Acute low back pain and physical therapy

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Acute low back pain and physical therapy - Low back pain: a bad back very common

Each year low back pain causes temporary disability in 3-4% of the population and total disability for 1% of the working age population. LBP-called pain associated with mechanical disorders of the spine that usually affect the lumbar spine (that is to say the succession of five vertebrae of the lower back, located just above the tailbone and sacrum).

Lower back pain usually have vertebral causes loss of elasticity of the intervertebral discs, herniated disc, osteoarthritis, tearing of the fibrous ring ... But besides these causes which affect the nerves or muscles, there nonvertebral causes the pain of fibromyalgia, a nerve related pain or vascular problem in an area close to the spine.

But in 90% of cases, the cause of back pain is not identified: there are no anomalies or on radiographs or biological examinations.

Acute low back pain and physical therapy

Each year low back pain causes temporary disability in 3-4% of the population and total disability for 1% of the working age population. LBP-called pain associated with mechanical disorders of the spine that usually affect the lumbar spine (that is to say the succession of five vertebrae of the lower back, located just above the tailbone and sacrum).

Lower back pain usually have vertebral causes loss of elasticity of the intervertebral discs, herniated disc, osteoarthritis, tearing of the fibrous ring ... But besides these causes which affect the nerves or muscles, there nonvertebral causes the pain of fibromyalgia, a nerve related pain or vascular problem in an area close to the spine.

But in 90% of cases, the cause of back pain is not identified: there are no anomalies or on radiographs or biological examinations.

Lumbago and back pain: it is the same thing?

By convention, doctors call low back pain "acute low back pain" when it lasts less than 3 or 4 months. When it persists, it becomes "chronic".

"But this is not the same disease" says Dr. Maigne, author of Dr. book, I have a bad back, Ed. Solar. "Most acute low back pain are caused by lesions affecting mobile segments, that is to say all of the elements that bind vertebrae together (disc, ligaments, small joints). And these lesions usually heal within a few weeks or months under the effect of standard treatments for back pain. " Thus, lumbago is a form of acute low back pain. It occurs very suddenly and the pain is very intense, up to prevent any movement.

"However, when back pain becomes chronic, it is likely that another cause has taken over, helping to burn pain in the nervous system, to be stored by the latter" added the doctor.

What should we do when we are paralyzed by pain?

Lumbago pain is often so severe that it prevents any movement back for a few hours. "In this case, you need to lie down, take painkillers (paracetamol, ibuprofen) and wait. The standing again become progressively possible," says Dr. Maigne. "But severe pain that does not decrease in 24 hours, merit medical advice and treatment."
For a first consultation, the GP will judge the severity and what treatment to offer. In low intensity of pain (0 to 4 on a scale of 0 to 10), it must be treated with non-opioid drugs: paracetamol, aspirin or anti-inflammatory drugs (ie, -dire that do not contain cortisone).
If moderate pain (between 4 and 6), mild narcotic drugs (codeine, tramadol, propoxyphene) are prescribed alone or in combination with paracetamol.
The intensive pain (between 6 and 10) require strong opioids (morphine, hydromorphone, fentanyl ...). There is no risk of addiction because treatment rarely lasts beyond two weeks.
"Do not neglect the simple ways: hot or cold application (choice) is sometimes very well, but the relief is often relatively short." Added the doctor.
Finally, the wearing of a lumbar belt is to immobilize the lumbar spine in part to allow a gradual reduction of inflammation. It must in principle wear all day for an effective result. But wear the waist belt night no interest.
As emphasized Dr. Maigne, understanding the mechanism of a bad back is not easy in view of the variety of possible causes. Also, in case of persistent or recurrent pain, we must consider seeing a rheumatologist, who will provide specialist advice.

Low back pain is pain in the lower back, which is often accompanied by limited mobility. The pain can sometimes go down to the foot or up towards the neck.

brief description
Low back pain is characterized by pain located in the lower back (between the bottom of the rib cage and the crease of the buttocks) that may be accompanied by a limitation of the more or less mobility.

The pain can sometimes go down one or both legs to walk or go up to the neck (this is called painful irradiation).

We speak of acute low back pain when pain is present for less than 4 weeks. We talk about chronic low back pain when the pain lasts more than 3 months. Between these two extremes, we speak of subacute low back pain common. This is a pivotal period in which it is important to intensify treatment.

Acute low back pain can be considered an ordinary life event, since nearly 80% of people (4 out of 5) will have at least one episode of back pain during their lifetime.

