Back Pain – Medical Treatment

What To Expect When You See A Doctor
Appropriate Health Care
When To See A Physical Therapist
Home Treatment – Back Stretches

When To Seek Medical Care

  • When pain  persists beyond 1-2 weeks and is not getting better with rest.  Sharp low back pain or neurological symptoms in the legs, such as numbness tingling and /or weakness in the foot.
  • Where to start?  In most cases you can start with you general Practitioner.  Usually they will prescribe some meds then refer you to physical therapy.
  • In many states you can go directly to a physical therapist. Depending on the nature of the condition, the therapist may want you to see a physician / Nurse Practitioner first .  The MD/ NP can prescribe medications, order tests and check to be sure you do not have a more serious medical condition that may be causing your symptoms.

What To Expect When You See A Doctor:

Diagnostic Measures

  • Observe your symptoms.(What makes the pain worse/better)
  • Medical history and exam by a doctor  & referral to a physical therapist for persistent symptoms.
  • Laboratory blood studies to determine if there is an underlying disorder, x-rays of the spine, sometimes a CT or MRI scan.
  • Testing (see above) is often not done unless the person is not responding to conservative (rest, medications, physical therapy) treatment.

Appropriate Health Care

  • Treatment will depend on severity of the pain and discomfort.
  • Acute – sudden onset of pain or severe pain – low back pain may require bed rest for first 24 hours and use of ice for first 72 hours.  This usually follows trauma, a car accident, a fall or sharp pain/popping/”giving out” feeling felt in low back    Additional treatment will be determined by severity of the problem. Recent medical studies indicate that staying more active is better for back disorders than prolonged bed rest.
  • Chronic – slow onset(over months or years) or low grade pain(constant dull ache). This may respond best to heat.  If you are not getting relief with heat, try ice.

When To See A Physical Therapist

  • Physical therapy should be prescribed when you have been treated by your M.D. but pain  persists beyond 1-2 weeks or if you have had multiple episodes of pain over the past year.
  • Physical therapy treatments should address risk factors, prevention & a home exercise program in addition to pain reduction treatments
  • A physical therapy evaluation should include:
    1. History( The therapists will ask: How did you hurt yourself, When did the pain first appear? What makes the pain worse/better? Have you had this type of pain before?  What were you doing just before you felt pain?  What does your daily routine involve? etc.)
    2. Physical exam: ( You will be asked to do certain movements to determine what movements increase your pain, Your posture – how you sit & stand – will be evaluated, Your muscles will be palpated(massaged) to look for painful “knots” or spasm (increased tension), The mobility and quality of the motion of your joints will be checked, Your may have your reflexes tested, etc.
  • Physical therapy treatments will vary depending on the condition.  A through treatment will include a few basic elements:
    1. Pain reduction may include use of heat, ice, massage, relaxation, stretches, joint mobilization and other modalities including ultrasound & electric stimulation.
    2. A home program  may start out as simple as a list of things to avoid.  This should increase gradually as you progress to include exercises, stretches and some type of simple first aid.  The goal is for you to gain control over the symptoms as you gradually eliminate the cause of the problem. * This is where physical therapy differs from traditional chiropractic care.
    3. Prevention includes:
      • discussing risk factors for your specific condition.
      • exercises to increase strength and flexibility.
      • training in how to sit, stand, bend, move, return to sports, etc. without re-injuring yourself.
      • Suggestions for basic equipment including chairs, lumbar supports, wrist rests, etc.  Depending on the person and the condition this may require purchasing a few items.  Many “lumbar supports” can be made from simple items in the home such as pillows, towels, blankets. ( Your jacket can work as a lumbar support if you are out and you run into an unfriendly chair.)
  • Options are available such as physical therapy, acupuncture, orthopedic care, treatment by a chiropractor, psychiatrist or neurologist and others including surgery for damaged disk, or a local injection(epidural).
  • Massage may help.  Be sure the person is well trained or the massage may cause more harm than help.

There are many simple things that you can do on your own to quiet the symptoms – See our Home Treatment Page

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