Low Back Pain – Proper Diagnosis and Management

Low back pain is so common – over 80% of the population will experience it at some point – that terming it a disease does not really make much sense. Everyone has experienced the common cold and we all get over it within a short period of time and although we clearly feel ill for a few days, no one considers it be a disease.

Low back pain – harmless?

An acute episode of lower back pain will usually subside within a few days to a week and rest, moderated activities and “over the counter” medication will usually be sufficient. Patients will intuitively know if their symptoms are “turning the corner” after a few days. If they are not, patients should consider consulting an authorised health care professional. This may come as a surprise to readers, but the most documented preventative results are obtained by 1st class and comprehensive care. High quality care is so very important in order to prevent reoccurrence and chronicity.

Proper Evidence based care – what does this involve?

  • A thorough case history
  • A thorough physical examination
  • Patient choice and empowerment
  • Providing treatment that the scientific literature has demonstrated to be safe, effective and cost effective.

Case History

The case history – or patient interview – is crucial in that experienced clinicians can arrive at a good working diagnosis simply by interviewing the patient. A thorough symptom description including exactly where the pain is, its intensity and duration, how they came about, aggravating and relieving activities, previous episodes, general health status and so forth all form the parameters of the interview. The clinician develops an “index of suspicion” during the interview and this will to a large extent determine where the focus of the physical examination should be.

The Physical Examination

There are of course standardised examination procedures that most authorised clinicians carry out. Range and quality of movement, the testing of reflexes, sensitivity and muscle strength are standards. Careful palpation of the area involved is also standard. Rashes, multi-joint pain, fever and general illness will necessitate referral a medical consultant. At our clinic we are fortunate to have the broadest team of practitioners of any private clinic in London.

Patient Choice – Empowerment

It has been demonstrated in numerous studies that patients should have a good understanding of their condition and that when choice is relevant – for example chiropractic or physiotherapy treatment for non-inflammatory low back pain – that they should be able to make an informed choice. They should be properly informed as to what to expect as regards symptom improvement, how long this should reasonably take and so forth.

Treatment

A solid and well evidenced treatment course for lower back pain involves spinal manipulation, pain relieving medication, information and concluding exercise/ergonomic instruction. This course of treatment is the most common at our clinic. If there is any suspicion of inflammatory disease – such as active arthritis or connective tissue disease – patients will be referred to our consultant rheumatologit. If findings indicate that a surgical or neurological evaluation should be undertaken this can also take place at our clinic. Gait analysis, acupuncture and massage are also available. On occasion, when stress levels appear to be high – not unusual in the City of London – we refer patients to our in-house stress experts.

Conclusion

Although usually benign and self-limiting lower back pain does not always “go away”. Up to 10% of patients still suffer from their initial episode of acute pain 1 year on and many will experience recurring symptoms with physical exertion. The best treatment is multi-disciplinary and comprehensive. No individual health discipline can manage the myriad of conditions related to lower back pain and being part of a cohesive team will usually result in better and long lasting results.

Dr Alan Jordan, Chiropractor

Clinic Director

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