Acute Lower Back Problems in Adults - Abstract
Abstract
Findings and recommendations on the assessment and treatment of adults with acute low back problems–activity limitations due to symptoms in the low back and/or back–related leg symptoms of less than 3 months' duration–are presented in this clinical practice guideline. The following are the principal conclusions of this guideline:
- The initial assessment of patients
with acute low back problems focuses on the detection of "red
flags" (indicators of potentially serious spinal pathology
or other nonspinal pathology).
- In the absence of red flags,
imaging studies and further testing of patients are not usually
helpful during the first 4 weeks of low back symptoms.
- Relief of discomfort can be
accomplished most safely with nonprescription medication and/or
spinal manipulation.
- While some activity modification
may be necessary during the acute phase, bed rest >4 days
is not helpful and may further debilitate the patient.
- Low–stress aerobic activities
can be safely started in the first 2 weeks of symptoms to help
avoid debilitation; exercises to condition trunk muscles are
commonly delayed at least 2 weeks.
- Patients recovering from acute
low back problems are encouraged to return to work or their normal
daily activities as soon as possible.
- If low back symptoms persist,
further evaluation may be indicated.
- Patients with sciatica may recover
more slowly, but further evaluation can also be safely delayed.
- Within the first 3 months of
low back symptoms, only patients with evidence of serious spinal
pathology or severe, debilitating symptoms of sciatica, and physiologic
evidence of specific nerve root compromise corroborated on imaging
studies can be expected to benefit from surgery.
- With or without surgery, 80
percent of patients with sciatica recover eventually.
Nonphysical factors (such as psychological or socioeconomic problems) may be addressed in the context of discussing reasonable expectations for recovery. This document is in the public domain and may be used and reprinted without special permission. AHCPR will appreciate citation of the source, and the suggested format is provided below:
Bigos S, Bowyer O, Braen G,
et al. Acute Low Back Problems in Adults.
Clinical Practice Guideline No. 14. AHCPR Publication No. 95–0642.
Rockville, MD: Agency for Health Care Policy and Research, Public
Health
Service, U.S. Department of Health and Human Services. December
1994.