Fortunately, most of these acute painful episodes disappear spontaneously, much without a specific treatment is required.

symptoms
Low back pain is manifested by pain in the lower back, sometimes with radiation in one or both legs.

Limitation of movement can be very important, eg the person has trouble getting out of bed

causes
We willingly seeks to link the onset of acute low back pain with a particular life event (movement or unusual effort, lifting or carrying a rather heavy load, move, gardening, etc.). In reality, most episodes occur without triggering event or during a movement already thousands of times without a problem.

Risk factors
The most recent data indicate that the main risk factor is genetic! Life events affect only slightly the occurrence of low back pain if not smoking. It seems associated with firstly an increase in the proportion of people with low back pain and also the intensity of low back pain.

Many misconceptions exist about back pain and seem deeply rooted in the popular mind. In particular, repeated small traumas do not increase the risk of low back pain. Similarly, according to recent studies, those conducting trades requiring more effort (within the limits of acceptable) or requiring "strange" positions or "not good for the back" do not seem to hurt more often back than others.

Warning: it is important not to confuse a risk factor (factor that increases the risk of occurrence of an episode) with a factor that increases the pain when a person is already suffering from low back pain. When we have back pain, many activities or positions may increase pain (very variable from one person to another). They are not provided with risk factors.

A back pain episode in a person to provide important daily physical efforts (strength worker) will have a greater impact on its activities (in terms of limitations or work stoppage for example).

Acute low back pain and physical therapy

Acute low back pain and physical therapy

Factors favoring a chronicity

Factors that increase the risk of persistent pain and significant impact on daily life are of two types:

factors related to the episode itself: pain intensity, extension of the painful area, presence of previous episodes
factors related to the social and psychological environment present during the episode: stress, anxiety, depressed mood, defeatism. These factors do not cause back pain but by well defined neurological phenomena, they tend to increase the pain (from all causes) and to make them last longer.
Treatment
Acute back pain (0-4 weeks)

The treatment of acute low back pain has been revolutionized in the 1990s.

Before 1990, acute low back pain was considered an injury, that is to say, as something damaged or displaced and linked to a too violent effort. For "that" repairs itself, it was necessary to rest up and avoid movement. It is not then understand why disability due to low back pain increased, while overall heavy work were less numerous.

Since 1990, it has gradually understood that during an episode of low back pain, there was nothing damaged, although the pain was sharp, strong and "nailed the person in bed." Now consider that acute low back pain episode corresponds to a malfunction, a sudden blockage of the system muscle - ligaments - joint (like a short circuit or a "crash" computer).

It was clearly shown that the most effective treatment (the episode is the least painful and the least possible) is to stay as active as pain allows, and take only the strictly necessary rest. This is logical if we think that healing requires the rehabilitation of the road system! Since there is nothing damaged, there is no risk of aggravating an injury leading as normal a life as pain allows.

The main goal is to maintain maximum mobility (in extreme cases, this can mean just go from bed to chair for a two days), all solutions that can help move are good. For example, it recommends:

search for positions that reduce pain and muscle spasms, avoid carrying heavy loads and movements that cause a violent increase in pain
apply hot on the painful area (bath, hot water bottle, etc.). However, it may be that in some people the cold is more effective; we must try to find out
to take medicine: painkiller paracetamol kind (Dafalgan, Dolprone, Panadol, etc.), or aspirin. The doctor may also prescribe other anti-inflammatory such as ibuprofen (Brufen, Grefen, Irfen, etc.), diclofenac (Ecofenac, Flector, Olfen, Voltaren), or a muscle relaxant (Sirdalud or Mydocalm) is often less well supported (sleepiness) and therefore rather a 2nd choice. Finally, in certain specific situations, the doctor may also prescribe a morphine derivative. With these drugs, it may not drive a car.
We must take advantage of the beneficial effect (but rarely complete) medications to start moving. Take painkillers and sitting on a chair, or worse, to sleep in a bed, is against-productive!
Any activity or movement are not prohibited, provided that this does not increase the pain too greatly
the prescription of a few sessions of manual therapy (chiropractic or osteopathy or) only when pain persists beyond a week or two. NO other techniques (infrared, pulse waves, massage, transcutaneous stimulation, etc.) is recommended.

Subacute low back pain (5-12 weeks)

When pain and physical discomfort it causes extend beyond a month, the doctor will first adapt and strengthen drug treatment.

