Understanding Acute Low Back Pain: A Comprehensiv Guide

Acute low back pain affects millions worldwide. It often strikes suddenly after lifting a heavy object or develops gradually over days. This discomfort can be unsettling, significantly impacting daily life.

What You Need to Know About Acute Low Back Pain

It is important to understand that acute lower back pain is rarely related to just one structure. There is often a complex cascade of muscle spasms, nerve irritation, and impacts on mental health that all influence one another. According to statistics posted in 2022 by the Australian Commission on Safety and Quality in Health Care, back problems are the number one cause of lost work productivity, early retirement, and income poverty. They are also a common reason for visiting emergency departments.

Most episodes of lower back pain should improve significantly within the first six weeks if managed appropriately. In the following six weeks, recovery may be slower, but improvements should still be evident. If symptoms do not improve within 12 weeks, a referral is indicated. About one in four individuals who recover from an acute episode may experience another episode within the year.

There is a general consensus that early appropriate intervention may reduce the risk of recurrence and progression to persistent or chronic lower back pain. Different providers may manage acute episodes differently; however, we adopt guidelines adapted from the Australian Safety Standards in Health Care and the NICE guidelines to ensure that you receive care aligned with current research standards.

Recognition of Risk Factors and Screening

We apply a comprehensive screening process where you will be asked a range of questions. These may include inquiries about impacts on your bowel or bladder, weakness in the legs, tingling or numbness, history of trauma, and other factors relating to your medical history, such as past cancers, bone density, and medications that impact bones. We also screen for biopsychosocial influences related to your complaint.

We do this to ensure:

1. You are appropriate for our care and do not warrant further assessment by an Emergency Department, General Practitioner, or Specialist.

2. We may need additional tools to assist you in recovery, such as cognitive behavior therapy, workplace adaptations, or screening tools for you to fill in.

3. You have risk factors that may require further monitoring during the early phase of recovery.

   
   

Examination Process

We conduct a thorough examination, breaking it into two parts: examination of risk factors and influences, and the physical examination. We will have you move your back, perform nerve testing maneuvers, and orthopedic testing maneuvers, as well as assess ranges of movement to try to localize the type of injury sustained.

We will also determine whether early referral is needed or if the condition is safe to be monitored in the interim. Often, acute back pain relates to multiple structures such as facets, muscles, ligaments, and discs. Therefore, you may not receive a “specific diagnosis” every time. Sometimes the complaint is too inflamed to carry out reliable testing to conclude a “single cause.”

Less commonly, acute low back pain can be attributed to compression fractures, stress fractures, inflammatory conditions, or even referred pain from other organs and structures. This is why a detailed history is essential.

The Role of Imaging in Low Back Pain

One of the first questions we often receive is, "Does it need a scan?" Generally, the answer is no. Most patients we see won’t require imaging.

So when is imaging a good idea?

• For bone stress injuries: generally, MRI is the most appropriate.

• For conditions causing weakness or where management should be modified.

• For conditions that are not improving where possible inflammatory or infections are suspected.

• In those with a complex health history where serious conditions should be excluded.

• When there are concerns about compression fractures or serious trauma involved.

  
  

Who refers you? We can refer you as Allied Health Professionals, but your GP may be the most appropriate or a Specialist who manages your condition. This depends on your circumstances. A recent review indicated that there was an overuse of imaging in primary care. Just like many of us have small scars on our skin or asymmetries in our faces, there are often similar variations beneath the surface. The honest truth is that there is rarely a 'perfect' back or scan, especially unless you are young.

Sometimes the findings of the scan do not actually relate to your symptoms. With patients receiving their reports, having a long list of findings in medical jargon can often lead to concerns over 'normal' findings on a scan. Just like our skin gains wrinkles with age, so does our spine and soft tissues. Often, people confuse 'pathology or disease' with the 'physiology or normal process of aging.'

Illustration of the lumbar spine

What Should I Do When I Have Acute Lower Back Pain?

Recognizing the symptoms of acute low back pain early can make a significant difference. If you have any concerns or worries, book an appointment. In many cases, this doesn’t need to be a prolonged management plan. It may involve some treatment, reassurance, guidance, and self-management tools specific to you.

If finances or time are limited, you can try these 'free' methods to self-manage:

• Heat and Ice: The use of heat and ice assists with the pain modulation of acute pain. Whether it truly helps with muscle inflammation or tightness is a constant point of contention in research, so we can only conclude it 'may' assist.

  
  

• Walking and Movement: During the early phase of acute pain, try to limit 'rest.' This doesn't mean sitting in the garden pulling weeds for hours. Instead, this may look like five short walks around the home, performing 'windscreen wiper' exercises, or even heading to a local pool for a gentle water walk or swim.

  
  

• Monitor Your Ergonomics: Take note if the symptoms worsen with certain movements, whether sitting or standing for long periods, or getting in and out of the car. It may be useful to limit these movements for a little while while the symptoms are acute and the back is inflamed.

  
  

• Chat to Your Local Pharmacist: Your local pharmacist is an untapped resource of information and arguably the most accessible primary care practitioner you can see without an appointment. I have received some of the best acute advice from pharmacists regarding pain management and supplements. If you regularly attend a pharmacist for your scripts, they should have your other medication information to suggest appropriate pain management if needed.

  
  

• Check Your Skin: This may seem a little strange, but check the skin overlying your pain. There may be instances where the acute pain signals a different process occurring (e.g., shingles or infection). Have someone check for you if needed.

  
  

Who Can You See for Treatment?

If you're struggling with acute low back pain, several healthcare professionals can help you. Physiotherapists and osteopaths can be consulted as a point of primary care; however, some prefer to seek their GP's opinion first. The most important factor is that you see someone who is qualified, educated, and aware of when your condition warrants further investigation.

When to Seek Immediate Help

While many cases of acute low back pain can improve with self-care, certain symptoms require immediate medical attention. You should see a healthcare professional if you experience:

• Severe pain lasting more than a few days

• Noticeable weakness in your legs

• Loss of bowel or bladder control

• Pain accompanied by fever

• A visible rash

  
  

Seeking help quickly can lead to a better recovery outcome.

Understanding Psychological Factors in Pain Management

Pain doesn't just stem from the body; psychological factors can intensify the experience of pain. Stress, anxiety, and depression may heighten your perception of discomfort. Seeking help from mental health professionals or exploring stress-relief techniques like mindfulness can be crucial for a complete recovery.

Moving Forward with Confidence

Acute low back pain can be challenging and often disrupts daily life. By identifying the structures potentially causing your pain and using effective management strategies, you can make strides toward recovery. Consulting with healthcare professionals, participating in appropriate physical activities, and addressing any psychological factors can create a holistic approach to pain management.

With commitment and the right plan, returning to an active and fulfilling life is within your reach. Take charge of your health today; don't let pain hold you back any longer.

Exercise mat and resistance band for rehabilitation exercises