Hey, DC. We don't have to tell you that low back pain is pervasive among patients.

But as PTs, it can sometimes be a tough nut to crack.

Here are a few insights gathered by our faculty of practicing clinicians over the years, that can help guide you in assessing and treating your patients who are struggling with it.

  1. Low back pain (LBP) is MOST OFTEN NOT a serious life-threatening medical condition; however, 3% of LBP is symptomatic of serious pathology and easily missed if the patient is not appropriately evaluated with a thorough history and neurological examination. Also, bad things get worse so keep an eye out for worsening symptoms and suggest further investigation.
  2. Healthy people have healthy neurological systems. Unhealthy people have unhealthy neurological systems. Learn to perform detailed, accurate neurological evaluations. It's often the first sign of much deeper and more serious problems.
  3. Most acute episodes of LBP improve quickly with conservative care --> early intervention with PT is more cost effective, improves long-term outcomes and decreases downstream health care spend. However, the longer persistent LBP is ignored, the more fearful patients can become. Address persistent pain. Mitigate fear. Evaluate, Listen. Relate. Refer when progress slows.
  4. Imaging generally does not correlate to the causes of low back pain. Worse, it often induces fear. The best role for imaging is to rule things out. Negative imaging is good news!! Move!!
  5. Graduated exercise and movement in all directions is safe and healthy for the spine, even when it hurts!!; If you have LBP, move. If it is painful, modify and move again. 
  6. Spine posture during sitting, standing and lifting does not predict LBP or its persistence; however IMPROPER posture in sitting, standing and lifting can increase shearing, torsion and loading on structures not intended to resist such forces. No need to put excessive load on irritated tissues, so aim for easy neutral to minimize strain.
  7. A weak core does not cause LBP, but poorly COORDINATED pelvic musculature can precipitate and perpetuate LBP.
  8. Spine movement and loading will be better tolerated when the neuromuscular system has been adequately trained to assist during the movement.
  9. Constant back pain can result acutely from chemical inflammation to sensitized or damaged tissues. Intermittent pain is more often mechanical. Learn to evaluate the difference!
  10. Effective care for low back pain must address the whole person, ex (hip, thorax).

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NAIOMT

The North American Institute of Orthopedic Manual Therapy

The North American Institute of Orthopedic Manual Therapy, Inc. (NAIOMT) is a private physical therapist-owned organization dedicated to achieving the highest standards of clinical practice for manual physical therapists.

NAIOMT specializes in a flexible teaching program, which seeks to promote the utilization of safe, effective and efficient manual physical therapy management of musculoskeletal dysfunction. It further seeks an environment that is conducive to the application of a reasoned approach to manual physical therapy through critical inquiry and the creation of new knowledge and skills based on scientific study and dissemination of that knowledge.

NAIOMT strongly supports the union of the clinician, academician and researcher to further facilitate the development of quality patient care, physical therapy education and the development of master clinicians.