treatment protocol for LBA (Low Back Ache)

can u all suggest me a treatment protocol for low back ache without sciatica and with sciatica

[sdkashif]

Acute Pain

Defined as onset within 0-6 weeks
90% of patients with low back pain
Only 10-20% can be given precise patho-anatomical diagnosis

Chronic Pain

Pain with onset > 3 months
5% of patients with low back pain
85% of costs due to loss of work and compensation
50% have clear structural diagnosis made for cause of their back pain

A brief outline of treatment will be as under:

Acute LBP

Bed rest
functional in 6.6 days compared to 11.8 days for those kept ambulatory 1
2 days of bedrest are as effective as 7 days and results in 45% less time away from work 2
more beneficial in radiculopathy
Analgesics
Muscle relaxants: controversial
Aerobic exercise
Weight loss
Stop smoking

Chronic LBP

Back exercises
Williams/flexion exercises: better tolerated
Extension exercises: may be more efficacious
Physical Therapy
Ultrasound
Diathermy
TENS
Exercise instruction
Traction
Bracing- controversial, not clearly efficacious, may weaken back/abdominal musculature
Facet injection: probably not effective
Epidural Steroid Injection for radiculopathy
controversial
66% with sx < 6 months show improvement
33% with sx > 12 months show improvement
Narcotics in chronic LBP are best avoided
Antidepressants in low doses may be beneficial

Important neurologic deficits (ie. foot drop) best treated surgically
Long-term functional outcome unaffected if surgery delayed up to 12 weeks


Surgery: Indications

Progressive or severe neurologic deficit
Persistent neuromotor deficit despite 4-6 weeks conservative therapy
Persistent radiculopathy, sensory deficit or reflex loss after 4-6 weeks
conservative therapy with +SLR, consistent clinical findings and favorable
psychosocial circumstances (no depression, substance abuse or
somatization disorder)


Outcome

Acute LBP

Resolution of pain (without sciatica) in 6 weeks with nonspecific treatment in 75-90%
60% will have a recurrence within one year

> 50% with sciatica recover in 6 weeks

Chronic LBP:

Successful rehabilitation (%) vs. length of symptoms

Summary Points

Back pain seen in up to 90% of population
Only 20-50% of cases have a clear patho-anatomic etiology identified
75-90% of those with acute back pain will have resolution of pain within 6 weeks
Know the "red flags"

Weight loss
fever
age > 50
Adenopathy
History of cancer, TB, IV drug abuse
Neurological symptoms
uni/bilateral
urinary retention
saddle anesthesia
Writhing in pain
(visceral/vascular)
Unrelenting pain at rest
(infection/ malignancy)

thank sir for the benificial information.
i would like to know the intensities as well as the duration for each modality u mentioned earlier. if not thn can u let me know the criteion for selecting the modalities coz giving all modalities will not b fine.

[sbbb]

if patient is with radiating LBA u should go for neural mobilization

[alophysio]

Hi sdkashif,

you mention 50% of chronic back pain have a structural diagnosis to explain their pain..what is the source for this statistic?

As for the OP, physiotherapy is not a receipe profession. Conduct your assessment and make a diagnosis. Treat the problems you find, not just the symptoms that are reported.

Also, If your patient takes longer than 6 weeks to get better, it is more likely that they got better on their own (natural recovery).

Lastly, there are seemingly god manual therapy courses in India that are VERY cheap - 3000 rupees is ~150USD i think for a 2 or 3 day course. That is good value. If they do what they say and teach you MT, then it is worth the money.