Health Tips | Jul 17
The new standards of care for the treatment of low back pain( 3 types).
1. Serious-Red Flag Issues= less than 2% of low back pain. If you are experiencing back pain after significant trauma, have a history of cancer, night pains, fevers, unexplained weight loss, inability to control your bowel or bladder functions, lower leg muscular weakness thats progressive or a failure to improve after 4 weeks of conservative care, contact your primary care physician or go to urgent care for immediate evaluation.
2. Disc Herniations= less than 10% of low back pain. Patients tend to experience more intense pain/numbness or tingling in the leg/calf or foot more than back pain with disc injuries. Studies have shown that an MRI is not necessary if you are showing progressive improvements. Failure to respond by week #4-6 may result in the doctor ordering a lumbar MRI. If you are given a diagnosis of lumbar disc hernation, studies have shown that 86% of MRI confirmed disc hernations will respond to conservative care. You have a 50% chance of resolution at 1 month and a 90% chance at 3 months. Disc herniations are strongly linked to repeated bending forward and twisting like shoveling or picking up items off the floor. Disc herniation shrinkage is a common finding found on post-MRI’s. Studies show that even pain-free patients when scanned by MRI can reveal disc herniations. It is important to remember that these tests are valuable but they do have limitations. Studies have estimated that 1.3-3% of disc hernations will require surgical intervention.
3. Mechanical(Muscle and Joint) Dysfunction= 85-90% of low back pain. Most muscle and joint injuries result from repetitive bending over especially early in the morning or after prolonged sitting. 50% of patients with acute low back pain will be back to normal activities within 1 week and 90% by 1 month. Several studies have shown the effectiveness of spinal manipulations and exercise with this group. X-rays are not recommended unless your condition worsens with care or you show no improvements by week #4.
*GENERAL GUIDELINES FOR ACUTE LOW BACK PAIN-GROUPS #2 & 3
– Reassure yourself that there is no serious cause for your acute/intense pain and the prognosis for recovery is good, however reoccurance is common( 45% will experience another acute episode within 4 years.)
– Avoid bed rest( 2 days max if its severe), stay as active as possible( we encourage walking), avoid early morning forward bending, and avoid sitting longer than 20 minutes without getting up to take a break.
– Symptom/Pain Relief: Your options include analgesics, NSAIDS, muscle relaxors, spinal manipulations, physical therapy & modalities, or if your intense leg pain does not progressively improve by week #4-6 a possible epidural steroid injection may be an option. Surgical indications for disc herniation typically include failure to respond to conservative care and an inability to resume normal activities within 6 weeks.
Subacute – Chronic Low Back Pain ( 2 week to 3 + months). Once the acute pain has improved it is essential for the provider to find the “key weak links” surrounding the injured spine. A spine devoid of muscles (just ligaments supporting it) has been shown to buckle with just 20 lbs of force. This demonstrates the supportive role that muscles play in stabilizing the spine during normal activities. The stability increases 36-64% with proper “co-contraction” of the surrounding musculature. It is common for certain muscles to be overactive(tight) that require stretching and massage while other muscle groups display weakness or a lack of coordination and endurance to stabilize the spine properly. Our doctors are trained to evaluate these imbalances and can provide you with a customized plan for self-care or if you prefer we would refer you to a physical therapist.
Chronic Low Back Pain ( 3+ months – Years) There is emerging evidence of the strong relationship between psychosocial factors like: stress/depression/ anxiety as drivers of chronic pain. If you are experiencing chronic pain and have not returned to your normal activities this relationship to your pain may need to be evaluated by a specialist.
Summary and Goals In The Treatment Of Low Back Pain:
1. Rule out serious causes of pain by performing a history and examination (90% effective at detecting serious causes.)
2. Determine if you have a Nerve Root/ Disc issue or a Mechanical cause.
3. Reassure yourself that the prognosis is good:
-Mechanical pain resolves in days-months, disc or nerve root issues usually take 1 – 3 months for complete resolution.
4. Educate yourself in the self-management by utilizing anti-inflammatory products, proper exercise and stretching techniques and avoid activities and postures that can perpetuate or cause harm to the spine.
5. Understand that low back pain is multi-factorial which may require co-management of your situation with multiple health care providers.