(This is the first post in a series on Low Back Pain.)

If you haven’t had low back pain (LBP) before, you are in luck.  Unfortunately, it’s only a matter of time before you experience one of the most common musculoskeletal complaints.  In fact, studies show that approximately 80% of individuals will experience low back pain at some point in their life.  This can vary from minor aches and pains to lifelong disability. 

 Many cases of LBP will resolve with time.  Others, depending on many factors that will be discussed in later posts, can develop into chronic conditions that can significantly limit a person’s ability to function and participate in their daily activities.  There is no one single cause of LBP and therefore, not all LBP should or can be treated the same.

This leads to the question for this LBP series – what treatments are available for LBP and which of them work best? 

Low Back Pain’s Normal Course

As mentioned before, many cases of low back pain are self-limiting.  These are the cases where a little too much yard work has you “down in the back” the next day.  Sources differ on the exact time frame ranging from a couple days to three weeks. 

Repetitive motions, lifting, sharp sudden movements, and trauma can all be the culprit that elicits your episode of low back pain.  How you respond when this sets in can help determine just how long you have to deal with the pain and impairments that come with low back conditions.

Typically, someone who injures their low back with see their primary care physician first.  Often, an anti-inflammatory drug, muscle relaxant, or both are prescribed along with instructions to rest or modify activity.  If this doesn’t work, the primary care physician will refer the patient to an orthopaedic specialist who will most certainly recommend some imaging (x-rays, MRI).  More drugs are likely and then, just maybe a referral to Physical Therapy for evaluation and treatment.

Herein lies the problem.

It’s been approximately three weeks and you still have back pain despite the drugs, imaging, and the changes in your activity.  All of this nonsensical over-utilization for what you could have done the day after your hurt your back. 

The scientific literature is becoming increasingly more supportive of Physical Therapy as the first-line, intervention of choice for patients with low back pain.  We know that patients who see us within the first 16 days of onset have a high probability of getting better in only a few visits, saving money and time.  The evidence also shows that classifying patients with LBP based on signs, symptoms, and their response to common clinical tests then matching how they are treated with these variables will greatly improve their likelihood of success. (More on classification and clinical prediction rules to come in a later post)

So the next time you have LBP (or if you have LBP now), seek the care of the licensed Physical Therapist.  Most states allow you to see the PT first (direct access), but the insurance companies are walking a step behind and often require a physician’s referral for payment.  In this case, ask you primary care physician for a referral to PT instead of the drugs and waiting line at the specialists office.

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