Avoiding Acute Lower Back Pain
Acute lower back pain is one of the most common conditions seen by Physiotherapists. It can affect up to 85% of the adult population at some stage in their life. Acute refers to an episode lasting less than 3 months.
Even minor events can cause acuteback painevents
Acute low back pain can occur from even the most minor of events, such as leaning over to pick up something small off the floor, or sneezing. The pain experienced can range from reasonably mild to being unable to move and the area of pain can vary from having it concentrated in the lower back to being felt in the buttocks or leg.
Any of the pain-producing structures of the lumbar spine can cause lower back pain
The major ones include: the intervertebral discs; the facet joints (the joints joining vertebrae together); the nerves and their sheaths; the muscles and the ligaments. In many cases, there will be a combination of the above but the most common causes are damage to the discs and facet joints. Often it is not possible to identify the exact structure/s causing the pain. A specific diagnosis is not necessary for effective management. The principles of management depend on careful assessment to detect any abnormality and then appropriate treatment to correct that abnormality. Serious conditions are rare, (less than 5% of cases), and Physiotherapists are trained as primary contact health professionals to pick up on signs indicating a problem requiring further investigation or referral.
Risk factors with lower back pain
There are a number of risk factors associated with low back pain including:
- Age: increased risk until age 50.
- Smoking: strong association with low back pain and sciatica.
- Physical work: increased risk in those whose work involves bending, twisting or heavy physical labour.
- Sedentary occupation: increased risk when sitting or driving a motor car. Jobs involving all standing or all sitting show higher incidence of low back pain than those with changing positions.
Get early advice from a physiotherapist
It is important to see a physiotherapist early so you can be provided with information about your injury, assurance and advice. You do not need a referral from a GP to see a physiotherapist. The majority of people who present for physiotherapy after only having their symptoms for a short time recover within three months, however milder symptoms often persist. Recurrences are also common so even if your symptoms seem to be settling on their own it is still good to visit the physiotherapist to ensure you receive the best advice to optimise your recovery and to manage your back in the long term.
Remain as active as possible
Your physiotherapist will encourage you to remain as active as possible as well as giving you specific exercises and advice related to your presentation. Bed rest is not encouraged but if it is necessary it should not be for any longer than two days. Medication for pain relief is important to encourage activity with paracetamol being the first choice. Early return to work is also encouraged.
Conditions are generally self limiting
An episode of acute low back pain can be very scary but it is important to remember that the condition is generally self-limiting and that serious conditions are rare. X-rays are not routinely ordered because common findings in patients with low back pain also occur in asymptomatic people; hence such findings may not actually be the cause of the pain. Also, requesting an x-ray will generally not change the management of the patient and it is considered unnecessary to expose the patient to the radiation.
What to do following an episode of acute low back pain
- Rest the back by avoiding using the back in anything even remotely strenuous.
- Ice applied over the area of pain for 15-20 minutes every 2-4 hours may help settle the acute pain.
- Remain active by continuing normal gentle activities within your pain free range.
- Medication taken as required to help with pain relief.
- Seek early treatment from your Physiotherapist to receive the individual advice for ongoing management of your acute low back pain.