Low back pain is an epidemic in the United States with 5% of people within a given year having an episode of low back pain and 60-90% of people experiencing an episode of low back pain during their life time. Only visits for the common cold out number visits to the doctor for low back pain. Most studies suggest that these episodes of low back are self limited with spontaneous improvement in up to 80% of people within two weeks. The exact cause of low back can be difficult to clearly define and is often multifactorial. There is an increased incidence of low back pain and disc herniation in smokers. Obesity may also contribute to an increased incidence of low back pain. These are two potential issues that patients who suffer from low back pain should address. The best strategy for addressing low back pain combines active intervention with education and rehabilitation. The patient is an active participant in the healing process. The treatments I commonly recommend for low back pain include activity as tolerated, non-narcotic medical management (nonsteroidal anti-inflammatory medications and muscle relaxants), and physical therapy. Physical therapy typically involves stretching, strengthening, and trunk stabilization exercises. The primary goal is for the patient to develop a low back home exercise program for the long-term. There are many modalities that physical therapy can try (traction, deep massage, TENs, ultrasound, etc.) which can be trialed on an individual basis. There is no evidence in the literature to support long-term use of braces for the treatment of low back pain. These measures will frequently resolve an acute episode of low back pain. If the patient continues to have low back pain after having undergone these measures, referral to an orthopaedic specialist for further evaluation and treatment is warranted.
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