Acute low back pain: What to do? What works and what doesn't?

Here is an excerpt from a recent review article in the official AFP journal American Family Physician:

Acute low back pain is one of the most common reasons for adults to see a physician. Most patients recover quickly with minimal treatment.

"Red flags"

Serious "red flags" include:

- significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis)
- major or progressive motor or sensory deficit
- new-onset bowel or bladder incontinence or urinary retention
- loss of anal sphincter tone
- saddle anesthesia
- history of cancer metastatic to bone
- suspected spinal infection


Without signs of serious pathology, imaging and laboratory testing often are not required.


Patient education, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and muscle relaxants are beneficial.

Bed rest should be avoided, if possible.

Exercises directed by a physical therapist, such as the McKenzie method and spine stabilization exercises, may decrease recurrent pain.

Spinal manipulation and chiropractic techniques are no more effective than established medical treatments.

No substantial benefit has been shown with:

- oral steroids
- acupuncture
- massage
- traction
- lumbar supports
- regular exercise programs


Diagnosis and treatment of acute low back pain. Casazza BA. Am Fam Physician. 2012 Feb 15;85(4):343-50.

Image source: Different regions (curvatures) of the vertebral column, Wikipedia, public domain.

1 comment:

  1. The problem with AFP's official statement is that is does inform people that the best indicator of whether you are going to get low back pain is whether you have had it already. Low back pain can easily become recurrent low back pain. Recent scientific evidence is shedding light on the complex changes that your body undergoes with injuries like low back pain. The most significant changes actually occur in the nervous system and are classified as neuroplastic changes. Plastic means change and neuroplastic means changes in your nervous system in response to stimuli. Chronic pain occurs due to neuroplastic changes and it is stimulating the same type of neuroplastic adaptations that are showing the most promise in treating such conditions. Check out my blog at for more articles on such topics as low back pain and neuroplasticity.