Prevalence of Low Back Pain
Lower back pain is becoming a growing problem in industrialized countries accounting for up to $50 billion spent per year in the United States alone (2000). Ninety percent of the budget is spent on 10 percent of patients who have persistent chronic pain lasting longer than three months (1).
Chronic back pain, often with associated leg pain, is the most common medical complaint in developed countries, (Bigos, et al. 1994). Headache is its only peer (Lawrence, 1977). A complaint of back pain is the most common reason for early Social Security disability in the USA. The disability issues are so important that several countries and many organizations have convened to examine the problem, (Anderson, 1996). (2)
Tips to Minimize Risk of Back Pain – While Standing:
Posture techniques that help avoid lower back pain while standing:
- Maintain good abdominal tone; keep abdomen flattened while standing.
- When prolonged standing is necessary, place one foot on a step for a few minutes.
- Wear cushion-soled shoes for prolonged standing.
While Bending, Lifting, or Carrying:
Posture techniques that help avoid back pain while bending, lifting or carrying:
- Bend at the knees, not at the waist.
- Lift with the thighs (keep heavy objects centered close to abdomen).
- Flex knees while bending.
- When carrying heavy objects, turn with the feet, not by twisting the trunk.
While Sitting and Lying:
Posture techniques that help avoid back pain while sitting and lying:
- Sit on a straight-backed, firm, supportive chair.
- Sit only for short periods.
- Sleep on your back with your knees bent, or on your side on a firm mattress.
- Avoid prolonged standing, prolonged sitting, and improper lifting (1).
Classifications of Low Back Pain with or Without Sciatica
“Transient– Self-limited; duration is hours to days; comes to medical attention when an episode of pain occurs.
“Acute– Self-limited, but protracted; duration is days to weeks; often seen by physicians; treatment is symptomatic; most recover spontaneously; evaluation and treatment required for severe symptoms.
“Persistent– Lasts more than 3-6 months; does not relent with time; high correlation with degeneration of the spine (spondylitis disease); surgical intervention occurs mostly in this group.
“Chronic Pain Syndrome– Lasts more than 6 months; worsens with time; associated with major co-morbidities (other conditions that also cause the same problem). ” (2)
Classifications of Low Back Pain
“Acute low back pain– generally defined as pain which lasts from a few days to a few months. Back pain with or without leg radiation is common (sciatica).
“Persistent low back pain– Progressively leads to the chronic state, defined by preoccupation with pain, depression, anxiety, and disability.” (2)
Management of chronic back / leg pain:
- Adequate analgesia.
- Weight loss.
- Restore flexibility.
- Restore strength: Along the spine first.
- Restore general conditioning.
- Teach posture and body mechanics. (2)
- Kelley’s Textbook of Internal Medicine, Fourth Edition, 2000, “Approach to the Patient with Back Pain,” written by Glen S. O’Sullivan, U.S.A.
- Textbook of Pain, 4th Edition, 1999, “Chronic Back Pain,” written by Donlin M. Long, U.S.A.