Acute low back pain

Find out how Pilates can help

Low back pain is one of the most common debilitating conditions that a physiotherapist will see in their clinical practice. Although it can be very painful for you your back pain will typically get better or resolve itself in 8-12 weeks times. The job of the physiotherapist is to speed this recovery time up and educate on how to prevent it happening again.

The first thing the physiotherapist needs to rule out is red flags (signs and symptoms that make you think that you need to see a specialist immediately). The red flags you need to look out for are things like intractable night pain and fevers, rapid or unexpected weight loss, co-ordination or balance disturbances, persistent bilateral pins and needles or numbness, saddle anaesthesia, changes in bowel and bladder habits such as faecal incontinence or urinary retention or a foot drop. If you experience a y of these go and see your GP.

However some often forgotten red flags include back pain in children under 15 years old and a first episode of back pain in people over 55 years old. The back pain in these populations can be more serious causes such as tumours or spinal fractures. Another red flag is back pain at rest. Normally if you have back pain it’s worse when you move and better when you rest it. However if you have back pain that seems to come on or gets worse as you are resting or if it wakes you up in the night you should see your GP.

With acute low back pain there are 5 different treatment options for people with back pain:

1. Do nothing. Well if you do nothing then nothing will change.
2. Take paracetamol, or other painkillers such as co-codamol or anti-inflammatories such as ibuprofen. You could also see you GP to speak about stronger painkillers and anti-inflammatories. Other drugs such as Gabapentin and Amitriptyline may be ineffective for acute back pain and.
3. Physical therapy such as having physiotherapy, osteopathy or chiropractic. You could also think about some Pilates mat work or on a reformer as physical therapy.
4. A steroid injection into the facet joints or for some people with sciatica a nerve root block into an aggravated nerve root. Patients should keep having these injections for as long as they work, such as once or twice a year. There is very minimal risk of osteoporosis from these injections.

These forms of back pain treatments are all fairly low risk and 98% of the time they are sufficient to help manage back pain. I say manage because if you have had an episode of back pain for 2-3 months it is likely that you are going to get it again in the future, it’s unfortunate but they are the cards you have been dealt and if you can find effective strategies to help yourself such as physiotherapy, Pilates, painkillers or injections you should manage well.

5. The higher risk treatment strategy for back pain is surgery and once you have chosen surgery there is no reverse gear, i.e. if you have had a spinal fusion, you can’t take it out again. Of course you can have successful outcomes from surgery and it does help a lot of people, but it is a higher risk treatment and should be a last resort.

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