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Lower Back Pain

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Lower Back Pain2021-07-21T08:49:31-05:00

About Lower Back Pain

Are you suffering from lower back pain? You are not alone. Lower back pain is one of the most common reasons that patients see the doctor, and it will impact 90% of all individuals at some point during their lives. There’s been a dramatic increase in spending for many of the most common back pain treatments, including medications, surgical procedures and injections, yet none of these treatments have been proven as a definite solution for resolving lower back pain. Since less than 5% of lower back issues are actually related to a serious underlying medical condition, many medical professionals now recommend taking a more conservative approach when treating back pain.

How Physical Therapy Can Help

At Total Motion, we utilize a combination of manual therapy techniques, exercise, soothing treatments and lifestyle changes to help resolve lower back pain. While pain medication and surgery were once the go-to options for treating lower back pain, today’s medical professionals recommend an approach that includes treatments that are specific to individual patient symptoms and the type of lower back pain they experience. 

When compared with the alternatives, an approach that includes a combination of different  treatment types has been found to provide improved outcomes and deliver long-term pain relief for those who suffer from lower back pain. These treatments include: 

  • Traction
  • Stabilization
  • Manipulation
  • Direction-specific exercises

What Medical Studies Say

Utilizing spinal manipulation and stability exercises has been shown to have a dramatic reduction in lower back pain for up to 6 months and there is a reduced risk of recurrence when compared to other treatments. Patients who receive these types of treatments over surgery and other treatments also report a lowered need for long-term pain medication and a decreased period of disability and inability to work. For those who have ruled out more serious health conditions that could be causing the pain, physical therapy has proven to be a highly effective treatment option.The number needed to treat for this intervention is 1-2, which indicates that for every patient who receives manipulation treatment, another patient will show improvement versus exercise alone (7).

Hides et al reported in a randomized controlled trial of spinal stabilizing training compared with typical medical management, a reduced recurrence risk (30% vs. 84%) and future medical care (42% vs. 15%) in the stabilization group. The recurrence risk for the medical management group stayed elevated for up to three years (10). There does not appear to be a larger effect of local versus global stabilization training among those who meet the sub group criteria for spinal stabilization (11).

Long et al. reported, in a large randomized controlled trial, that there was a reduction in pain in the back and legs, reduced disability, less need for pain medication and reduced psychosocial variables, such as lowered depression, when patients with a directional preference for lumbar exercises were matched to their respective directions (12). In another study, Browder et al. reported a reduction in pain and disability in both short and long term outcomes when manual therapy was combined with direction specific exercises (referred to as the Extension Oriented Treatment Effect) (13).

low-back-1-webLess evidence has been found for the effectiveness of traction for acute lower back pain. However, there is one subgroup of patients who may benefit from this type of treatment, including those who have issues with nerve compression, where pain doesn’t originate with movement and who have a (+) contralateral straight leg raise (14).

Based on a patient’s signs and symptoms, the Treatment Based Classification System (TBC), is far less costly ($774 vs. $1004), and is better at improving pain, disability and getting people back to work when compared with national medical guidelines (AHCPR) (15). “Non specific LBP should not be viewed as a homogenous condition. Outcomes can be improved when sub grouping is used to guide treatment decision-making.” (5)

Those who have acute lower back pain without any red flags that could indicate a more serious condition should utilize physical therapy for treatment.

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Resources

Contact Total Motion for Help

Don’t let lower back pain get in the way of your lifestyle. If you are looking for an alternative to traditional medical treatments that may or not provide the relief you need, physical therapy may be the right solution for you. Contact Total Motion today to schedule an evaluation and we’ll take a look at your overall health, your current pain levels and your lifestyle to create a personalized treatment plan designed to reduce your pain and restore your function for a total life. Remember a referral may not necessary.

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References

  1. Patel, A. et al. Diagnosis and Management of Acute Back Pain. Am Fam Physician. 2000 Mar 15;61(6):1779-1786.
  2. Hart, L. et al. Physician office for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine. 1995. 20(1):11-9.
  3. Luo, X. et al. Identifying Subgroups of Patients with Acute/Sub acute “Nonspecific” Low Back Pain: Results of Randomized Clinical Trial. Spine. 2006.
  4. Stewar, W. Lost Productive Time and cost Due to Common Pain Conditions in the US Workforce. JAMA. 2003. 290(18):2443-2454
  5. Brennan, G. et al. Identifying Subgroups of Patients with Acute/Sub acute “Nonspecific” Low Back Pain: Results of a Randomized Clinical Trial. Spine. 2006.
  6. Deyo, R. et al. What Can the History and Physical Examination tell Us About Low Back Pain/ JAMA. 1992. 268(6):760-766.
  7. Childs, J. Fritz, J. et al. A Clinical Prediction Rule to Identify Patients with Low Back Pain Most Likely to Benefit from Spinal Manipulation: A validation Study. Annals if Int Med. 2004/920-928.
  8. Brinjikjii, W. Systematic Literature Review of Imaging Features of Spinal Disorders in Asymptomatic Population. Am J Neuroradiology. 2014.
  9. Chiu, C. et al. The probability of spontaneous regression of lumbar herniated discs. A systematic review. Clinical Rehab. 2015, Vol. 29(2) 1845-195.
  10. Hides, J. et al. Long-Term Effects of Specific Stabilizing Exercises for First-Episode Low Back Pain. Spine. 2001. 26(11):243-248.
  11. Koumantakis, G. et al. Trunk Muscle Stablization Training Plus General Exercise Versus General Exercise Only: Randomized Controlled Trial of Patients With Recurrent Lower Back Pain. Phys Ther. 2005;85:209-225
  12. Long, A. Donelson, R. Does it matter which exercise. A randomized control trial of exercise for low back pain. Spine. 2004;29:23:2593-2602.
  13. Browder, D. et al. Effectiveness of an Extension-Oriented Treatment Approach n a Subgroup of Subjects with Low Back Pain: A Randomized Clinical Trial. PT. 2007;87:1608-1618
  14. Fritz, J. et al. Is There a Subgroup of Patients with Low Back Pain Likely to Benefit From Mechanical Traction? A RCT and Subgrouping Analysis. Spine. 2007. 32(6):E793-E800.
  15. Fritz, J. et al. Comparison of Classification-Based Physical Therapy with Therapy Based on Clinical Practice Guidelines for Patients with Acute Low Back Pain. A Randomized Clinical Trial. Spine. 2003;1363-1372.