Treatment of low back pain will vary depending on what the underlying cause of the acute low back pain is. Most of the back pains are harmless and self-limiting, but extremely annoying to the patient. In the acute phase icing the back may give relief. Some patients have perhaps a weaker connective tissue. Chiropractors, physiotherapist and specialist in Rehabilitative medicine (physiatrists) have all their place in the treatment of low back pain. Electroacupuncture is a useful technique to use, once it has been established by your care giver that your back pain is harmless and consists of reoccurring muscle spasms. Once thee treatments have given you relieve it is imperative that you engage in a regular muscle strengthening program like a regular gym program.
When you are more prone to recurrent acute lower back problems you may benefit from a few chiropractic manipulative treatments. Minor malalignments of the facet joints can be treated very quickly and effectively this way. But some patients are very sensitive in their back, perhaps because they lean more towards developing fibromyalgia or myofascial pain when they have a back pain.
These patients will find out that they do better with physiotherapy treatment modalities and they should be sent there. Once the patient knows what works for them, they usually gravitate into the right treatment modality. It would be a mistake to recommend one therapy over another. Some patients also seem to respond best to a few acupuncture treatments combined with stretching exercises and subsequent reactivation exercises.
If this is what it takes to overcome the acute back pain, go for it! After an initial one or two weeks of passive treatment modality such as chiropractic, physiotherapy or acupuncture treatments it is important in all cases to switch over to a more active reactivation program with active exercises and stretching exercises as indicated above.
Apart from modalities by therapists that help the patient’s back pain we need to be aware of postural problems. An obese patient for instance will develop a hyper-lordosis in the lower lumbar spine, which will cause recurrent lower back problems. Only will power and weight loss will help normalize this on the long run (see image).
If reactivation of the lower back is neglected, the patient gets muscle atrophy from disuse and this sets the patient up to get a chronic back pain, post-traumatic fibromyalgia or myofascial pain syndromes.
The following lists the specific therapeutic recommendations for the more common underlying causes of back pain. Links are provided in the table for more details of these therapeutic modalities.
Treatment modalities for lower back pain
facet joint disease (lower back strain) : chiropractic or physiotherapy treatments initially followed by active exercises
degenerative disc and facet joint disease: anti-inflammatory medication and physiotherapy treatments, swimming; end stage intractable disease, if confined to one or two levels may respond to fusion surgery by spinal surgeon
spondyloarthropathies: treat underlying disease and use antiinflammatories; rheumatologist referral for more specific therapy
osteoporosis: treat underlying hormone disbalance, if present; regular walking and swimming; avoid alcohol, caffeine, stop smoking; use calcium, bisphosphonates, vitamin D
scoliosis : bracing during growth spurts; good posture; strengthening exercises; in severe cases corrective surgery with Harrington rods by spinal surgeon
spinal stenosis: decompression surgery for severe cases to free spinal cord and nerve roots
posttraumatic fibromyalgia: low dose antidepressants, cognitive therapy, mild physical exercises
disc herniation with or without sciatica : only in 3% of all back pain is surgery indicated; many cases heal on their own
spondylolisthesis and other congenital malformations: grade I to IIIA do not need surgery, stage IIIB and IV need fusion with instrumentation by spinal surgeon
bone metastases: underlying cancer needs treatment, often chemotherapy required
The underlying disease such as Crohns disease, ulcerative colitis, psoriasis or ankylosing spondylitis that has lead to this inflammatory disease of the spinal column needs to be treated. Sulfasalazine in the case of Crohns disease and ulcerative colitis might also help the spondyloarthropathy. The COX-2 inhibitory drug (brand name: Celebrex) is also useful, as are the regular anti-inflammatories. Keep an eye on side-effects of the COX-2 inhibitory medications, which are easier on the stomach, as one of these drugs (VIOXX) was pulled from the market in October of 2004. The VIOXX link explains this story in detail.
Otherwise reactivation, physical rehabilitation programs and postural improvements are helpful.
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