic primary low back pain.

A comprehensive review by Cashin and colleagues, published online in JAMA on June 15, 2026, reported that approximately 90% of patients presenting for care with low back pain have nonspecific low back pain, meaning that no specific spinal disorder is identified as the cause. [2]

This estimate concerns patients presenting with low back pain generally. It should not be interpreted as an exact prevalence figure for every population with chronic symptoms.

The finding also does not mean that symptoms can be dismissed without assessment. Although serious spinal disorders account for a relatively small proportion of presentations, delayed recognition can have important consequences.

The absence of a clearly identifiable structural cause does not make a person's pain less real. Persistent pain can involve interactions among musculoskeletal, neurological, psychological, and social processes. Understanding these influences may improve care without reducing the patient's experience to a psychological problem.

The first clinical responsibility is therefore to determine whether the presentation is consistent with nonspecific low back pain or whether further investigation, referral, or condition-specific treatment is necessary.

Recognizing Red Flags Without Overinvestigating Everyone

Identifying potentially serious causes of back pain is essential to safe clinical care. However, the presence of a so-called red flag does not automatically establish a diagnosis.

Certain symptoms and examination findings require particular attention because delayed recognition could result in significant harm.

New bladder or bowel dysfunction, including urinary retention, altered sensation around the saddle or perineal region, and severe or progressive lower-limb neurological deficits may indicate cauda equina syndrome or another serious neurological condition. Such presentations require urgent medical assessment through an appropriate emergency pathway.

Suspected spinal infection, malignancy, or vertebral fracture also warrants timely investigation, with urgency determined by the overall clinical presentation.

Other findings are less specific. Older age, persistent pain, night pain, or failure to improve can occur in people without serious spinal disease. Their significance depends on the medical history, examination findings, associated symptoms, and likelihood of an underlying condition.

Cochrane reviews examining red flags for spinal malignancy and vertebral fracture have demonstrated important limitations in the diagnostic accuracy of individual findings. [3,4]

A previous history of cancer is among the more informative findings when assessing possible spinal malignancy. By contrast, several other commonly cited warning features have substantial false-positive rates.

For vertebral fracture, factors such as significant trauma, advanced age, corticosteroid exposure, and findings suggesting injury may increase suspicion, particularly when considered together.

These findings support a balanced approach. Investigating every isolated, nonspecific warning feature as though it confirms serious disease can lead to unnecessary testing and anxiety. Conversely, dismissing concerning symptoms because serious spinal conditions are uncommon can delay appropriate care.

In Viet Nam, clinical assessment may also need to consider infectious spinal disease, including spinal tuberculosis, when the patient's history, examination, and other findings raise suspicion. This does not justify routine tuberculosis testing for everyone with low back pain, but it illustrates why assessment should remain responsive to relevant clinical and epidemiological circumstances.

Healthcare professionals need to consider combinations of findings, changes over time, and the consequences of missing a clinically important diagnosis. When uncertainty remains or symptoms evolve, reassessment is necessary.

For Lifestyle Medicine, this establishes an important boundary: rehabilitation and supported self-management should be introduced within an appropriate clinical pathway, after serious or otherwise significant conditions have been considered and the proposed intervention is judged suitable.

Diagnostic Imaging Should Help Make Decisions

Magnetic resonance imaging can provide valuable information when a serious spinal condition, significant neurological compromise, or another disorder requiring specific management is suspected. However, routine imaging is not recommended for every person with persistent low back pain.

The United Kingdom's National Institute for Health and Care Excellence guideline NG59, updated on July 29, 2026, recommends against routinely offering imaging in nonspecialist settings for low back pain, with or without sciatica. In specialist settings, imaging should be considered when the findings are likely to change management. [5]

The 2026 JAMA review similarly emphasizes selective imaging rather than routine scanning for nonspecific low back pain. [2]

One reason is that degenerative findings are common in people who do not experience back pain.

A systematic review by Brinjikji and colleagues, published in the American Journal of Neuroradiology, found that imaging features of spinal degeneration frequently occur in asymptomatic individuals and become increasingly common with age. [6]

Disc degeneration, disc bulging, and facet joint changes may therefore be visible on imaging without necessarily explaining a person's symptoms.