However, the most important element of the management will remain the physical treatment. It is either a few sessions of manual therapy (chiropractic or osteopathy or) if they have not already been tried in the acute stage, or the introduction of a physiotherapy treatment using techniques called 'active'. This includes all techniques that move and they are many! All types of exercises are generally beneficial, for example muscle building (cladding), endurance or proprioception exercises (strengthening of the unconscious and automatic perception of the joint space, to correct a wrong position or to restore balance). There is a great variability between individuals and it is useful to replace a technique by another when it is not effective.

Techniques called "passive" like massage can be used in early trading, but should not form the core of the treatment. The electrotherapy is normally not recommended as useless.

It is possible that lumbar support (belt) used in crisis phase can shorten the duration of the episode and decrease the amount of medication needed.

Chronic low back pain (over 12 weeks)

When pain continues to have a significant impact on activities of daily living beyond three months, it is essential to use a multidisciplinary management, that is to say combining several specialized treatments at the same time.

An evaluation by a rheumatologist or rehabilitation physician to explore in detail the presence of factors favored the transition to the chronic phase and coordinate treatment is often necessary. Thus, in situations, in addition to the general practitioner, specialist physician and physiotherapist, we can use (not exhaustive) occupational therapist, psychiatrist, psychologist, ergonomist to improve the work environment, or assistant social.

In the most difficult situations, some specialized centers have implemented intensive multidisciplinary treatment programs (daily treatment, several hours a day for three to five weeks).

The utility of lumbar support (support belt) to facilitate the resumption of certain activities is heavily discussed. The results of scientific studies are contradictory.

The use of spinal infiltration (in the back) is widespread, although the vast majority of studies failed to demonstrate a benefit than a placebo treatment. In addition, complications are sometimes been reported. They are probably very rare, but their actual frequency is not known.

Other techniques grouped under the term "minimally invasive" are often proposed but their effectiveness has not actually been proven scientifically. In general, these techniques have not even been the subject of serious study to check their no danger (complication) and are also not supported by the basic medical insurance. It is not totally impossible that either could have a positive effect, but they should only be used as part of a research protocol, like any new drug.

The use of an operation is limited to exceptional situations and should be considered only after trying all other measures. The results of surgery are rather mediocre except for carefully selected special cases. Again, the care by a multidisciplinary team can be helpful.

Evolution and possible complications
In most cases, the symptoms disappear quickly without medical consultation. Among those who consult, two thirds will see their pain disappear within 3 months.

The LBP never causes paralysis and does not lead to the wheelchair. However, among those who consult a ten or twenty progresses to chronic low back pain is an extremely problematic situation because it generates a significant personal impact, social and professional. In this case, treatment is often long and difficult and generally requires the joint intervention of several specialists (multidisciplinary care). It is therefore important not to let the situation deteriorate to this point. If the pain leads to impaired quality of life beyond 8 to 12 weeks despite physiotherapy treatment favoring the movement (active), specialist advice is recommended.

Prevention
Primary prevention (before the onset of a first episode of LBP)

No action, whatever its nature, has shown efficacy in reducing the frequency of occurrence of a first episode of acute back pain.

To reduce the number of people developing a disabling chronic low back pain, the only effective measure has been conducting a broad media information campaign giving information similar to those shown here.

secondary prevention (after the onset of a first episode of LBP)

After the first episode, regular exercise, preferably oriented jogging type of endurance sport, cycling, swimming or skiing (depending on personal preference) reduces the occurrence of a new episode frequency (recurrence ), and its intensity and duration if it still occurs. No other technique, though frequently cited or used (or lumbar support belt, etc.), has demonstrated its effectiveness.

When to contact a doctor?
Acute low back pain is a problem Benin which often disappears in a few days without treatment.

If this is not the case or if the pain is too strong or too catastrophic, the doctor will prescribe appropriate treatment.

Furthermore, if the pain is accompanied by one or more of the following symptoms, it may be it another problem requiring analysis and specific treatment.

Get medical emergency (call 144) if:

you have difficulty passing urine (retention or loss of urine)
you have sensory disturbances around the anus
trauma is causing pain (violent shock, fall, car accident, motorcycle ...).
Consult a physician or care center without waiting (including after hours) if you have:

fever or chills
lost weight inexplicably
taken intravenous drugs
observed a decrease in the strength in the legs
severe night pain.
Her from her regular doctor appointment if:

the pain increases when lying down
pain always extend further in the leg
you have a history of cancer
taking medications related to cortisone (steroids)
you are aged over 55 or under 20
Information of doctor
The doctor will be interested in whether:

you have difficulty passing urine (retention or loss of urine)
you have sensory disturbances around the anus
trauma is causing pain (violent shock, fall, car accident, motorcycle ...)
you have fever or chills
you lost weight inexplicably
you have taken drugs intravenously
you have observed a decrease in strength in the legs
the pain increases in supine position, always extend further into the leg or are stronger overnight
you have a history of cancer
taking medications related to cortisone (steroids).
With this information associated with a physical examination, the doctor is usually able to differentiate a common low back pain from another cause of back pain, without further examination.

exams
In principle the history and physical examination are sufficient to diagnose low back pain!

