Management of back pain

Purpose: Low back pain (LBP) constitutes one of the most difficult and costly medical problems in industrial countries, with a prevalence of 25 to 30% in an adult lifetime span and an incidence of about 5% per year. Method: Based on risk factors cited in the pertinent literature, the evaluation, diagnosis and therapeutic options for LBP are outlined. Especially the latter can be highlighted on the basis of a large number of systematic reviews. Results: Bed rest is no longer regarded as an effective treatment for episodes of acute LBP, except when the patient has evident clinical signs of nerve root compression. Exercise therapy comprises a wide range of concepts and underlying physiological principles. Different concepts are discussed. Evidence suggests no specific effects of exercise therapy in acute LBP. In chronic LBP, exercise as well as combined treatment with several modalities appear to be superior to conventional medical care. In the past decade, reconditioning of the paraspinal muscles is being given increasing importance in research. Several studies indicate the effectiveness of vigorous strengthening of paraspinal and trunk muscles on pain and even disc surgery. Different underlying pathologies seem to respond equally well to this concept. Back school concepts are not proven to have long-term effects on LBP. The literature on electrotherapy and massage in LBP is generally sparse. Nevertheless, some studies suggest the effectiveness of electrotherapy on pain reduction at least in the short term. Spinal mobilization seems to be effective in reducing pain. Conclusion: Based on these evidence-based conclusions, the patient's medical history, the investigation and the diagnosis the clinician has to devise an individual treatment plan that takes the deficiencies and requirements of the patient into account.