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Acute Low Back Pain

Wait and See…… or Immediate Physiotherapy?

Is it too early to send my patient to Physiotherapy?

Will Physiotherapy make the injury worse?

The sports medicine approach has long been successful with immediate physical rehabilitation. The focus is early return of function allowing these people to return to sport as quickly as possible. Research has recently been questioning our reasons for having not employed the same approach to returning individuals back to work when they have suffered an occupational injury.

Traditionally medical practitioners treating occupational injuries have focused on pain relief and symptom control. While obviously important in the early stages of rehabilitation, the main emphasis should be functional restoration.

Internationally there are countries who’s health authorities still propose a "wait and see" approach to acute low back pain. Health authorities in North America and the UK recommend various forms of early physical intervention.

One study divided patients into 3 groups based on the time post injury at which Physiotherapy was initiated. This study showed that the earlier the intervention the better the results.

Group 1: Immediate (1-2 days post-injury)

Group 2: Early (3-7 days post-injury)

Group 3: Delayed (>7 days post-injury)

A second study compared assess/advise/treat against assess/advise/wait approaches to management of acute low back pain.

At 6 weeks the early treatment group demonstrated significantly greater improvements in disability, mood, general health and quality of life than those patients in the "wait" group. This is showing an early return to function.

The psychosocial impact of early treatment still continued to show benefit long term. This is a very important feature of early intervention as the psychosocial status of a client can provide significant barriers to physical rehabilitation.

References:

Zigenfus GC, Yin J, Giang GM, Fogarty WT. Effectiveness of early physiotherapy in the treatment of acute low back musculoskeletal disorders. J Occup Environ Med. 2000 Jan;42(1):35-9

Wand BM, Bird C, McAuley JH, Dore C, MacDowell M, DeSouza L. Early Intervention for the Management of Acute Low Back Pain: A Single-Blind Randomized Controlled Trial of Biopsychosocial Education, Manual Therapy and Exercise. Spine. 2004 Nov1;29(21):2350-6