It is only in case of doubt that a diagnostic x-ray, CT scan, an MRI, or a blood test can be made.
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Lumbago and back pain: it is the same thing?

By convention, doctors call low back pain "acute low back pain" when it lasts less than 3 or 4 months. When it persists, it becomes "chronic".

"But this is not the same disease" says Dr. Maigne, author of Dr. book, I have a bad back, Ed. Solar. "Most acute low back pain are caused by lesions affecting mobile segments, that is to say all of the elements that bind vertebrae together (disc, ligaments, small joints). And these lesions usually heal within a few weeks or months under the effect of standard treatments for back pain. " Thus, lumbago is a form of acute low back pain. It occurs very suddenly and the pain is very intense, up to prevent any movement.

"However, when back pain becomes chronic, it is likely that another cause has taken over, helping to burn pain in the nervous system, to be stored by the latter" added the doctor.

What should we do when we are paralyzed by pain?

Lumbago pain is often so severe that it prevents any movement back for a few hours. "In this case, you need to lie down, take painkillers (paracetamol, ibuprofen) and wait. The standing again become progressively possible," says Dr. Maigne. "But severe pain that does not decrease in 24 hours, merit medical advice and treatment."
For a first consultation, the GP will judge the severity and what treatment to offer. In low intensity of pain (0 to 4 on a scale of 0 to 10), it must be treated with non-opioid drugs: paracetamol, aspirin or anti-inflammatory drugs (ie, -dire that do not contain cortisone).
If moderate pain (between 4 and 6), mild narcotic drugs (codeine, tramadol, propoxyphene) are prescribed alone or in combination with paracetamol.
The intensive pain (between 6 and 10) require strong opioids (morphine, hydromorphone, fentanyl ...). There is no risk of addiction because treatment rarely lasts beyond two weeks.
"Do not neglect the simple ways: hot or cold application (choice) is sometimes very well, but the relief is often relatively short." Added the doctor.
Finally, the wearing of a lumbar belt is to immobilize the lumbar spine in part to allow a gradual reduction of inflammation. It must in principle wear all day for an effective result. But wear the waist belt night no interest.
As emphasized Dr. Maigne, understanding the mechanism of a bad back is not easy in view of the variety of possible causes. Also, in case of persistent or recurrent pain, we must consider seeing a rheumatologist, who will provide specialist advice.

Low back pain is pain in the lower back, which is often accompanied by limited mobility. The pain can sometimes go down to the foot or up towards the neck.

brief description
Low back pain is characterized by pain located in the lower back (between the bottom of the rib cage and the crease of the buttocks) that may be accompanied by a limitation of the more or less mobility.

The pain can sometimes go down one or both legs to walk or go up to the neck (this is called painful irradiation).

We speak of acute low back pain when pain is present for less than 4 weeks. We talk about chronic low back pain when the pain lasts more than 3 months. Between these two extremes, we speak of subacute low back pain common. This is a pivotal period in which it is important to intensify treatment.

Acute low back pain can be considered an ordinary life event, since nearly 80% of people (4 out of 5) will have at least one episode of back pain during their lifetime.

Fortunately, most of these acute painful episodes disappear spontaneously, much without a specific treatment is required.

symptoms
Low back pain is manifested by pain in the lower back, sometimes with radiation in one or both legs.

Limitation of movement can be very important, eg the person has trouble getting out of bed

causes
We willingly seeks to link the onset of acute low back pain with a particular life event (movement or unusual effort, lifting or carrying a rather heavy load, move, gardening, etc.). In reality, most episodes occur without triggering event or during a movement already thousands of times without a problem.

Risk factors
The most recent data indicate that the main risk factor is genetic! Life events affect only slightly the occurrence of low back pain if not smoking. It seems associated with firstly an increase in the proportion of people with low back pain and also the intensity of low back pain.

