Summary of Am College of Occupational & Environmental Medicine’s findings: 60-80% of the general population will have low back pain during their lifetime with 25-60% having pain annually. Low back pain is the most common occupational disorder with 20 per 10,000 full-time employees affected. The direct cost of occupational low back pain is $10.8 billion/year!
After reviewing all the research over the past few decades the ACOEM’s guidelines for treatment of low back pain are as follows:
- Assess for Red Flags
- Focus on functional recovery on day 1.
- Reduce fear-avoidance and assure excellent prognosis on day 1.
- No bed rest. Maintain ordinary activity as much as possible for most rapid recovery.
- Return to work as quickly as possible for the best outcome.
- Mechanical assessment with directional preference associated with better outcome.
- Exercise prescription, NSAIDs, heat, and ice may be helpful
- In the absence of red flags, imaging and other test are not recommended in the first 4-6 weeks
- Aerobic exercise has the best evidence of efficacy for acute, subacute and chronic low back pain.
- Patients should be encouraged to accept responsibility for managing their recovery, rather than relying on the healthcare provider for a cure.
- If symptoms persist without improvement, further evaluation is recommended
- Patient outcomes are not adversely affected by delaying non-emergent surgery and continued conservative care is recommended.
- Patients with moderate or severe neurological deficits that are not improving at 4-6 weeks may benefit from earlier surgical intervention. Progressive neurological deficits have an indication for immediate surgery.
- Psychiatric, psychosocial, environmental and socioeconomic problems should be investigated and addressed, especially in any delayed recovery.