Dr. Ebraheim’s educational animated video describes instructions and education information for patient suffering from low back pain.
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85% of people will experience low back pain at some point during their life. Low back pain is very common and it actually occurs in equal frequencies between males and females. It affects all age groups, but it commonly affects people between the ages of 35 - 50 years old. Acute low back pain is usually transient and it resolves within a few weeks. Most patients recover quickly without residual loss of function. The patient should recieve education and knowledge about the history and the favorable outcome of acute low back pain. Its also important for individuals to learn that 90% of people may develop degenerative changes in their lumbar discs by the age of 50 years old. It is important to differentiate between acute and chronic low back pain. Acute low back pain is defined as low back pain that lasts up to 12 weeks. Chronic low back pain lasts longer than 12 weeks and frequently recurs. In acute low back pain, most patients recover quickly without any residual loss of function. About 90% of the patients return to work within 12 weeks. In most cases, the treatment is directed at reducing the pain and improving the function, even if we do not find a cause. When you are dealing with a patient with acute low back pain, make sure that there are no red flags (tell-tale signs) which can signify an underlying, serious condition. A patient with acute low back pain will recover even if the low back pain is severe as long as there is no radiation, no constitutional symptoms (fever, chills, weight loss), no history of trauma, no neurological deficit and no bladder or bowel dysfunction. No infection! No tumor! No pathologic reflexes to indicate that they may have cervical spinal cord compression. There are a lot of people who have positive MRI findings who have no symptoms. That is called false positives! In a healthy patient with acute onset of nontraumatic low back pain, this patient does not need diagnostic imaging before proceeding with the treatment. The patient should receive education about the factors to low back pain:
• Occupations that require heavy lifting and continuous vibration
• Driving certain motor vehicles
• Cigarette smoking
• Depression and anxiety
• Sedentary lifestyle
• Job dissatisfaction
• Certain sports
• Pregnancy
In addition to reassurance and education to the patient, what other information or instructions should we give the patients? Smoking is definitely a risk factor for low back pain.
• Maintain an ideal body weight
- The spine in overweight patients will experience increased loads and a dietary consult may be helpful in this situation.
• Stay in shape
- The patient needs to be conditioned and needs to be physically fit and improve the cardiovascular fitness by walking, bicycling, swimming, and gradually increase the fitness exercises in frequency and in time.
- Aerobic exercises help to increase the nutrition of the discs and improve the condition of the muscles.
• Stop the use of narcotics!
- Narcotics are addictive and they prevent an effective rehab exercise program.
- There is strong evidence to support the use of aspirin and nonsteroidal anti-inflammatory medications in addition to appropiate use of muscle relaxants.
There is moderate evidence supporting spine manipulation, especially in acute back pain.
The patient needs to do active physical therapy! The exercise therapy has limited value for the acute low back pain but has strong value in chronic low back pain. The patient should avoid prolonged sitting. The patient needs to stand, stretch and move around. Avoid any exercises that aggravate the back pain!
With epidural injection, the evidence is weak in acute low back pain. Epidural injection is strong for the short term relief of chronic low back pain and limited for the long term relief of chronic low back pain. What is NOT supported by evidence?
• Facet joint injection
• Orthosis.
• Traction.
• Magnets.
• Acupuncture.
• Dry needle therapy.
Basic body mechanics, activity modification and behavioral modification can reduce the symptoms of low back pain. The patient should learn the proper technique of sitting, standing, lifting and lying down! The lowest IDP is measured while the patient is lying supine. The highest IDP is measured while the patient is sitting, leaning forward and carrying weight. In general, when you are carrying weight, try to hold the weight close to the body. Postural changes in the disc itself and movement of the spine in a certain way can affect the pressure inside of the disc and can also effect the pain of the patient. In general, if the patient does not have red flags then conservative treatment with anti-inflammatory medications and physical therapy is sufficient and no further work-up is necessary initially.
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