Many misconceptions exist about back pain and seem deeply rooted in the popular mind. In particular, repeated small traumas do not increase the risk of low back pain. Similarly, according to recent studies, those conducting trades requiring more effort (within the limits of acceptable) or requiring "strange" positions or "not good for the back" do not seem to hurt more often back than others.

Warning: it is important not to confuse a risk factor (factor that increases the risk of occurrence of an episode) with a factor that increases the pain when a person is already suffering from low back pain. When we have back pain, many activities or positions may increase pain (very variable from one person to another). They are not provided with risk factors.

A back pain episode in a person to provide important daily physical efforts (strength worker) will have a greater impact on its activities (in terms of limitations or work stoppage for example).

Acute low back pain and physical therapy

Factors favoring a chronicity

Factors that increase the risk of persistent pain and significant impact on daily life are of two types:

factors related to the episode itself: pain intensity, extension of the painful area, presence of previous episodes
factors related to the social and psychological environment present during the episode: stress, anxiety, depressed mood, defeatism. These factors do not cause back pain but by well defined neurological phenomena, they tend to increase the pain (from all causes) and to make them last longer.
Treatment
Acute back pain (0-4 weeks)

The treatment of acute low back pain has been revolutionized in the 1990s.

Before 1990, acute low back pain was considered an injury, that is to say, as something damaged or displaced and linked to a too violent effort. For "that" repairs itself, it was necessary to rest up and avoid movement. It is not then understand why disability due to low back pain increased, while overall heavy work were less numerous.

Since 1990, it has gradually understood that during an episode of low back pain, there was nothing damaged, although the pain was sharp, strong and "nailed the person in bed." Now consider that acute low back pain episode corresponds to a malfunction, a sudden blockage of the system muscle - ligaments - joint (like a short circuit or a "crash" computer).

It was clearly shown that the most effective treatment (the episode is the least painful and the least possible) is to stay as active as pain allows, and take only the strictly necessary rest. This is logical if we think that healing requires the rehabilitation of the road system! Since there is nothing damaged, there is no risk of aggravating an injury leading as normal a life as pain allows.

The main goal is to maintain maximum mobility (in extreme cases, this can mean just go from bed to chair for a two days), all solutions that can help move are good. For example, it recommends:

search for positions that reduce pain and muscle spasms, avoid carrying heavy loads and movements that cause a violent increase in pain
apply hot on the painful area (bath, hot water bottle, etc.). However, it may be that in some people the cold is more effective; we must try to find out
to take medicine: painkiller paracetamol kind (Dafalgan, Dolprone, Panadol, etc.), or aspirin. The doctor may also prescribe other anti-inflammatory such as ibuprofen (Brufen, Grefen, Irfen, etc.), diclofenac (Ecofenac, Flector, Olfen, Voltaren), or a muscle relaxant (Sirdalud or Mydocalm) is often less well supported (sleepiness) and therefore rather a 2nd choice. Finally, in certain specific situations, the doctor may also prescribe a morphine derivative. With these drugs, it may not drive a car.
We must take advantage of the beneficial effect (but rarely complete) medications to start moving. Take painkillers and sitting on a chair, or worse, to sleep in a bed, is against-productive!
Any activity or movement are not prohibited, provided that this does not increase the pain too greatly
the prescription of a few sessions of manual therapy (chiropractic or osteopathy or) only when pain persists beyond a week or two. NO other techniques (infrared, pulse waves, massage, transcutaneous stimulation, etc.) is recommended.

Subacute low back pain (5-12 weeks)

When pain and physical discomfort it causes extend beyond a month, the doctor will first adapt and strengthen drug treatment.

However, the most important element of the management will remain the physical treatment. It is either a few sessions of manual therapy (chiropractic or osteopathy or) if they have not already been tried in the acute stage, or the introduction of a physiotherapy treatment using techniques called 'active'. This includes all techniques that move and they are many! All types of exercises are generally beneficial, for example muscle building (cladding), endurance or proprioception exercises (strengthening of the unconscious and automatic perception of the joint space, to correct a wrong position or to restore balance). There is a great variability between individuals and it is useful to replace a technique by another when it is not effective.

Techniques called "passive" like massage can be used in early trading, but should not form the core of the treatment. The electrotherapy is normally not recommended as useless.

It is possible that lumbar support (belt) used in crisis phase can shorten the duration of the episode and decrease the amount of medication needed.

Chronic low back pain (over 12 weeks) Acute low back pain and physical therapy 

When pain continues to have a significant impact on activities of daily living beyond three months, it is essential to use a multidisciplinary management, that is to say combining several specialized treatments at the same time.

