What is reasonable when visiting a doctor for low back pain?

Q: I just spent $125.00 on an office visit with a physician for my low back pain. All I got was advice to stay on my feet and active, a brochure on low back pain, and a boot out the door. Does this seem reasonable to you?  Not even a prescription for pain relief.

A: Based on current evidence, it sounds like your physician is actually following the recommended clinical practice guidelines (CPGs) for the treatment of acute low back pain. Prescribing medications without evidence of their benefit is poor medicine at best and just giving in to patient complaints of pain, misery, and suffering.

All the studies confirm that if you follow the advice as given to you by this physician, you will actually do better in the short- and long-term. Rest and inactivity may be okay for the first 24 hours but after that, the proof we currently have strongly supports patients with low back pain stay active. That doesn't mean go out and run a marathon (or some other extreme level of activity) but rather, keep moving as much as possible in the pain free range.

It's best to avoid adopting what's commonly referred to as the sick role (e.g., staying in bed) as this will delay recovery. One recommendation the research supports that may have been mentioned by your physician was the use of manipulation for acute (early onset) low back pain.

Early onset means seeing a chiropractor or physiotherapist for manipulation of the spine within the first three weeks after symptoms began. During a spinal manipulation, the practitioner applies a high-velocity force to shift position of the vertebra.

Realigning the spinal bones also helps restore more normal soft tissue structures around the spinal joints. The results are decreased pain and more normal movement -- or perhaps the other way around: more normal movement and subsequently less pain. Paying attention to posture and alignment and including a program of exercises for flexibility and strength is also a good idea and supported by the medical literature.

Reference: Shira S. Weiner, PhD, et al. Managing Nonspecific Low Back Pain. In Spine. November 1, 2011. Vol. 36. No. 23. Pp. 1987-1994.

Our staff and patients are our top priority and we will be taking all the necessary precautions and following guidelines set out. We look forward to your next visit.