Management of acute low back pain,
I have always suggested manipulative physiotherapy treatment to start as soon as possible after an injury. I believe that therapeutic (for treatment) intervention is to create an optimal environment in which healing can take place. It could therefore be argued that the best way to manage chronic (long-standing) low back pain is to manage acute low back pain at its early stage well. It is a general belief within the medical community that most cases of acute low back pain recover quickly with or without treatment. Acute low back pain is portrayed as benign and self-limiting. This belief seems to be the basis for the minimal intervention approach that is promoted in many clinical practice guidelines for the management of acute low back pain. However, recent research at the University of Sydney led by Associate Professor Chris Maher has shown that this optimistic view is not true. The typical clinical course of acute low back pain is for rapid improvement in the first month followed by ongoing mild pain and disability for some months with a high risk of recurrence in the next year. The reality is that for many people acute low back pain is not a self-limiting condition. Given the new knowledge about clinical course, Professor Maher suggests reconsideration of the minimal treatment approach for acute low back pain. Advice and paracetamol may not be sufficient for all patients with acute low back pain. This basic care may need to be supplemented for example with physiotherapy treatments such as spinal manipulative therapy, Mckenzie therapy (emphasizing extension) , and directional preference exercise – which have been shown to be effective for acute low back pain. Preventing recurrence is also now a key issue for researchers and clinicians, Two quite different approaches to exercise – one developed at the University of Queensland, Australia and the other in Scandinavia – have been shown to markedly reduce the risk of recurrence. Ultrasound-guided multifidus (small backward bending muscles) exercises delivered during the acute phase and active back school delivered after the initial symptoms have resolved, have both been shown to markedly reduce the risk of recurrence. In the Queensland study, the risk of recurrence in the exercise group was a third of that in the control group who did not exercise. In the Scandinavian study, the risk of recurrence halved and the protective effect of exercise remained at three-year follow-up. The management of acute pain presents far fewer problems than that of chronic pain. In most cases in the acute pain, we are only dealing with local tissue damage and the nociceptive (pain sensitive) system. With chronic pain, the mechanisms and tissues involved are far more complex. While we are able to help patients with chronic conditions to recover or at least to minimize their symptoms, it is much better to prevent their conditions become chronic. Early intervention is the key to better recovery.