Lower back pain is the most common musculoskeletal problem to present to healthcare providers, with 85% of all people experiencing lower back pain at some point during their lifetime.
In the acute stage of lower back pain, conservative management is indicated with over the counter pain medications and patient education for further options of care including physical therapy, chiropractor care, pain clinic management, and surgery. Exercise therapy should be implemented after the patient has experienced constant lower back pain for greater than four weeks or experiences frequent recurrences of lower back pain.
Physical therapy and chiropractor care is contraindicated in those patients with “red flags” for a potentially serious underlying cause of lower back pain. Both physicians and physical therapists should monitor for trauma, unexplained weight loss, osteoporosis, history of cancer, IV drug use, steroid use, focal neurologic deficits, prior surgery, and history of abdominal aortic aneurysm.
If the physician is able to rule out any serious causes of lower back pain, the patient will benefit from a referral to a chiropractor or physical therapy. The goals of physical therapy are to decrease back pain, increase function, and provide education on a maintenance program to prevent further recurrences.
The physical therapist typically implements passive physical therapy that focuses on reducing muscle spasms and inflammation by applying heat or ice, TENS (transcutaneous electrical nerve stimulator), lontophoresis, and ultrasound. Heat and ice therapy can be alternated applying for ten to twenty minutes every two hours with the best results during the first few days of lower back pain.
Lontophoresis is sending steroids through the skin via an electrical current to produce an anti-inflammatory effect in the area of the back that is causing pain. TENS also uses electrical stimulation to override the painful signals that are sent to the brain from the lower back which may be used at home long term if the treatment is successful. Ultrasound can also be performed on the lower back to deliver deep heating via sound waves to relieve acute episodes of back pain and possibly enhance tissue healing.
Active or exercise-based therapy should be used in combination with passive therapy for stretching and strengthening for back pain and low impact aerobic conditioning. Studies have shown that patients with the highest and lowest degrees of physical activity are at risk for more serious back problems but that moderate physical loading of the spine has a protective effect.
Home exercises can be individualized for each patient and taught by physical therapists for self-management of mild to moderate back pain. Almost all patients with lower back pain should stretch their hamstring muscles twice per day even if there is little or no pain. Low impact aerobics should be done for thirty to forty minutes three times a week. Patients should work to increase their flexibility to provide both immediate and long-term relief in the lumbar region of the back. Those with lower back pain may also benefit from core strengthening exercises for control of the muscles involved in spinal stability. Therefore, those patients suffering from acute lower back pain, it is best to remain active rather than bed rest for the best outcomes and relief of lower back pain.
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