This does not mean such abnormalities are always irrelevant. Some findings may be clinically important when they correspond with the patient's symptoms, neurological findings, and examination results.

The problem arises when imaging abnormalities are interpreted without sufficient clinical correlation.

Someone told that their spine is severely damaged because an imaging report shows degeneration may become fearful of ordinary movement. They may avoid exercise, lifting, or returning to work even when those activities could be resumed safely.

Imaging may also lead to further investigations, specialist consultations, injections, or procedures that offer limited additional benefit when the original findings do not adequately explain the clinical presentation.

This is not an argument against medically indicated imaging.

Severe or progressive neurological deficits, suspected malignancy, spinal infection, vertebral fracture, or cauda equina syndrome may require urgent or targeted investigation. Selected patients with persistent radicular symptoms or suspected spinal stenosis may also benefit from imaging when specialist treatment decisions depend on the results.

The important question is not simply whether an abnormality can be identified. It is whether identifying that abnormality will help clinicians make a better decision for the patient.

Exercise Therapy: Evidence Supports Movement, Not One Universal Method

For appropriately assessed patients with chronic primary or nonspecific low back pain, exercise therapy is an important component of evidence-based care.

The World Health Organization's 2023 guideline conditionally recommends that structured exercise therapy may be offered as part of care for adults with chronic primary low back pain. The recommendation is based on low-certainty evidence and recognizes the importance of individual circumstances, preferences, and available resources. [1]

A Cochrane systematic review published in 2021 included 249 randomized trials involving 24,486 participants. The review found moderate-certainty evidence that exercise improves pain compared with no treatment, usual care, or placebo. [7]

On a standardized 100-point scale, the average difference in pain was approximately 15 points in favor of exercise at the earliest follow-up, meeting the review's prespecified threshold for a clinically important difference.

The average improvement in functional limitations was smaller, at approximately seven points on a 100-point scale, and did not reach the review's threshold for a clinically important difference.

Compared with other conservative treatments, the additional benefits of exercise were generally small.

These findings support exercise as a useful treatment option, but they do not justify promising substantial improvement or complete recovery for every patient.

The 2026 JAMA review likewise identifies exercise as a first-line treatment for chronic nonspecific low back pain. [2]

Different programs may include progressive strengthening, aerobic activity, mobility exercises, motor control training, Pilates, yoga, or combinations of approaches. No single exercise method has been established as consistently superior for everyone.

The most appropriate approach depends on clinical findings, physical capacity, individual goals, preferences, available resources, and the ability to participate regularly.

A person who has become inactive because of pain may benefit from a gradual return to movement and progressive strengthening. Another may already be physically active but struggle with prolonged standing, lifting, or particular work-related movements.

Their rehabilitation needs are different, even if both describe their symptoms as chronic low back pain.

Exercise does not need to eliminate pain immediately to be useful.

Improved walking tolerance, greater confidence in movement, better physical endurance, and increased participation in work or household activities can represent meaningful progress even when some discomfort remains.

Temporary discomfort during rehabilitation does not necessarily indicate tissue damage. However, substantial symptom worsening, new neurological findings, or significant changes in the clinical presentation may require adjustment or reassessment.

Professional supervision may be helpful for people with significant functional limitations, uncertainty about technique, or difficulty progressing safely. Home-based exercise may also be appropriate when supported by suitable instruction and follow-up.

The objective is not to identify one perfect exercise program. It is to select an approach that is clinically appropriate, acceptable to the individual, and sustainable enough to support meaningful improvement.

What a 2026 Study From Viet Nam Adds

Local research matters because rehabilitation approaches developed elsewhere may not automatically fit the resources, work patterns, and healthcare circumstances of patients in Viet Nam.

A study published in the Can Tho University Journal of Science in 2026 examined changes in quality of life following community-based rehabilitation using McKenzie exercises among 87 patients with chronic low back pain. [8]

The investigators assessed participants before the intervention and again after one and three months. Quality of life was measured using the five-level EuroQol five-dimension questionnaire.

Compared with baseline, the average quality-of-life index increased by 0.047 points after one month and 0.211 points after three months.

In the adjusted analysis, greater pain intensity was associated with poorer quality of life, while higher exercise adherence was associated with better quality-of-life scores.

