Lower Back Pain: What should I do? A Physical Therapy Perspective

By Paul Gaspar
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Physical therapist treating low back pain

Lower back pain is one of the most common reasons people visit their family physician and it has been estimated that over 80% of people will have a significant incidence of lower back pain during their lifetime. In a sense, this fact makes lower back pain more ‘normal’ than ‘abnormal.’ Because of its high prevalence, more treatments methods have been invented to ‘cure’ lower back pain than almost any other musculoskeletal disorder. While some choices are better than others, the best treatment approaches always include educating patients so that they understand the nature of their lower back pain, how serious it is, and how aggressively it should be treated.

Acute lower back pain occurs up to four weeks. It is generally not cause for alarm and most often resolves without any medical evaluation or treatment. For those reasons, low cost treatments such as heat, massage, acupuncture, manipulation, and/or a brief course of physical therapy have been recommended. Non-steroidal anti-inflammatories are often recommended because they are inexpensive and may be helpful, however they do have some risks (see RESCU ratings. )

Light pain medications, such as Tramadol and Cymbalta may be helpful if the patient does not respond sufficiently to other treatments, but stronger opioid pain medications are generally not recommended. While acute lower back pain is generally not considered serious, a consultation with a licensed clinician may be important to identify specific risk factors for developing chronic back pain. There is some evidence that patients who see a clinician, such as a chiropractor or physical therapist, will get better faster. It is also advisable for patients to seek professional care if the back pain was caused by a car accident or work-related injury.

Subacute lower back pain lasts between four and twelve weeks. While subacute lower back oftentimes also resolves on its own, most experts believe patients should seek conservative medical care, especially if the pain is severe or causes significant difficulty moving, sitting, or standing. Recommended treatments are similar to acute lower back pain, especially if the pain is confined to the back and/or buttock. If the pain continues to be severe, extends into the leg, or is associated with leg weakness, numbness, tingling, or bowel/bladder difficulties, the patient may require more aggressive medical evaluation and treatment.

Chronic lower back pain persists beyond 3 months from the date of onset. It can be frustrating for the patient and difficult to treat, but patience, realistic expectations, and a disciplined approach are crucial to achieve best outcomes. Treatments mentioned above can be helpful, especially if used in combination with an active exercise program designed to restore patient function. Treatments directed at the psychological and behavioral aspects of pain, such as multi-disciplinary rehab, counseling, and stress reduction techniques may be helpful, particularly if the other conservative/alternative treatments have not provided sufficient relief. Moreover, it is very important that patients with chronic lower back pain strive to improve their physical and mental well-being. Doing so will help patients avoid risky medications and more invasive medical procedures, such as injections and surgery.

Paul Gaspar
Author: Paul Gaspar