November 14, 2018

Low Back Pain

August 2018

Wood man back pain

Every year, 25-50% of adults seek health care services for low back pain.

 

According to the National Committee for Quality Assurance (NCQA), 25-50 % of adults will seek health care services for low back pain every year.  Eighty percent of Americans will have suffered from low back pain in their lifetime.  Age, poor physical fitness, weight, and occupational factors are several causes for acute back pain. 

 

Most cases of back pain are caused by muscle strain or inflammation of the spine, muscles, discs, and/or nerves, and most cases are resolved within a few weeks.  X-rays, CT scans, and MRIs should be avoided within the first six weeks of onset in the absence of red flags, including history of cancer, fracture or suspected fracture based on clinical history, progressive neurologic symptoms and infection, as well as conditions that potentially preclude a dynamic thrust to the spine, such as osteopenia, osteoporosis, axial spondyloarthritis, and tumors.  Likewise, patients not responding to chiropractic treatment do not benefit from repeat imaging intended to monitor progress without a major change in diagnosis, documented worsening of symptoms, or significant progression of disease.  Diagnostic imaging does not accurately identify the cause and does not improve the time to recovery.  It should be avoided to reduce radiation exposure and unnecessary cost.

 

Recommended treatment often includes normal physical activity within the limits of the pain, over the counter pain relievers and anti-inflammatory medications, heat to affected area, and physical therapy.  Typically bed rest should be avoided after the first 48 hours. In addition, opioid treatment for back pain is not recommended, as the risk for opioid dependence is high and it does not resolve the problem that is causing the back pain.  It is recommended that patients consult their primary care physician when experiencing back pain to determine the appropriate course of treatment. 

 

Recommendations for low back health include:

  • Stretch before exercise or strenuous activities;
  • Refrain from slouching while standing or sitting;
  • Keep body weight balanced on your feet when standing;
  • Wear comfortable, low heal shoes;
  • Refrain from lifting heavy objects and other activities that may result in back strain;
  • Utilize proper lifting techniques; and
  • Maintain a healthy weight to avoid unnecessary strain on your back from your mid-section.

 

Sources:

Choosing Wisely

Michigan Quality Improvement Consortium

National Committee for Quality Assurance

National Institute of Neurological Disorders and Stroke