Acute Low Back Pain

Diagnosis/Definition

A condition of pain in the lower (lumbar-sacral) back region, with or without radiation of symptoms to the buttocks or lower extremities, of less than 6 weeks duration, in the non-pregnant patient.


Initial Diagnosis and management

• Elicitation of history and performance of physical examination.  Special attention to presence or absence of "red flags" to include: age <18 or >55; history of malignancy, steroid use, HIV positivity; constitutional symptoms (fevers, chills, unintended weight loss); structural deformity; anal or urethral sphincter disturbance; saddle anesthesia; gait disturbance; or widespread neurologic deficits.

• If red flags are present, diagnostic testing needs to include plain radiographs (AP, Lateral, and Spot Views); CBC with differential; ESR; C-Reactive Protein. Consider bone scan; CT scan and/or MRI scan and electrodiagnostics as indicated.

• If red flags are absent a diagnostic workup is generally not necessary.

• Initial treatment for the first 4-6 weeks consists of

  • reassurance that most episodes resolve uneventfully within 6 weeks

  • encouragement to maintain as close to normal activity as is tolerable

  • prescribing a limited number of back exercises and stretches avoidance of bed rest greater than 24 hours

  • NSAIDS (unless contraindicated)

  • muscle relaxants for up to one week

  • acetaminophen as needed

  • steroid taper if symptoms of radiculopathy present

  • weak opiates (codeine; propoxyphene) unless contraindicated

  • passive modalities (e.g. ice, heat) for symptomatic relief.

Ongoing Management and Objectives

• If pain has not improved in 4-6 weeks: re-evaluate for "red flags", change NSAID, refer to Physical Therapy for evaluation and treatment.

Indication a profile is needed

• Any limitations that affect strength, range of motion, and general efficiency of feet, legs, lower back and pelvic girdle.
• Slightly limited mobility of joints, muscular weakness, or other musculo-skeletal defects that may prevent hand-to-hand fighting and disqualifies for prolonged effort.
• Defects or impairments that require significant restriction of use