Acute low back painno spasm

The common problem of low back pain caused by facet joint dysfunction and/or limited disc disruption usually responds well to the following treatment. The typical patient is aged 20-55 years, is well and has no radiation of pain below the knee. 14

• back education program

• encouragement of normal daily activities according to degree of comfort

• regular non-opioid analgesics, e.g. paracetamol

• exercise program (when exercises do not aggravate), swimming (if feasible)

• physical therapy: stretching of affected segment, muscle energy therapy, spinal mobilisation or manipulation (if no contraindication on first visit) 10 12 14

• review in about 5 days (probably best time for physical therapy)

• no investigation needed initially

Most of these patients can expect to be relatively pain free in 14 days and can return to work early (some may not miss work and this should be encouraged). The evidence concerning spinal manipulation is that it reduces the period of disability.

Note: NSAIDs are not usually recommended. They can be used for 10-14 days if evidence of inflammation.

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