Low back pain
Back pain affects nearly 75% of people at some point in their life, but many people have misconceptions about the cause of pain, diagnostic process, and how to manage it.
Back pain is the most common occupational injury, and the most common cause of disability in the young and middle aged.
Good news:
40% recover in 1 week
80% recover in 3 weeks
90% recover in 6 weeks
Only 1% require surgery
Mechanical causes are responsible for 90% of cases. Often called non-specific low back pain, these cases have no signs of serious underlying pathology, and the pain does not correlate with anything seen on imaging.
Imaging can show all kinds of changes, which might be congenital or a result of aging, but often these abnormalities are not responsible for the symptoms someone feels.
People with significant radiologic abnormalities may be completely asymptomatic.
After the age of 50, nearly 2/3 of people show degenerative changes on imaging.
Red flags include saddle anesthesia, bladder/bowel involvement, circulatory instability, loss of tendon reflexes. If you are experiencing these, get in to see your doctor immediately.
In general, the best advice for low back pain is to remain active. Bed rest is not recommended! Move your body within its limits based on your pain. Gentle stretching can feel good, and walking can often decrease symptoms. Pain is scary, and sometimes our brains jump to catastrophic conclusions based on pain. So get in to see a physical therapist to get more specific advice based on your symptoms. One study showed that people who received early PT (within 14 days of onset of back pain) had quicker resolution of symptoms and required less ongoing or invasive treatment.
Handa R. Low back pain- myths and facts. J Clin Orthop Trauma. 2019 Jul-Aug;10(4):828-830. doi: 10.1016/j.jcot.2019.05.024. Epub 2019 May 29. PMID: 31316266; PMCID: PMC6611834.
Childs, J.D., Fritz, J.M., Wu, S.S. et al. Implications of early and guideline adherent physical therapy for low back pain on utilization and costs. BMC Health Serv Res 15, 150 (2015). https://doi.org/10.1186/s12913-015-0830-3