There are many treatments for back pain – but the key to all treatment is to have a proper diagnosis. A proper diagnosis leads to the correct treatment. Many treatments which may be effective for one person will not be effective for someone else if their diagnosis is wrong. The key to proper treatment of lower back pain is a proper diagnosis.
Diagnosis of back pain starts with a proper history of how the pain began, followed by a thorough look at the patient’s life style including exercise patterns, work postures, and general diet and health program, then a thorough physical examination is performed including orthopedic and neurologic examination to rule out serious pathologic lower back pain caused by cancer or other systemic disease or fracture. Proper biomechanical analysis includes a study of movement patterns in real life including range of motion testing and plain film x-rays.
Physical examination and neurologic examination will reveal whether or not more advanced imaging is necessary including MRI, CT scan, or nerve testing. Once the results of the tests are available and reviewed with the patient, and a diagnosis is reached, then treatment can be ordered.
Treatment depends on diagnosis, however for medical problems including cancer, proper referral is necessary.
For biomechanical lower back pain, which comprises 95% of all lower back pain, physical medicine is very effective. Treatment should first focus on the reduction of pain and inflammation followed by treatment designed to increase range of motion back toward normal. Once this is accomplished, thorough physical therapy modalities including therapeutic exercise should be instituted and slow return to increased and normal activities of daily living.
All patients should be given home exercises and stretches to not only help in recovery but also to help prevent future bouts of lower back pain. Counseling regarding posture and lifting techniques, work and play injury prevention should be given.
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