The cause of acute low back pain is often serious. A recent Australian study reveals most people who experience low back pain believe imaging will pinpoint the cause of their pain. But trials (www.ncbi.nlm.nih.gov/pubmed/19200918) show there are no benefits, and some potential harms, for routine imaging of low back pain. Tests are often unnecessary and expensive, and lead to potential harms, such as exposure to radiation.
Imaging results can make people worry because they often detect changes in the spine that are normal for age. This leads to choosing treatments that target the scan findings, rather than treating the current movement problems. Wrongly focused treatments may cause more harm than good and delay improvement.
Most patients just want a good explanation of why they are getting pain and how they can help themselves.
The prevalence of underlying serious causes, including nerve or bone damage, infection or cancer, is very low. Despite this many patients are routinely sent for diagnostic imaging, such as an X-ray, CT or MRI scan.
Dr Traeger says physiotherapists can detect the potential risk of more serious causes of low back pain with a thorough consultation including a good clinical history, examination, and explanation to replace a lot of these tests,” he says.
The APA’s Choosing Wisely recommend:
1. Don’t request imaging for patients with non-specific low back pain and no indicators of a serious cause.
Patients can self-manage an episode of back pain through staying active and using simple pain medicines or a hot pack to relieve their pain. Physiotherapists can provide treatment to relieve the pain and can also educate patients about caring for their back.
2. Don’t request imaging of the cervical spine in trauma patients, unless indicated by a validated decision rule.
The Canadian C-Spine rule identifies patients who can safely be managed without imaging with high sensitivity.
3. Don’t request imaging for acute ankle trauma unless indicated by the Ottawa Ankle Rules.
Most clinically significant acute ankle injuries can be diagnosed with history, examination, and selective use of plain radiography.
4. Avoid using electrotherapy modalities in the management of patients with low back pain.
Instead, patients with subacute low back pain should be reassured, advised to stay active, and be referred for prescribed analgesia if necessary.
For chronic low back pain, helpful interventions include short-term use of medication/manipulation/acupuncture, supervised exercise therapy, cognitive behavioural therapy and multidisciplinary treatment.
Physiotherapists treating osteoarthritis should collaborate with the patient as part of a multidisciplinary team to prescribe exercise-based intervention in association with other evidence-based managements, such as weight control, use of assistive aids, disease education, self-management and medicines review.