What can we say? Low back pain is pervasive among our patients. And as PT's, it can be a tough nut to crack. Here are few insights gathered by our faculty of practicing clinicians over the years, that can help guide you in assessing and treating your patients who are struggling with it.
- Low back pain (LBP) is MOST OFTEN NOT a serious life-threatening medical condition; however, 3% of LBP is symptomatic of serious pathology and easily missed if the patient is not appropriately evaluated with a thorough history and neurological examination. Also, bad things get worse so keep an eye out for worsening symptoms and suggest further investigation.
- Healthy people have healthy neurological systems. Unhealthy people have unhealthy neurological systems. Learn to perform detailed, accurate neurological evaluations. It's often the first sign of much deeper and more serious problems.
- Most acute episodes of LBP improve quickly with conservative care --> early intervention with PT is more cost effective, improves long-term outcomes and decreases downstream health care spend. However, the longer persistent LBP is ignored, the more fearful patients can become. Address persistent pain. Mitigate fear. Evaluate, Listen. Relate. Refer when progress slows.
- Imaging generally does not correlate to the causes of low back pain. Worse, it often induces fear. The best role for imaging is to rule things out. Negative imaging is good news!! Move!!
- Graduated exercise and movement in all directions is safe and healthy for the spine, even when it hurts!!; If you have LBP, move. If it is painful, modify and move again.
- Spine posture during sitting, standing and lifting does not predict LBP or its persistence; however IMPROPER posture in sitting, standing and lifting can increase shearing, torsion and loading on structures not intended to resist such forces. No need to put excessive load on irritated tissues, so aim for easy neutral to minimize strain.
- A weak core does not cause LBP, but poorly COORDINATED pelvic musculature can precipitate and perpetuate LBP.
- Spine movement and loading will be better tolerated when the neuromuscular system has been adequately trained to assist during the movement.
- Constant back pain can result acutely from chemical inflammation to sensitized or damaged tissues. Intermittent pain is more often mechanical. Learn to evaluate the difference!
- Effective care for low back pain must address the whole person, ex (hip, thorax).
Have valuable tips to add? DM them to us on Instagram and we may feature! Better yet, explore these insights and more with our faculty at an upcoming Lumbopelvic Spine I and II course. These can be taken in any order convenient to you, and 2nd and 3rd year PTs enjoy a deep discount off their course registration fee.
For a full overview of all NAIOMT courses during 2020, please visit our course schedule page.