Body Health Blog
In the assessment of lower back pain, differential diagnosis utilizing a “triage” concept of classifying low back injuries into one of three categories helps to guide the doctor of chiropractic. These categories of diagnosis include:
- Non-specific: mechanical back pain in the lumbar spine (most common type of presentation).
- Sciatica: when the nerve root in the low back is pinched or compressed causing a referral of pain or numbness and weakness into the buttocks or leg.
- Potentially serious: tumor, infection, fracture, major neurological problem (cauda equina), local open wound or burn, prolonged bleeding (hemophilia), artificial joint implant problems, pacemaker problems, joint infection
Sciatica is a common cause of low back pain
With a diagnosis of potentially serious injuries, chiropractic manipulation is typically avoided over the relevant anatomy, although it may not be ruled out on other areas.
Lower back pain symptoms are typically described by chiropractors on the following scale:
- Acute (symptoms lasting less than 6 weeks)
- Sub-acute (symptoms lasting between 6 and 12 weeks)
- Chronic (symptoms lasting for 12 weeks or more)
- Recurrent/flare up (symptoms are similar to original symptoms and return sporadically or as result of exacerbating circumstances). (17)
These lower back pain symptoms may be further broken down as mild, moderate or severe in pain.
Chiropractic Treatment Plan for Lower Back Pain
Goal setting for the chiropractic treatment plan is driven by the patient’s pain and disability issues and activity intolerance levels. Patient education with the guidance of the chiropractor is important to reduce anxiety levels that often accompany intense low back pain. The guidelines recommend chiropractic care 3–5 visits/week over 1–2 weeks.
If no measurable improvement is noted in a 2–4 week trial, the history and examination, diagnosis and treatment modalities should be reviewed. The compliance and sincerity of the patient should be evaluated and the risk factors that may prolong recovery identified, the initiation of a different treatment or followed by discharge, referral to another chiropractor, or medical practitioner. (18)
Consistent among all guidelines of low back pain treatment is the prevention of chronicity. The use of active care (care that is patient-driven such as exercise, activity modification, ergonomic modifications, etc.) is emphasized to accomplish this goal.
16 and 17. Globe G, Morris C, Whalen W et al. Chiropractic Management of Low Back Disorders.
18. Bigos S, Bowyer O, Braen G et al (1994) Acute low back problems in adults.
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