These findings are encouraging for the development of community-based rehabilitation approaches in Viet Nam. They suggest that structured exercise programs may be feasible and that supporting continued participation deserves attention.

However, the study has important limitations.

It was an uncontrolled clinical intervention involving a relatively small sample and a short follow-up period. Without a comparison group, the observed improvements cannot be attributed exclusively to McKenzie exercises.

Natural changes in symptoms, other treatment received, patient expectations, and additional factors may have contributed.

The association between adherence and better quality of life also does not independently establish causation. People who experienced improvement may have found it easier to continue exercising, while other factors may have influenced both participation and outcomes.

The study therefore does not demonstrate that the McKenzie method is superior to other exercise programs or that the same improvements would occur in all patients with chronic low back pain.

Its value lies in providing local evidence that can inform future research and practical implementation, rather than definitive proof of comparative treatment effectiveness.

For healthcare professionals, the lesson extends beyond any particular exercise technique. Rehabilitation should be evaluated not only by whether patients attend sessions, but also by whether their symptoms, functioning, quality of life, and participation in everyday activities improve over time.

Avoiding Low-Value Care Without Withholding Necessary Treatment

Low-value care refers to investigations or interventions that provide little meaningful benefit relative to their potential harms, financial costs, or burden on patients.

In chronic low back pain, examples may include repeated imaging without a clear clinical indication, prolonged reliance on passive treatments without meaningful functional improvement, or routine use of interventions whose benefits have not been established for the condition being treated.

The WHO's 2023 guideline identifies several interventions that should not be routinely used for most adults with chronic primary low back pain. These include lumbar braces or belts, traction, and opioid medications. [1]

NICE similarly recommends against spinal traction for low back pain, with or without sciatica, and against opioid treatment for chronic low back pain. [5]

These recommendations must be interpreted within their intended clinical populations.

A spinal brace may be appropriate for selected fractures or other specific conditions. Similarly, medications and procedures may have a role when a particular diagnosis or clinical indication justifies their use.

Avoiding low-value care does not mean limiting treatment to exercise alone.

Manual therapy, including selected mobilization or manipulation techniques, may provide benefit for some patients. NICE recommends considering manual therapy only as part of a treatment package that includes exercise, rather than as an isolated treatment. [5]

This reflects an important distinction between temporary symptom relief and meaningful long-term improvement.

Medication decisions also require balance. Nonsteroidal anti-inflammatory medicines may be considered for selected patients when clinically appropriate, but their potential gastrointestinal, kidney, cardiovascular, and medication-interaction risks require assessment.

Treatment should be reviewed according to both benefit and harm rather than continued indefinitely without reassessment.

For healthcare professionals, the aim is not simply to reduce the number of tests, prescriptions, or procedures. It is to ensure that each intervention has a clear clinical purpose, is supported by appropriate evidence, and contributes to care that matters to the patient.

What Changed in the NICE Guidance in July 2026?

An important evidence update occurred on July 29, 2026, when NICE withdrew two recommendations from guideline NG59. [5]

These concerned psychological therapies for low back pain, with or without sciatica, and combined physical–psychological programs for people with persistent symptoms.

The withdrawal followed an exceptional surveillance review identifying that the previous recommendations had relied partly on evidence that was subsequently retracted.

NICE decided not to prioritize a full update of these areas and instead removed the recommendations. It also amended related wording elsewhere in the guideline.

This development matters because clinical guidance may need to change when the reliability of its supporting evidence is questioned.

However, withdrawing a recommendation is not the same as recommending against the intervention.

The revised NICE guideline does not establish that all psychological therapies or multidisciplinary rehabilitation programs are ineffective or inappropriate.

The World Health Organization's 2023 guideline continues to conditionally recommend that cognitive behavioral therapy may be offered as part of comprehensive care for adults with chronic primary low back pain, although the certainty of evidence is very low. [1]

The 2026 JAMA review also recognizes selected psychological interventions and multidisciplinary approaches as potentially useful for people with chronic nonspecific low back pain. [2]

These approaches may be particularly relevant when persistent pain is accompanied by substantial disability, fear of movement, emotional distress, or difficulty resuming valued activities.

Their use should reflect individual needs, available evidence, professional competence, and the purpose of treatment.

A psychological intervention should not be presented as proof that pain is imaginary or entirely caused by stress.

