It shouldn’t be surprising for a condition so common and with such pervasive consequences that countless treatment modalities have been used to treat lower back pain.
Some of these have little or no scientific basis, such as the use of hologram bracelets, while others have substantial proof of efficacy.
Most cases of lower back pain are “mechanical”. As most of these cases can and should be treated conservatively, this article will focus on the non-surgical treatment options.
First, and perhaps most importantly, there are a number of self-help strategies that have proven benefits for those with chronic lower back pain.
Remaining active has proven to be more effective than bed rest in both acute (less than three weeks) and sub-acute back pain (three to six weeks). As an adjunct to exercise, remaining active has been shown to be the most effective strategy for easing pain and improving function in chronic lower back pain (for longer than six weeks).
Heat in various forms, including heated pillows and infrared lamps, has proven short-term benefit for acute lower back pain.
The long-term use of elasticised corsets, if worn correctly, can improve the symptoms of chronic lower back pain and there is no evidence to suggest that this causes back muscle fatigue or weakness.
On the other hand, there is insufficient evidence to recommend the use of a rigid lumbar support for mechanical lower back pain.
A medium-firm, as opposed to a firm mattress, is proven to be better for patients with lower back pain. However, this doesn’t mean bed rest is advised. In fact, bed rest for more than two to three days is ineffective and probably harmful. Even when patients have sciatica (symptoms in the leg from sciatic nerve irritation), the clinical outcome is the same whether they are bed-rested or remain active.
Providing patients with the accurate, evidence-based information about their condition is an effective self-help strategy on its own.
There are a number of medications that can be used with proven benefit in the management of acute and chronic lower back pain.
Your doctor will no doubt prescribe the correct medicine, but there are some important considerations to bear in mind.
Adequate pain relief can be achieved with oral painkillers - one should simply follow the World Health Organisation’s “analgesic ladder” when prescribing these medicines.
Although muscle relaxants are often prescribed, the doses used by general practitioners are considered ineffective by the pain specialists.
Systemic corticosteroids are no better than placebo for lower back pain, whether nerve irritation is present or not.
* Marshall is a sports medicine practitioner at Prime Human Performance Institute in Durban.