Managing Lower Back Pain

Author(s): Albert Graziosa, M.D., Ariq Rabadi D.C.

Lower Back Pain (LBP) is a common ailment that, in most cases, has no singular cause or origin. Doctors normally classify Lower Back Pain as either mechanical or non specific or Lower Back Pain secondary to identifiable causes. The doctor or chiropractor will always start patient management by taking a clear, concise and comprehensive medical history followed by a physical exam assessing everything from posture to motor strength and sensory exams. Specific clinical maneuvers will alert the clinician of possible abnormalities that may require further, more aggressive evaluations.

Mechanical Lower Back Pain most commonly involves poor posture in combination with muscle strains and associated spasms. Most of these patients will, with appropriate management improve over a 4-6 week period of time progressing to their normal activities of daily living. Approximately 10-15% of these patients may become chronic and require more aggressive management and diagnostic workups. The average treatment protocol for Lower Back Pain involves anti-inflammatory medications and Physical Therapy (PT) / Chiropractic Management. Physical Therapy most commonly will involve heat/cold management, ultrasound, TENS unit and exercises to help manage spasm and pain. For those patients that don’t improve adequately, x-rays, MRI’s, CAT scans and/or EMG’s, may be required to further evaluate the patient considering the possibilities of herniated/bulging discs (HNPS), fractures, dislocations, facet arthrosis, spondylolisthesis, spinal stenosis with or without nerve involvement and cancer. More aggressive, conservative management requires a referral to a pain management specialist with continued PT/chiropractic treatment. The pain specialist may then institute epidural injections, facet injections and/ or trigger point- acupuncture injections. Less than 10% of patients will normally progress to the spinal surgeon for surgical management.

Successful management for LBP involves a multi-disciplinary approach. Working together as a team, the doctors and chiropractors will formulate an appropriate game plan in order to successfully treat the patient and progress them to living their normal lives.