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I Have Acute Low Back Pain – What Do I Do!?

lowbackpainJordan A. Gliedt, DC

Low back pain is a common condition that affects many Americans, and it is one of the most common reasons for visits to the doctor.  Low back pain may originate from injured structures of the low back, such as vertebrae, facet joints, intervertebral discs, spinal ligaments, muscles and nerves.  However, low back pain can be a complex condition, with the exact source(s) hard to identify.  Back pain may also be caused from other conditions not related to the spine , such as conditions of the kidneys, liver and gastrointestinal system.

Acute low back pain is typically a self-limiting condition, with symptoms going away within four to six weeks.  It is important, however, to address low back pain in the acute stage due to the high incidence of recurrence and risk for the pain becoming chronic.  Let’s review the best choices for the management of acute low back pain.

Consult Your Physician:  Most acute low back pain episodes are of mechanical nature (meaning originating from the musculoskeletal system).  However, acute low back pain can be a result of disease of non-spinal origin, such as kidney, liver and gastrointestinal diseases.  A trip to your doctor will serve to diagnose the origin of pain, and individualize your treatment.

Remain Active:  Often, the most important step one can take to manage acute low back pain is to continue to remain active “as tolerated”.  Although bed rest may be your natural inclination, it most often is counterproductive.  Stretching muscles in the legs and back during an acute episode can be helpful; however, stretching should not cause more severe pain.

Ice:  Use cold packs for 20 minutes at a time and allow at least 30 minutes between icing sessions.  Do not apply ice directly to the skin.

Physiotherapy:  Therapy, including specific prescriptive exercises programs can address biomechanical faults, decrease functional limitations and assist in resuming normal activities of daily living. Many episodes of acute low back pain can be treated with directional stretches and physiotherapist guidance.

Manual Therapy/Spinal Manipulative Therapy:  Several studies have shown that spinal manipulation is an effective therapy in the management of acute low back pain.

Medication:  Studies suggest that over the counter non-steroidal anti-inflammatory medications may help in the reduction of acute low back pain, while reducing inflammation.  Medication should be taken only as recommended and prescribed by a physician.

Acupuncture:  Current evidence for acupuncture treatment for acute low back pain is encouraging.  Acupuncture may be beneficial in the short-term management of acute low back pain.

Due to the high risk of recurrence and transition into chronic pain conditions, taking steps to reduce your risk is recommended.  Incorporating the following steps into your life can help to reduce your chances of recurring back pain!

Smoking Cessation:  Smoking has been correlated to spine related disorders, low back pain and decreased effectiveness of medical treatments for spinal disorders.  Studies have also shown that stopping smoking can decrease pain levels and reduce your risk for future back pain.

Exercise:  The benefits of exercise extend beyond your spine.  Regular (spine sparing) exercises that address core strengthening and aerobic activity improves your overall health and reduces your risk of back injury.

Use Proper Body Mechanics:  It is easy to overload and isolate one area of your spine while sitting, standing, sleeping or lifting.  Use a chair with good low back support, avoid sitting forward flexed for long periods, place a pillow under your knees while sleeping to support your lower back, use proper lifting and carrying techniques, and practice proper posture during these activities.

Weight Management:  Excessive weight may contribute to added musculoskeletal stress, particularly of the spine.  It is recommended to stay within 10 pounds of your ideal weight to reduce your risk of back and neck pain.

Sources:

North American Spine Society.  KnowYourBack.org.  Acute Low Back Pain.  Accessed 8 May 2013.  <http://www.knowyourback.org/Pages/SpinalConditions/LowBackPain/Acute.aspx>

Bronfort G, Haas M, Evans R, Leininger B, Triano J.  Effectiveness of manual therapies: the UK evidence report.  Chiropr Osteopat. 2010 Feb 25;18:3. doi: 10.1186/1746-1340-18-3.

Bronfort G, Haas M, Evans RL, Bouter LM.  Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis.  Spine J. 2004 May-Jun;4(3):335-56.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians; American College of Physicians; American Pain Society Low Back Pain Guidelines Panel.  Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society.  Ann Intern Med. 2007 Oct 2;147(7):478-91.

Furlan AD, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B.  Acupuncture and dry-needling for low back pain: an updated systematic review within the framework of the cochrane collaboration.  Spine (Phila Pa 1976). 2005 Apr 15;30(8):944-63

Haas M, Goldberg B, Aickin M, Ganger B, Attwood M.  A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up.  J Manipulative Physiol Ther. 2004 Mar-Apr;27(3):160-9.

Globe GA, Morris CE, Whalen WM, Farabaugh RJ, Hawk C, Council on Chiropractic Guidelines and Practice Parameter. Chiropractic management of low back disorders: report from a consensus process. J Manipulative Physiol Ther 2008 Nov-Dec;31(9):651-8. [9 references]

Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H.  Acupuncture for acute low back pain: a systematic review.  Clin J Pain. 2013 Feb;29(2):172-85. doi: 10.1097/AJP.0b013e31824909f9.


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