Our Practice Manager, Stenie Landsbergen assists many injured workers get back to work and their lives. She is often asked what is the best way to manage acute lower back pain. She recently recommended these guidelines as they are clear and provide good advice. They are provided by Dr Stan Lee (MD) Orthopaedic Spine Surgeon at St Lucent Spine, PLLC and Specialists in Spine Surgery.
It is relevant to anyone with back pain including workers compensation patients; adults with low back pain or back related leg symptoms for less than 6 weeks.
Reassure: 90% of episodes resolve within 6 weeks regardless of treatment. Advise that minor flare-ups may occur in the subsequent year.
Therapy: Stay active and continue ordinary activity within the limits permitted by pain. Avoid bed rest. Early return to work is associated with less disability.
Injury prevention (e.g. use of proper body mechanics, safe back exercises). Recommend ice for painful areas and stretching exercises. Exercises are helpful for pain radiating below the knee.
Before considering surgery refer patient for physical consult, or manual therapy. If persistent disability at 2 weeks, consider referral for non-invasive therapy for improving flexibility and strength, not modalities such as heat, traction, ultrasound, TENS.
If persistent disability at 6 weeks, consider referral to a program that provides a multidisciplinary approach for back pain, especially if psychosocial risks to return to work exist.
Surgical referral is usually not required.
Prescribe medications on a time-contingent basis, not pain-contingent basis. Opiates are generally not indicated as first-line treatment. Although opiates relieve pain, early opiate use may be associated with longer disability, even after controlling for case severity. If prescribed, opiate use should be limited to short-term (i.e. two weeks).
Testing: Diagnostic tests or imaging is usually not required. Consider imaging if red flags are present, or if there is no improvement after 6 weeks.
These guidelines were published after a review of the medical literature by a group of 13 cross discipline physicians.
Stenie Landsbergen. Practice Manager -Financial Services , WCD – Workers' Compensation Solutions.