Low back pain is a common musculoskeletal disorder which affects the lumbar segment of the spine. It can be either acute, subacute or chronic in its clinical presentation. Typically, the symptoms of low back pain do show significant improvement within two to three months from its onset. In a significant number of individuals, low back pain tends to be recurrent in nature with a waxing and waning quality to it. In a small proportion of sufferers this condition can become chronic. Population studies show that back pain affects most adults at some stage in their life and accounts for more sick leave and disability than any other single medical condition.[citation needed]
An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened. In acute cases, the structures damaged will more than likely be soft tissue like muscles, ligaments and tendons. With a serious accident or due to osteoporosis or other causes of weakened vertebral bones, vertebral fractures in the lumbar spine may also occur. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint at the bottom of the lumbar spine, called sacroiliac joint dysfunction (see sacroiliac joint for more information) .
Chronic lower back pain usually has a more insidious onset, occurring over a long period of time. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae, or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, a tumor (including cancer) or infection. The cause may also be psychological or emotional or due to other non-anatomical factors.
Treatments
The course of treatment for low back pain will usually be dictated by the clinical diagnosis of the underlying cause of the pain.
Conservative treatment
For the vast majority of patients, low back pain can be treated with non-surgical care. For those with acute, short-term back pain, certain home remedies may be effective.[citation needed] ClinicalEvidence.com has systematically reviewed randomized controlled trials published through April, 2004 and concluded:
Treatments likely to be beneficial
* Advice to stay active.
* Analgesics (pain medications), such as NSAIDs or acetaminophen.
* Spinal manipulation for acute or chronic pain. A clinical prediction rule can guide who is most likely to respond to manipulation.
* Muscle relaxants for acute or chronic pain.
* Antidepressants for chronic low back pain.[4]
* Exercise for chronic pain.
* Intensive multidisciplinary treatment programs may help subacute[3] or chronic low back pain.
* Behavioral therapy
* Acupuncture may help chronic pain; however, a more recent randomized controlled trial suggested significant difference between real and sham acupuncture.
Other treatments
Additional treatments have been more recently reviewed by the Cochrane Collaboration:
* Massage therapy may benefit some patients.
* Ice and/or heat application (or moist heat) has uncertain benefit.
Individual randomized controlled trials, thus interpretation may be subject to publication bias, also confounded by absence of double blinding have shown benefit for:
* Viniyoga, Iyengar, and Hatha yoga (small trial).
* Correcting leg length difference may help. To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust.
* Muscle Energy Technique (MET) may help (small study).
Surgery
Lumbar surgery is indicated when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurologic symptoms such as leg weakness, bladder or bowel incontinence, which can be seen with severe lumbar disc herniation, spinal abscess or cauda equina syndrome.
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