Persistent pain may involve interacting biological, psychological, and social processes. Addressing these influences can be appropriate without removing the need for clinical assessment of the underlying condition.

For healthcare professionals, the 2026 NICE update reinforces an important principle: recommendations must be interpreted in context, reviewed as evidence evolves, and not extended beyond what the supporting research can justify.

Measuring Recovery Beyond Pain Scores

Pain intensity is important, but it provides only one perspective on recovery.

A patient may report modest pain reduction while remaining unable to work, walk comfortably, or complete household activities. Another may continue to experience intermittent discomfort but regain mobility, physical confidence, and independence.

A meaningful rehabilitation plan should consider both situations.

Validated instruments such as the Oswestry Disability Index and Roland-Morris Disability Questionnaire can help assess functional limitations associated with low back pain.

Pain scores, health-related quality of life, activity tolerance, and progress toward individual functional goals provide complementary information.

The choice of measures should reflect the healthcare setting and the patient's circumstances. Not every consultation requires an extensive assessment battery, but consistent follow-up can make changes easier to interpret.

One person may want to sit comfortably through a working day. Another may hope to resume walking for exercise, care for family members, or return to physically demanding employment.

Reviewing progress toward these goals may provide a more useful understanding of recovery than asking only whether pain has disappeared.

Follow-up should also consider barriers to rehabilitation, treatment-related adverse effects, and whether symptoms have changed in a way that requires further assessment.

When expected improvements do not occur, the response should not automatically be to repeat the same intervention. The clinician may need to reconsider the diagnosis, modify rehabilitation, address additional contributing factors, or arrange specialist review.

For healthcare organizations, counting exercise sessions or completed referrals does not establish that patients have improved.

Meaningful evaluation should consider whether care produces relevant changes in symptoms, function, participation, and quality of life without unnecessary risk or burden.

Making Evidence-Based Rehabilitation Practical in Viet Nam

Applying international recommendations requires attention to the circumstances in which people receive healthcare.

In Viet Nam, patients with persistent back pain may seek care through primary healthcare facilities, hospitals, rehabilitation departments, and other health services.

Access to appropriately qualified professionals, the availability of follow-up, and the affordability of repeated consultations can influence which interventions are practical.

Employment and daily activities may also shape rehabilitation needs.

An office worker who spends much of the day sitting may experience different difficulties from someone involved in agricultural work, manufacturing, construction, or physically demanding services.

A useful rehabilitation plan should consider the activities that matter to the individual and the physical demands they need to resume.

Recommendations should also fit work schedules, home environments, financial circumstances, and access to care.

This may involve home-based exercise with periodic professional review, understandable written instructions, or supervised rehabilitation when clinically appropriate and available.

Healthcare professionals should avoid creating unrealistic expectations. Chronic pain can fluctuate, and improvement is not always linear. A temporary increase in discomfort does not necessarily mean that treatment has failed, but new neurological symptoms or other warning features require appropriate reassessment.

At the organizational level, better care may involve strengthening the pathway from initial assessment to rehabilitation and follow-up.

Clear referral arrangements, reliable recognition of urgent neurological symptoms, appropriate imaging decisions, and consistent measurement of functional outcomes can help reduce both missed diagnoses and unnecessary interventions.

These activities may require collaboration among physicians, rehabilitation professionals, nurses, and other appropriately qualified healthcare practitioners.

The objective is not to introduce more rehabilitation techniques simply because they are available. It is to make appropriate care accessible and ensure that its effects are evaluated.

Professional and Legal Considerations in Viet Nam

Lifestyle Medicine can contribute to chronic low back pain care through professional education, appropriate physical activity, supported self-management, and behavior-change approaches that help people maintain physical function.

However, diagnosing the cause of back pain, assessing neurological deficits, determining whether imaging is indicated, prescribing treatment, and providing specialized clinical rehabilitation are regulated healthcare activities.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15, as amended and reflected in Consolidated Document No. 26/VBHN-VPQH dated February 26, 2026, provides the principal legal framework for medical examination and treatment. [9]

Relevant implementing regulations, including Circular No. 32/2023/TT-BYT as amended by subsequent instruments, including Circular No. 25/2026/TT-BYT effective August 15, 2026, also govern relevant aspects of healthcare practice. [10]

Healthcare professionals must act within their qualifications, professional competence, and legally authorized scopes of practice.

