Guidelines for Low Back Pain

Treatment Algorithm for joint and Back Injuries: After you begin to experience back pain, either as the result of an injury, or whether it develops spontaneously, there are several directions that your treatment program may go in based on your symptoms and the types of treatments you receive. The direction that your treatment program goes in may depend on there the pain is, wheat is found in the diagnostic exams, the extent of your injuries, and how your body responds to the back pain treatments. Let's take a look at a Treatment algorithm for joint and Back Injuries.

If a patient experiences acute back pain that is significant enough for a person to require medical attention, the doctor will have to determine one of two things:
  1. The pain is the result of a fracture or serious medical condition. If the back pain is determined to be the result of a serious medical condition, than it must be treated immediately, so that the injury does not become irreversible. Signs of a serious medical condition may include symptoms of other medical conditions such as weight loss and fever, bladder/bowel incontinence, pain in patients with a history of osteoporosis and tumors/bone cancer, and pain along with weakness and loss or feeling in the leg. Doctors will order immediate diagnostic tests and/or treatments as emergency care in order to preserve life or prevent permanent damage to the body.
  2. The pain is not determined to be related to a fracture or serious medical condition.
In this case of acute back pain that is not considered to be related to a serious condition, the doctor will offer two conservative treatments:
  1. Rest or an avoidance of any movements or activities that exascerbate the pain symptoms.
  2. Analgesics (pain killers) to alleviate the pain while the injury heals on its own.

In about 90% of all cases of acute back pain, the symptoms of pain and stiffness are not serious and will resolve as a result of one of these two conservative treatments.

If pain continues for weeks despite rest or the use of pain medications, the doctor will typically prescribe physical therapy for the patient that is appropriate to their specific type of injury. Prior to directing the patient to undergo physical therapy, the doctor may order diagnostic tests to get a better look at the patient's back and any pathology related to the patient's symptoms. The most common diagnostic tests ordered to diagnose the cause of back conditions are X-Rays. If soft tissue injuries are suspected, the doctor may recommend an MRI or CT Scan to get a look at structures such as the tendons, ligaments, facet joints, intervertebral discs, and spinal nerves. Ultrasound is a less common medical imaging diagnostic test that is ordered to diagnose back conditions.

Based on the findings of the medical imaging results, as well as the physical findings of the doctor's physical examination, the doctor will make a diagnosis of the injury. The most common injuries that are diagnosed in back medicine are soft tissue injury - muscle injury, tendon or ligament injury, cartilage damage, or discogenic injury.
  • If there is tendon damage and subsequent strain, two treatments that may be available are platelet-rich plasma injections and Prolotherapy. Physical therapy may also be beneficial to treat tendon damage by restoring strength and flexibility to the damaged tendons.
  • If these is ligament damage, the most common treatments offered are rest, bracing, and physical therapy. Some doctors recommend Prolotherapy to accelerate the healing process in the event of extensive damage to the ligaments.
  • If a muscle injury is diagnosed, the patient will be treated with one or more of the following: massage/myofascial release, trigger point injections, strain/counterstrain technique, or botulinum toxin.
  • If there is cartilage damage, the patient may be treated with Glucosamine with Chondroitin, hyalurinic acid, and Prolotherapy.
  • If there is damage to a ligament and intervertebral disc, chiropractic manipulation will be recommended.