The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. The presence of respiratory disorders in individuals with low back pain: A systematic review. [1] Men and women are equally affected. Exercise programmes may include the following elements: In subacute low-back pain there is some evidence that. [53], Non-specific low back pain is defined as low back pain not attributable to a recognizable, known specific pathology. Diagnostic triage (non-specific low back pain, radicular syndrome, serious pathology). [85], For older people with chronic pain, opioids may be used in those for whom NSAIDs present too great a risk, including those with diabetes, stomach or heart problems. Low back pain is a common symptom in people of all ages and socioeconomic status. When warranted, imaging such as MRI can provide clear detail about disc related causes of back pain (L4–L5 disc herniation shown), disorder involving the muscles, nerves, and bones, Transcutaneous electrical nerve stimulation, "The prognosis of acute and persistent low-back pain: a meta-analysis", "An updated overview of clinical guidelines for the management of non-specific low back pain in primary care", "Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians", "A systematic review of the global prevalence of low back pain", "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010", "Use of imaging studies for low back pain: percentage of members with a primary diagnosis of low back pain who did not have an imaging study (plain x-ray, MRI, CT scan) within 28 days of the diagnosis", "Imaging strategies for low-back pain: systematic review and meta-analysis", "Overtreating chronic back pain: time to back off? MIGHTY BLISS Deep Tissue Back and Body Massager Cordless Electric Handheld Percussion Muscle Hand Massager - Full Body Pain Relief Vibrating Therapy Massage Machine, Neck, Shoulder, Leg, Foot Wahl Hot Cold Deluxe Heat Therapy Electric Corded Massager with Variable Intensity for Customized Pain Relief – Model 4295-400 Download Download PDF. Several lumbar structures are plausible sources of pain (eg, the intervertebral disc, the facet joints), but clinical tests do not reliably attribute the pain to those structures. Read Paper. Do not offer interferential therapy for managing low back pain with or without sciatica. Download Download PDF. Low back pain is the leading cause of long term disability worldwide.1 The lifetime incidence of low back pain is 58-84%,2 and 11% of men and 16% of women have chronic low back pain.3 Back pain accounts for 7% of GP consultations and results in the loss of 4.1 million working days a year.2 More than 30% of people still have clinically significant symptoms after a year after … 2017;166(7):493- 505. doi: 10.7326/M16-2459. Network meta-analysis", "Yoga for low back pain: a systematic review of randomized clinical trials", "Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology", "Randomized Trial of General Strength and Conditioning Versus Motor Control and Manual Therapy for Chronic Low Back Pain on Physical and Self-Report Outcomes", "Acute low back pain without radiculopathy", "Non-steroidal anti-inflammatory drugs for spinal pain: a systematic review and meta-analysis", "Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials", "Non-steroidal anti-inflammatory drugs for chronic low back pain", "Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials", "Illicit Substance Use in US Adults With Chronic Low Back Pain", "Opioids for chronic noncancer pain: a position paper of the American Academy of Neurology", "CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016", "Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis", "Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society", "Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis", "Epidural Corticosteroid Injection: Drug Safety Communication – Risk of Rare But Serious Neurologic Problems", "Fusion rates of instrumented lumbar spinal arthrodesis according to surgical approach: a systematic review of randomized trials", "Complementary therapies in addition to medication for patients with nonchronic, nonradicular low back pain: a systematic review", "Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials", "A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain", "Cost-effectiveness of guideline-endorsed treatments for low back pain: a systematic review", "Cognitive and Mind-Body Therapies for Chronic Low Back Pain and Neck Pain: Effectiveness and Value", "Mindfulness-based stress reduction for low back pain. This is the second edition of the booklet which contains practical advice on how to deal with back problems and stay active. Spine (Phila Pa 1976). 1995 Dec 15;20(24):2702-9. If you are unable to import citations, please contact "Non-specific low back pain." Heidi Prather, Clayton Skaggs, in Interventional Spine, 2008. The presence of respiratory disorders in individuals with low back pain: A systematic review. depression, fear of movement and catastrophising) and social factors (eg. Consider risk stratification (such as with the STarT Back tool) to target more intensive support at initial presentation for those less likely to recover quickly, Consider exercises such as stretching, strengthening, aerobic, yoga, or Tai Chi in a group setting for all patients with low back pain and sciatica as the main component of non-invasive treatment. The condition is normally not serious, resolves without much being done, and recovery is helped by attempting to return to normal activities as soon as possible within the limits of pain. A multi-site pragmatic cluster randomized trial. Back Pain: a movement problem is a practical manual to assist all students and clinicians concerned with the evaluation, diagnosis and management of the movement related problems seen in those with spinal pain disorders. A short summary of this paper. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. Massage Therapy Treatment Manual ... Works well for low back and arthritic pain; excellent for minor aches and pains. [81][13] These medications carry a risk of addiction, may have negative interactions with other drugs, and have a greater risk of side effects, including dizziness, nausea, and constipation. Management of people with acute low back pain This Australian guideline recommends nine principles in the management of acute low back pain. The condition may be further classified by the underlying cause as … Include an educational component consistent with this guideline as part of other, Take into account the person's expectations and preferences when considering. The rear lumbar compartment consist the vertebral arch, the processus spinosus, the processes transversi and the facet joints. Consider psychosocial factors (yellow flags) if there is no improvement. 50% of people with LBP will recover in 2 weeks with no treatment. However, the determination of a pathoanatomic origin of low back pain is made difficult by the rate of false-positive findings on imaging studies, that is, individuals without low back pain showing abnormal findings. [4] Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages. [52], Exercise therapy is effective in decreasing pain and improving physical function, trunk muscle strength and mental health for those with chronic low back pain. Small joints called facet joints limit and direct the motion of the spine. Hippocrates (c. 460 BCE – c. 370 BCE) was the first to use a term for sciatic pain and low back pain; Galen (active mid to late second century CE) described the concept in some detail. What is the relevance of the latest kinematic findings to the prevention and treatment of low back pain? Movement, Stability and Low Back Pain brings together the latest findings which help to provide the answers to these questions. Download Download PDF. "An update of stabilisation exercises for low back pain: a systematic review with meta-analysis." Acetaminophen (paracetamol) was once the first medication recommendation in the management of low back pain, however, this is now only recommended when used with weak opioids when NSAID are not well tolerated or ineffective. 1, 2 In several studies, manual therapy has been shown to be superior to traditional … Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. Patient prognosis- matching treatment to patients prognosis such as the likelihood of persistent pain and disability (e.g. [116] In the United States, Low Back pain is highest of Years Lived With Disability (YLDs) Rank, Rate, and Percentage Change for the 25 Leading Causes of Disability and Injury, between 1990 and 2016. [11] Some low back pain is caused by damaged intervertebral discs, and the straight leg raise test is useful to identify this cause. Level of evidence 1A [1]. [40], With other causes ruled out, people with non-specific low back pain are typically treated symptomatically, without exact determination of the cause. the intervertebral disc) as the source of pain, as might be the case in peripheral joints such as the knee[24]. [5] There are three general types of low back pain by cause: mechanical back pain (including nonspecific musculoskeletal strains, herniated discs, compressed nerve roots, degenerative discs or joint disease, and broken vertebra), non-mechanical back pain (tumors, inflammatory conditions such as spondyloarthritis, and infections), and referred pain from internal organs (gallbladder disease, kidney stones, kidney infections, and aortic aneurysm, among others). the main outcome measures were the Minimal Clinically Important Change (MCIC) of the pain intensity numerical rating scale (PI-NRS), the Quebec Back Pain Disability Scale (QBPDS), and the Euroqol (EQ) in patients with low back pain. The diagnosis is based on the observation of active movements. PA mobilisations are a commonly used manual therapy technique that has shown to be effective at reducing pain in patients with low back pain (LBP) . Manual therapy. Non-specific Low Back Pain: Classification and treatment. Non-specific back pain is thus a major problem for diagnosis and treatment. A short summary of this paper. Cognitive behavioural interventions yield long-term improvements in pain, disability and quality of life in comparison to no treatment and other guideline-based active treatments for patients with LBP of any duration and of any age. Low back pain is an extremely common problem that is often poorly managed. [12], As the structure of the back is complex and the reporting of pain is subjective and affected by social factors, the diagnosis of low back pain is not straightforward. Epub 2017 Feb 14. Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. [115] The popularity of such proposed causes decreased during the 20th century. [32] Teaching people with chronic low back pain how to use these muscles is recommended as part of a recovery program. Eur Spine J 2010;19:2075–94. [5] Lumbar provocative discography may be useful to identify a specific disc causing pain in those with chronic high levels of low back pain. [94] National guidelines reach different conclusions, with some not recommending spinal manipulation, some describing manipulation as optional, and others recommending a short course for those who do not improve with other treatments. When refering to evidence in academic writing, you should always try to reference the primary (original) source. Whitehouse, and N. Roberts, The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males. --> function: protection against rotation and extreme movements + attachment site for