Education or certification in Lifestyle Medicine, exercise coaching, or a related field does not independently authorize an individual to diagnose spinal disorders, determine medical contraindications, prescribe clinical rehabilitation, or deliver regulated healthcare services outside the applicable professional framework.

International recommendations from WHO, NICE, and other professional bodies may inform education and clinical decision-making, but they do not automatically become legally binding Vietnamese treatment requirements.

These distinctions are particularly important when educational materials discuss potentially serious symptoms or clinical exercise interventions.

Information about red flags should encourage appropriate recognition and referral, not create expectations that readers can independently diagnose neurological emergencies or other spinal conditions.

Clinical rehabilitation should be assessed, selected, delivered, supervised, or referred according to the person's condition and the lawful responsibilities of the professionals involved.

Healthcare organizations must also protect patient information.

Medical histories, imaging results, clinical assessments, rehabilitation records, and other identifiable health information may contain sensitive personal data.

The Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, establish relevant requirements for processing and protecting personal data. [11,12]

Educational publications should avoid identifiable patient accounts unless applicable legal, confidentiality, and consent requirements have been satisfied.

For the Vietnam Lifestyle Medicine Alliance (VLMA), chronic low back pain is a relevant area for evidence-based professional education and scientific knowledge exchange.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. Its intended contribution is to support evidence appraisal, professional learning, scientific knowledge exchange, and responsible collaboration within the Vietnamese healthcare context.

Potential educational topics include understanding exercise therapy evidence, recognizing the limitations of routine imaging, interpreting emerging rehabilitation research, and distinguishing clinically meaningful interventions from low-value care.

Such activities would benefit from collaboration with appropriately qualified rehabilitation physicians, physiotherapists, other relevant medical specialists, and healthcare professionals.

These are potential directions for professional education rather than claims that VLMA currently operates a low back pain clinic or provides individualized rehabilitation services.

The objective is to strengthen professional understanding while respecting the clinical responsibilities and legal requirements governing healthcare in Viet Nam.

Toward Safer and More Meaningful Care for Chronic Low Back Pain

Chronic low back pain illustrates why evidence-based Lifestyle Medicine needs to go beyond general advice to exercise more.

The first priority is to recognize when persistent pain may indicate a condition requiring urgent investigation or specific treatment. Once serious or otherwise clinically important causes have been appropriately considered, care can focus on interventions that help people regain function and participate more fully in daily life.

Exercise therapy is an important option for chronic primary and nonspecific low back pain, but no single program is optimal for everyone.

Patient education, selected psychological interventions, and multidisciplinary rehabilitation may also contribute according to the person's clinical presentation, treatment goals, and circumstances.

Equally important is avoiding investigations and treatments that add cost, burden, or risk without a reasonable expectation of improving care.

The international evidence available in 2026 reinforces the importance of selective imaging, appropriate rehabilitation, careful interpretation of clinical recommendations, and meaningful outcome measurement.

The study from Can Tho University adds useful local evidence while demonstrating why small, uncontrolled studies should not be interpreted as definitive proof of treatment superiority.

For healthcare professionals in Viet Nam, the opportunity is not simply to introduce more rehabilitation techniques. It is to strengthen the connection between clinical assessment, appropriate treatment selection, supported self-management, and follow-up.

The most important question is not whether every source of pain can be identified on imaging or whether pain disappears completely. It is whether care helps the person function better, participate in everyday life, and regain confidence while ensuring that serious conditions are not overlooked.

That is where evidence-based Lifestyle Medicine can make a practical contribution to safer, more effective chronic low back pain care in Viet Nam.

Selected References

1. World Health Organization. WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings. Geneva: World Health Organization; December 7, 2023. ISBN: 978-92-4-008178-9.

2. Cashin AG, Chou R, Weimer MB, McAuley JH. Low Back Pain: A Review. JAMA. 2026;336(2):144–158. Published online June 15, 2026. DOI: 10.1001/jama.2026.9631.

3. Henschke N, Maher CG, Ostelo RWJG, et al. Red Flags to Screen for Malignancy in Patients With Low-Back Pain. Cochrane Database of Systematic Reviews. 2022;4. DOI: 10.1002/14651858.CD008686.pub2.