An evaluation by a rheumatologist or rehabilitation physician to explore in detail the presence of factors favored the transition to the chronic phase and coordinate treatment is often necessary. Thus, in situations, in addition to the general practitioner, specialist physician and physiotherapist, we can use (not exhaustive) occupational therapist, psychiatrist, psychologist, ergonomist to improve the work environment, or assistant social.

In the most difficult situations, some specialized centers have implemented intensive multidisciplinary treatment programs (daily treatment, several hours a day for three to five weeks).

The utility of lumbar support (support belt) to facilitate the resumption of certain activities is heavily discussed. The results of scientific studies are contradictory.

The use of spinal infiltration (in the back) is widespread, although the vast majority of studies failed to demonstrate a benefit than a placebo treatment. In addition, complications are sometimes been reported. They are probably very rare, but their actual frequency is not known.

Other techniques grouped under the term "minimally invasive" are often proposed but their effectiveness has not actually been proven scientifically. In general, these techniques have not even been the subject of serious study to check their no danger (complication) and are also not supported by the basic medical insurance. It is not totally impossible that either could have a positive effect, but they should only be used as part of a research protocol, like any new drug.

The use of an operation is limited to exceptional situations and should be considered only after trying all other measures. The results of surgery are rather mediocre except for carefully selected special cases. Again, the care by a multidisciplinary team can be helpful.

Evolution and possible complications
In most cases, the symptoms disappear quickly without medical consultation. Among those who consult, two thirds will see their pain disappear within 3 months.

The LBP never causes paralysis and does not lead to the wheelchair. However, among those who consult a ten or twenty progresses to chronic low back pain is an extremely problematic situation because it generates a significant personal impact, social and professional. In this case, treatment is often long and difficult and generally requires the joint intervention of several specialists (multidisciplinary care). It is therefore important not to let the situation deteriorate to this point. If the pain leads to impaired quality of life beyond 8 to 12 weeks despite physiotherapy treatment favoring the movement (active), specialist advice is recommended.

Prevention
Primary prevention (before the onset of a first episode of LBP)

No action, whatever its nature, has shown efficacy in reducing the frequency of occurrence of a first episode of acute back pain.

To reduce the number of people developing a disabling chronic low back pain, the only effective measure has been conducting a broad media information campaign giving information similar to those shown here.

secondary prevention (after the onset of a first episode of LBP)

After the first episode, regular exercise, preferably oriented jogging type of endurance sport, cycling, swimming or skiing (depending on personal preference) reduces the occurrence of a new episode frequency (recurrence ), and its intensity and duration if it still occurs. No other technique, though frequently cited or used (or lumbar support belt, etc.), has demonstrated its effectiveness.

When to contact a doctor?
Acute low back pain is a problem Benin which often disappears in a few days without treatment.

If this is not the case or if the pain is too strong or too catastrophic, the doctor will prescribe appropriate treatment.

Furthermore, if the pain is accompanied by one or more of the following symptoms, it may be it another problem requiring analysis and specific treatment.

Get medical emergency (call 144) if:

you have difficulty passing urine (retention or loss of urine)
you have sensory disturbances around the anus
trauma is causing pain (violent shock, fall, car accident, motorcycle ...).
Consult a physician or care center without waiting (including after hours) if you have:

  • fever or chills
  • lost weight inexplicably
  • taken intravenous drugs
  • observed a decrease in the strength in the legs
  • severe night pain.

    Her from her regular doctor appointment if:

  • the pain increases when lying down
  • pain always extend further in the leg
  • you have a history of cancer
  • taking medications related to cortisone (steroids)
  • you are aged over 55 or under 20

Information of doctor
The doctor will be interested in whether:

  • you have difficulty passing urine (retention or loss of urine)
  • you have sensory disturbances around the anus
  • trauma is causing pain (violent shock, fall, car accident, motorcycle ...)
  • you have fever or chills
  • you lost weight inexplicably
  • you have taken drugs intravenously
  • you have observed a decrease in strength in the legs
  • the pain increases in supine position, always extend further into the leg or are stronger overnight
  • you have a history of cancer
  • taking medications related to cortisone (steroids).

With this information associated with a physical examination, the doctor is usually able to differentiate a common low back pain from another cause of back pain, without further examination.

exams
In principle the history and physical examination are sufficient to diagnose low back pain!

It is only in case of doubt that a diagnostic x-ray, CT scan, an MRI, or a blood test can be made.

Acute low back pain and physical therapy