Acute Low Back Pain
Acute Low Back Pain is one of the most common human afflictions. Approximately
ten percent of the U.S. population experiences back pain each year. The
lifetime incidence of low back pain has been reported at 60 percent to
80 percent, and has an equally high lifetime recurrence rate.
Disorders of the back and spine are the most frequent and most costly
musculoskeletal impairments and rank third behind arthritis/rheumatism
and heart disease as a cause of disability in people in their working years.
The total medical cost attributable to this condition has been estimated
between $50 billion and $100 billion annually. Individuals with persistent
and disabling back pain account for 85 to 90 percent of this cost.
Low back pain is associated with a wide variety of both mechanical and
medical disorders. Mechanical disorders of the spine are caused by spinal
arthritis, disc degeneration, overuse, trauma or physical deformity. Medical
disorders that cause spine pain are associated with other illnesses, diseases
in other organ systems, infections and benign or malignant tumors. Mechanical
causes account for over 90 percent of low back complaints.
In the initial evaluation of patients with back pain the physician must
identify those patients with mechanical disorders from those with systemic
illnesses. The patient’s symptoms and physical signs help differentiate
mechanical from systemic causes of back pain.
The initial evaluation includes a history and physical examination. In
many patients, x-rays and laboratory tests are not necessary. These tests
are most helpful in patients who are 50 or older, who have a history of
cancer, who have had significant trauma, or have symptoms suggesting other
The majority of patients with spinal pain and systemic illnesses can be
identified by the presence of one or more of the following fever or weight
loss, pain when lying still, prolonged morning stiffness, localized bone
pain, and pain originating from abdominal or pelvic organs or blood vessels.
Mechanical disorders are the most common causes of low back pain. These
disorders include muscle and ligament strains and sprains, herniated discs,
spinal arthritis, spinal stenosis, spondylolisthesis and adult scoliosis.
Back pain arising from a mechanical disorder is frequently described as
deep, boring, aching, stabbing or catching. It is typically increased
with bending, twisting, lifting or sitting or standing for prolonged periods of time.
This pain is often felt to travel to the hip, buttock, thigh or leg. It
may be accompanied by feelings of numbness, pins and needles sensation
or weakness of the back or leg. Mechanical pain may be reduced by changing
position or lying down in certain positions.
Back strains or sprains are preceded by a recognizable traumatic event
that can range from a cough or sneeze to lifting a heavy object.
The lumbar disc is a fibrous shock absorber between the bones of the spine.
The disc can weaken from trauma, degeneration or aging. A disc herniation
occurs when a portion of disc material displaces into the spinal canal.
This can put pressure on the spinal nerves and in addition to back pain
can also lead to sciatica, which is pain traveling down the leg, usually
below the knee.
Spinal arthritis, also known as spondylosis, is a result of age-related
changes that occur almost universally. Symptoms may come and go over time
and are often worse at the end of the day.
Spinal stenosis can result from advanced spinal arthritis. The combination
of degenerative bulging discs, bone spur formation and thickening of the
ligaments decreases the space available for the spinal nerves. This can
not only cause back pain, but can also produce leg symptoms, especially
when walking. This pain needs to be differentiated from poor circulation,
which is also seen in the same population age group.
Spondylolisthesis is slipping forward of one vertebra on another. This
is usually secondary to disc degeneration but can also occur as the spine develops.
Scoliosis is an abnormal lateral curvature of the spine. This condition
most commonly develops during adolescence and is more common in girls
than boys. In the lumbar spine a curve greater than 40 degrees can progress
at a rate of one degree per year and cause increasing back pain.
The vast majority of patients with mechanical low back pain will improve
within two months. About 50 percent of patients with low back pain will
improve after one week. Since the natural history is so favorable, treatment
is directed at relieving symptoms.
Individual patients’ response to any one particular treatment can
be quite varied. This makes scientific evaluation of treatment methods
difficult. Treatment starts with an adequate explanation of the diagnosis
and expected outcome. Bed rest for short periods of time provides temporary
relief for many patients. The use of nonsteroidal anti-inflammatory medication
drugs or Tylenol may be appropriate. Muscle relaxers may help some patients.
A short course of narcotic medication may be needed in more painful cases
of acute low back pain.
Early movement should be encouraged for most patients. This helps to limit
muscular and cardiovascular deconditioning. After acute pain has subsided
further, aerobic conditioning is a good idea for most patients. Referral
to a physical therapist may be appropriate to provide closer supervision
and insure the patient is following the treatment plan, and to individualize
an exercise program.
Some patients will benefit from spinal manipulation. Injection therapy
is not typically used for acute low back pain. It would also be rare for
surgery to be indicated in acute mechanical low back pain.
There is also growing evidence that general fitness measures such as weight
reduction, smoking cessation, and regular aerobic exercise may reduce
the frequency and severity of back problems.
Acute low back pain is a common malady experienced by most adults during
their lifetime. It is usually readily diagnosed by your physician and
is generally responsive to simple non-invasive treatments and time.