Acute Low Back Pain Management

Lower back pain is an extremely common condition, affecting up to 80% of adults at some point in their lives. It is one of the leading causes of disability worldwide and results in significant healthcare costs and loss of work productivity. This article will provide you with an overview of the causes of lower back pain and summarize evidence-based, non-pharmacologic options to help manage acute and chronic symptoms. The goal is to educate readers on effective ways to relieve lower back pain and improve functioning without reliance on medications.

Causes of Lower Back Pain

Lower back pain has several potential underlying causes:

Mechanical Causes

Mechanical causes related to the spine itself are the most common source of lower back pain. These include strained ligaments, injured intervertebral discs, irritated facet joints, and muscle spasms or strains. Improper lifting, sudden movements, poor posture, lack of exercise, and obesity can contribute to mechanical back pain.

Neuropathic Causes

Pinched or compressed nerves can result in lower back pain that radiates down the leg (sciatica). A herniated disc, bone spurs, spinal stenosis, or piriformis syndrome are examples of conditions that may compress or irritate spinal nerves. This neuropathic type of pain is often described as sharp, shooting, or burning.

Referred Causes

Sometimes pain arising from other structures can be perceived in the lower back region. Referred pain can originate from organs, tumors, pregnancy, or arthritis in the hips or sacroiliac joints. Identifying the true origin is important for proper treatment.

Acute Versus Chronic Lower Back Pain

Lower back pain is generally categorized as either acute or chronic:

Acute Pain

Acute lower back pain comes on suddenly and lasts less than 6 weeks. It is often traced to a specific incident like lifting a heavy object or a sudden awkward movement. Acute pain usually improves with rest and conservative treatment.

Chronic Pain

When lower back pain persists for over 12 weeks, it is considered chronic. Chronic pain is complex with many contributing biopsychosocial factors. Risk factors for developing chronic lower back pain include genetics, anxiety/depression, smoking, obesity, and occupational activities. Chronic pain often requires a multidisciplinary approach to management.

Exercises for Lower Back Pain

Evidence supports the use of various exercises to help reduce lower back pain and improve mobility and function:

Strengthening and Endurance Exercises

Performing targeted exercises to strengthen the postural muscles of the back, abdomen and hips can improve stability and fatigue-resistance. Common examples are bridges, planks, bird dogs, and various abdominal crunches.

Activation Exercises

Exercises that specifically activate the deep core stabilizer muscles like the transversus abdominis can help improve control and coordination in the lumbopelvic region. Drawing the navel in toward the spine or co-contracting the abdominals on exhale are simple activation techniques.

Movement Control Exercises

These exercises aim to improve balance, proprioception, and coordination during normal functional movements like bending, lifting, reaching, and transitional movements. A physical therapist can help tailor the exercises and provide feedback on quality of movement.

General Fitness Exercises

Aerobic, flexibility, and full-body strengthening exercises improve overall conditioning and help maintain a healthy weight. Walking, swimming, yoga, and using an elliptical machine are excellent options.

Manual Therapies for Lower Back Pain

Hands-on techniques delivered by licensed professionals can provide short-term relief from lower back pain:

Mobilization

Mobilization uses gentle repetitive movements to restore normal joint mobility. Thrust and non-thrust mobilization techniques help improve spinal and hip mobility.

Soft Tissue Techniques

Methods like massage, myofascial release, and trigger point therapy help relax tight musculature. Reducing muscle tension can alleviate referred and radiating pain patterns.

Dry Needling

Dry needling involves inserting thin needles into trigger points in muscles to relieve knots and cramping. It may reduce local and referred pain.

Neural Mobilization

Gently mobilizing nerver roots and peripheral nerves can help reduce inflammation and decompress tissue in cases of radicular pain and sciatica.

Classification Systems

Identifying the underlying pain generator or movement impairment can help guide optimal treatment:

Treatment-Based Classification

This approach identifies the tissue source of pain and matches treatments accordingly. Categories include disc, facet joint, muscle, and nerve pain.

Mechanical Diagnosis

Patterns of symptom response to repeated movements help classify patients. Centralization, peripheralization, and directional preference help indicate appropriate exercises.

Pathoanatomic Classification

Imaging and clinical tests identify the pathoanatomic source, such as disc pathology, facet arthropathy, stenosis, or sacroiliac joint dysfunction.

Education and Self-Management

Lower back pain should be viewed through a biopsychosocial lens, addressing physical, psychological, and social factors. Key self-management strategies include:

• Remaining active within pain tolerance limits
• Pacing activities to avoid flare-ups
• Relaxation techniques like diaphragmatic breathing
• Adopting proper posture, movement patterns, and ergonomics

Prevention and Risk Factors

Steps to help prevent and minimize lower back pain include regular exercise, maintaining a healthy weight, proper lifting mechanics, managing stress, and avoiding smoking. Obesity, poor posture, anxiety, depression, and occupational activities are risk factors.

Conclusion

Lower back pain is highly prevalent but there are many evidence-based conservative options to help manage symptoms. A combination of targeted exercises, manual therapies, psychologically-informed education, self-management strategies, and addressing risk factors provides a comprehensive approach to relieve acute and chronic lower back pain.