connective tissue and muscles. Findings In this randomized clinical trial, 33 of 50 participants (66%) randomized to 4 weeks of pain reprocessing therapy were pain-free or nearly pain-free … The cost of care for LBP has been reported (in the USA) to be over $50 billion annually[9]. [5] Some evidence supports the use of facet joint injections, transforminal epidural injections and sacroiliac injections as diagnostic tests. Patients … The front lumbar compartment consist the vertebral body and the discus intervertebralis (and also the ligamentum longitudinale anterius/posterius) --> function: support the biggest part of the body weight against gravity and also as a shock absorber. Read Paper. Because non-specific low back pain does not have a known … NICE guideline [NG59]. So far, evidence suggests immediate pain relief following treatment, and also some evidence suggests an increased range of movement (ROM) of lumbar extension [53] [54] [55] . If no serious pathology is suspected there is no indication for x-rays or MRI diagnostic imaging unless guidance is need to change the management protocol. "The effectiveness of cognitive behavioural treatment for non-specific low back pain: a systematic review and meta-analysis." Denizita Medina. [3] The condition may be further classified by the underlying cause as either mechanical, non-mechanical, or referred pain. Design Pragmatic randomised clinical trial. [12], Initial management with non-medication based treatments is recommended. [7][8] About 40% of people have LBP at some point in their lives,[7] with estimates as high as 80% among people in the developed world. [54] For acute pain that is causing only mild to moderate problems, the goals are to restore normal function, return the individual to work, and minimize pain. 24 Full PDFs related to this paper. Chou R, Deyo R, Friedly J, et al. The dominant role of psychosocial risk factors in the development of chronic low back pain disability. weakness, stiffness), psychological factors (eg. The ligaments play an important role in resisting heavy movements. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). Studies suggests that that multifidus and paraspinal muscle groups are significantly smaller in patients with chronic low back pain than in control patients who are healthy and on the symptomatic side of patients with chronic unilateral low back pain compared with the asymptomatic side. [1] A 2015 Cochrane review found that for acute low back pain massage therapy was better than no treatment for pain only in the short-term. Further, even when abnormalities are present, establishing a direct cause and effect between the pathological finding and the patient condition has proven to be elusive and most often does not assist greatly in patient management. Acute low back pain is an episode of low back pain for less than 6 weeks, sub-acute low back pain between 6 and 12 weeks and chronic low back pain for 12 weeks or more. Anthony Delitto, Steven Z. George, Linda Van Dillen, Julie M. Whitman, Gwendolyn Sowa, Paul Shekelle, Thomas R. Denninger, Joseph J. Godges. A short summary of this paper. The diagnosis of non-specific low back pain implies no known pathoanatomical cause. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. This Paper. Read Paper. 1995 Mar 15;20(6):722-8. Remaining cases are non-specific low back pain. We do not capture any email address. Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The groups had similar outcomes at 6 and 12 months. Non-specific low back pain affects people of all ages and is a leading contributor to disease burden worldwide. [11], Exercise appears to be useful for preventing low back pain. Level of evidence 1A. Nerves come from and go to the spinal cord through specific openings between the vertebrae, providing the skin with sensations and messages to muscles. "The McKenzie method for low back pain: a systematic review of the literature with a meta-analysis approach." [91], Surgery may be useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. The UK guideline now only supports the use of weak opioids, in contrast to its previous recommendation of strong opioids. [26] Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position may also contribute to low back pain. Presenting the 4th edition of this excellent text, with the expertise of 19 leading specialists representing the fields of orthopedic surgery, neurosurgery, osteopathy, physical therapy, and chiropractic. Learn how to safely try these eight McKenzie exercises for yourself. [13] Although the antiseizure drugs gabapentin, pregabalin, and topiramate are sometimes used for chronic low back pain evidence does not support a benefit. Back pain is a particular challenge because it is so common, demanding of medical resources and a major cause of physical, psychological and social disability. [17] The evidence for chiropractic care[18] and spinal manipulation is mixed. Chapter 3. [99] Massage therapy is recommended for selected people with subacute and chronic low back pain, but it should be paired with another form of treatment like aerobic or strength exercises. [49][57] For acute pain, low- to moderate-quality evidence supports walking. Found inside – Page 44American Physical Therapist Association. Guidelines: Physical Therapist Scope of Practice. 