Non-Emergent Low Back Pain Drug-Free Treatment and Evaluation

I know all of you at some point or another have had patients with low back pain and probably even had low back pain yourself. We are all aware of how common low back pain is — and the reality of it being a costly issue due to lost work days, a decrease in productivity and its associated health care costs. 

Working in a physical medicine setting, I’d say about 40% of the patients I see on a daily basis have a primary complaint of low back pain. While an NSAID and muscle relaxer help with low back pain, it’s important as health care providers we try to figure out why they have low back pain and then fix the low back pain, not just put a band-aid on it with medications

I’m going to share some pearls that I have learned along the way regarding chronic non-emergent, non- red flag low back pain.

Visual Assessment for Low Back Pain

Look beyond the low back, assess the patient’s stance barefoot. Is the patient flat footed, do their ankles pronate, do they have genu valgum or genu varus deformity at the knees, is a pelvic shift present (is one side of the pelvis riding higher than the other)?

All of these visual assessments are important when it comes to patients who have chronic low back pain or frequent low back flare-ups. 

These visual assessments are important because they could be a culprit to the low back pain. Example, you have a patient who is a warehouse manager and spends most of the day standing and walking on a concrete floor. During the visual exam you notice the patient is flat footed and bilateral ankles pronate in to a small degree.

Ordering specific shoe orthotics for flat feet (pes planus) can be a HUGE game changer for this patient in regards to their low back pain. 

Assess Work and Daily Habits

When collecting the history from the patient find out what they do for work or what they do on a daily basis. This will yield great information.

Do they have a desk job where they are sitting at a computer the majority of the day? If so, do they have a supportive chair to sit in? I’m sure you’ve heard the phrase, “sitting is the new smoking.” Sitting all day, most days of the week is hard on the low back and body in general. 

A solution for this is ordering an ergonomic workstation assessment to assess the patient’s workstation set up. The Occupational Safety and Health Administration (OSHA) website provides a Computer Workstations eTool. The eTool goes over “good working positions” and has a “checklist” section for an optimal workstation.

What I want to point out for low back pain in particular is, OSHA recommends the ability to alternate between sitting and standing positions and having seating that provides lumbar support. Prescribing your patient a sit to stand desk or a lumbar supportive chair could change your patients world for the better. This OSHA Computer Workstations eTool is also a GREAT resource to utilize for patients with neck and upper back pain, tons of useful information. 

Physical Therapy

Physical therapy is wonderful for patients with chronic low back pain. Physical therapy that combines a small amount of passive physical therapy such as, soft tissue manipulation and manual stretching and a large amount of active physical therapy. This can include monitored stretching and strengthening exercises, a great combination.

Patients who get the most relief from physical therapy are the ones who do their stretching and strengthening exercises, learned in physical therapy, at home on a frequent basis. 

Exercise as Treatment for Low Back Pain

One of my favorite clinical pearls I’ve learned along the way for low back pain treatment is exercise in general. I’ll save all of that juicy information for my next blog post. 

It is our job as health care providers to figure out why a patient is having chronic low back pain or frequent low back flare ups. The treatment may come from outside of the box thinking and it could be as simple as changing up their work area to resolve their continuing issue. 

References 

Occupation Safety and Health Administration. (2020). Computer workstations eTool. United States Department of Labor. https://www.osha.gov/SLTC/etools/computerworkstations/index.html 

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