The purpose of this report is to present the use of a classification system based on signs and symptoms to guide treatment in 3 patients with low back syndrome. Each patient had signs and symptoms of compressive nerve root pathology with a similar anatomical distribution of pain. Each patient was treated with a different approach based on the assigned classification. One patient was classified as needing treatment for a lateral shift, one patient was classified as needing flexion-oriented treatment, and the other patient was classified as needing extension-oriented treatment. The approach used for each patient was successful in reducing patient-reported pain severity and level of functional disability (Modified Oswestry Low Back Pain Questionnaire score). The potential advantages of the use of signs and symptoms to guide treatment classifications and decisions versus decisions based on suspected pathology or symptom distribution are discussed.