4. Han CS, Hancock MJ, Downie A, et al. Red Flags to Screen for Vertebral Fracture in People Presenting With Low Back Pain. Cochrane Database of Systematic Reviews. 2023;8. DOI: 10.1002/14651858.CD014461.pub2.

5. National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management. NICE Guideline NG59. Published November 30, 2016. Updated July 29, 2026.

6. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2015;36(4):811–816. DOI: 10.3174/ajnr.A4173.

7. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise Therapy for Chronic Low Back Pain. Cochrane Database of Systematic Reviews. 2021;9. DOI: 10.1002/14651858.CD009790.pub2.

8. Lê Nguyễn Trí Nhân, Phan Đức Bằng, Võ Duy Nhàn, Ngô Văn Tán, Lê Trọng Tài. Sự thay đổi chất lượng cuộc sống và các yếu tố liên quan sau phục hồi chức năng dựa vào cộng đồng bằng bài tập McKenzie ở bệnh nhân đau lưng mạn tính. Tạp chí Khoa học Đại học Cần Thơ. 2026;62(Special Issue—Natural Sciences):280–289. DOI: 10.22144/ctujos.2026.204.

9. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH: Law on Medical Examination and Treatment. February 26, 2026.

10. Ministry of Health of Viet Nam. Circular No. 32/2023/TT-BYT Detailing Certain Articles of the Law on Medical Examination and Treatment, as amended, including by Circular No. 25/2026/TT-BYT, effective August 15, 2026.

11. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. June 26, 2025. Effective January 1, 2026.

12. Government of Viet Nam. Decree No. 356/2025/NĐ-CP Detailing Certain Articles and Measures for Implementing the Law on Personal Data Protection. December 31, 2025. Effective January 1, 2026.

Editorial and Professional Scope Note

This article presents the professional perspective of the Vietnam Lifestyle Medicine Alliance on the contribution and limitations of evidence-based Lifestyle Medicine in chronic low back pain care, including clinical assessment, exercise therapy, rehabilitation, appropriate imaging, and avoidance of low-value care. It reflects scientific and regulatory information reviewed as of October 30, 2026.

The article is intended for professional information, education, and scientific knowledge exchange. It does not constitute an official clinical practice guideline, individualized medical advice, a diagnostic assessment, an exercise prescription, a rehabilitation protocol, a medication recommendation, or an authoritative interpretation of Vietnamese law. The introductory scenarios are hypothetical and do not describe actual VLMA clinical activities.

Chronic low back pain has multiple possible causes. Lifestyle-related and rehabilitation interventions must not delay or replace appropriate assessment of potentially serious spinal, neurological, infectious, malignant, or other medical conditions.

People experiencing new bladder or bowel dysfunction, saddle sensory changes, severe or progressive limb weakness, or other concerning symptoms require urgent medical assessment.

The WHO recommendations discussed in this article specifically concern chronic primary low back pain in adults. They should not be automatically extended to all forms of low back pain, including conditions requiring specific medical, surgical, or emergency management.

Exercise therapy, diagnostic imaging, medication, specialist referral, and other treatments require individualized clinical judgment by appropriately authorized healthcare professionals and facilities acting within their lawful scopes of practice.

International guidelines and scientific publications are referenced for educational purposes. Their inclusion does not imply automatic adoption as Vietnamese clinical requirements or establish the local approval, availability, reimbursement, or suitability of particular interventions.

VLMA is a physician-led professional platform operated by Vietnam Lifestyle Medicine Alliance Company Limited. It is not a licensed medical examination or treatment facility, rehabilitation service provider, medical licensing authority, or healthcare accreditation organization. VLMA does not independently diagnose spinal conditions, prescribe clinical exercise therapy, provide rehabilitation treatment, interpret imaging for individual patients, or conduct individualized medical follow-up.

Patient information must be handled in accordance with applicable confidentiality and personal data protection requirements.

This article does not endorse any particular commercial rehabilitation method, exercise program, medical device, medication brand, or healthcare provider. References to international evidence and professional guidance do not imply that VLMA has formally adopted, clinically implemented, evaluated, validated, or certified any chronic low back pain treatment or Lifestyle Medicine program discussed in this article.