Low Back Pain 101

Low back pain has one of the highest medical costs in the United States for overall care and disability (2). In 2019, The National Center of Health Statistics performed a survey and found back pain increased with age, ranging from 28.4% (18-29 yrs), 35.2% (30-44 yrs), 44.3% (30-44 yrs), and 45.6% (over 65 yrs) (3). Additionally, women reported greater experiences of back pain than men, 40.6% (women) and 37.2% (men) (3). For athletes, the numbers vary greatly for one-year prevalence of 17-94% to a lifetime of 33-84% (1). Low back pain was highest among skiers, floorball, and rowers and lowest among shooters, golfers, and triathletes (1). The prevalence and incidence of low back pain is not going to decrease.

Low back pain comes in a variety of conditions and varying levels of pain and disability. Low back pain is classified as either acute or chronic. Acute low back pain last up to six weeks (4, 7). Chronic low back pain is more persistent and generally greater than three months (5, 7). The goal is to treat back pain acutely for better success and results. When low back pain reaches chronicity, it becomes more challenging to solve the problem.

Most often low back pain is categorized into groups: acute or chronic, low back pain with leg pain (includes sciatica, disc herniation/bulge), low back pain in older adults (stenosis), and postoperative low back pain (2).

First and foremost, The SHOP will rule out red flags for low back pain. Red flags are tumors, fractures, infection, and Cauda Equina Syndrome (6). Once cleared, we will further evaluate for causation of symptoms and work toward pain relief and resolution.

References

1. Farahbakhsh F, Rostami M, Noormohammadpour P, et al. Prevalence of low back pain among athletes: A systematic review. Journal of Back and Musculoskeletal Rehabilitation. 2018;31(5):901-916. doi:https://doi.org/10.3233/bmr-170941

2. George SZ, Fritz JM, Silfies SP, et al. Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11):CPG1-CPG60. doi:https://doi.org/10.2519/jospt.2021.0304

3. Lucas J, Connor E, Bose J. Key Findings Data from the National Health Interview Survey.; 2021. https://www.cdc.gov/nchs/data/databriefs/db415-H.pdf

4. See Q, Tan B, Kumar D. Acute low back pain: diagnosis and management. Singapore Medical Journal. 2021;62(6):271-275. doi:https://doi.org/10.11622/smedj.2021086

5. Meucci RD, Fassa AG, Faria NMX. Prevalence of chronic low back pain: systematic review. Revista de Saúde Pública. 2015;49(0). doi:https://doi.org/10.1590/s0034-8910.2015049005874

6. Parr A, Askin G. Non-radicular low back pain: Assessment and evidence-based treatment. Australian Journal of General Practice. 2020;49(11):724-727. doi:https://doi.org/10.31128/ajgp-06-20-5476

7. Zhou T, Salman D, McGregor AH. Recent clinical practice guidelines for the management of low back pain: a global comparison. BMC musculoskeletal disorders. 2024;25(1):344. doi:https://doi.org/10.1186/s12891-024-07468-0

8. Oliveira CB, Maher CG, Pinto RZ, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. European Spine Journal. 2018;27(11):2791-2803. doi:https://doi.org/10.1007/s00586-018-5673-2