2014. ... The use of trigger point dry needling and intramuscular electrical stimulation for a subject with chronic low back pain: a case report. As mentioned above it is not necessary to determine the specific pain causing structure to effectively manage this patient group. [96], Acupuncture is no better than placebo, usual care, or sham acupuncture for nonspecific acute pain or sub-chronic pain. This work presents a fresh approach to therapeutic exercises for the back. Instability of the back is now recognized as a major underlying cause of back pain and this work focuses on stabilization training of those muscles through exercise. You can download a PDF version for your personal record. Note: The methods for this review are found in Chou, et al., 2016. Offer educational advice that includes information on the nature of non-specific low back pain and encourages the person to be physically active and continue with normal activities as far as possible. What you’ll learn from this book: · How to break the fear and anxiety cycle that keeps you in a vulnerable and painful state. · A new understanding of how our spine and body works. · How to increase your confidence levels through ... Level of evidence 1A, Macedo, Luciana G., et al. [116] Low back pain causes disability in a larger percentage of the workforce in Canada, Great Britain, the Netherlands and Sweden than in the US or Germany. [9][10] Despite this, the use of imaging in low back pain has increased. [34] The process of pain sensation starts when the pain-causing event triggers the endings of appropriate sensory nerve cells. A few studies that have contradicted this notion have also failed to include sleep posture and mattress firmness. [44] Thus, if a person's medical history and physical examination do not suggest a specific disease as the cause, medical societies advise against imaging tests such as X-rays, CT scans, and MRIs. Level of evidence 1A, Almeida M, Saragiotto B, Richards B, Maher C. Primary care management of non-specific low back pain: key messages from recent clinical guidelines. 1173185, G. Combined physical and psychological treatment programme, Balagué, Federico, et al. [52], The management of low back pain often includes medications for the duration that they are beneficial. [112] Current smokers – and especially those who are adolescents – are more likely to have low back pain than former smokers, and former smokers are more likely to have low back pain than those who have never smoked. Model of care. [3][1], There are a number of ways to classify low back pain with no consensus that any one method is best. [2] People at higher risk of long-term disability include those with poor coping skills or with fear of activity (2.5 times more likely to have poor outcomes at one year),[110] those with a poor ability to cope with pain, functional impairments, poor general health, or a significant psychiatric or psychological component to the pain (Waddell's signs). Model of care. [33] Any of these changes may result in back pain. Low back pain is a self limiting condition[11]: However these figures may be deceptive because although the pain may go away the the re-occurrence rate of LBP is extremely high and these individuals are likely to experience another episode of LBP within 3-6 months. Additionally, the pain modulation mechanisms may not function properly. [107], KT Tape has been found to be no different for management of chronic non-specific low back pain than other established pain management strategies. MIGHTY BLISS Deep Tissue Back and Body Massager Cordless Electric Handheld Percussion Muscle Hand Massager - Full Body Pain Relief Vibrating Therapy Massage Machine, Neck, Shoulder, Leg, Foot Wahl Hot Cold Deluxe Heat Therapy Electric Corded Massager with Variable Intensity for Customized Pain Relief – Model 4295-400 The middle lumbar compartment consist the vertebral canalis --> function: protection of the spinal cord. Level of evidence 2A, Fortin, Maryse, and Luciana Gazzi Macedo. 24 Full PDFs related to this paper. [90], A study with 80 patients found magnesium to be useful in those with chronic back pain. Stretching, especially with limited range of motion, can impede future progression of treatment like limiting strength and limiting exercises. Pain can vary from a dull constant ache to a sudden sharp feeling. In the United States, it is the most common type of pain in adults, responsible for a large number of missed work days, and is the most common musculoskeletal complaint seen in the emergency department. The condition may be further classified by the underlying cause as … The book furnishes clear advice on diagnosis, clinical presentation, and therapeutic intervention, also covered are workmen's compensation, chronic pain programs, disability evaluations, and legal issues. Copyright © 2021 BMJ Publishing Group Ltd 京ICP备15042040号-3, , musculoskeletal physician and general practitioner, , guideline development group chair, consultant pain physician, musculoskeletal physician and general practitioner, guideline development group chair, consultant pain physician, Low back pain and sciatica: summary of NICE guidance, Taurus Healthcare: Flexible opportunities for GPs, Peartree Group Practice: Permanent Salaried GP Position, University Hospitals of Leicester NHS Trust: Consultant Paediatric Anaesthetist, Women’s, children’s & adolescents’ health. And no longer recommends opioids in the management of chronic LBP. [2]. December 2016 Download PDF. [52] Shoe insoles do not help prevent low back pain. [40] The best determinant of the presence of cancer is a history of the same. Diagnostic investigations have a role when the clinician suspects a specific disease process that would be managed differently from non-specific low back pain. Each lumbar vertebra consists of a vertebral body, a vertebral arch and a processus spinosus, a processes transversi and facet joints. NSW Agency for Clinical Innovation. Download Free PDF. Level of evidence 1A, Poquet, Nolwenn, et al. [3][1] Efforts to uncover factors that might complicate the diagnosis, such as depression, substance abuse, or an agenda concerning insurance payments may be helpful. Pain can vary from a dull constant ache to a sudden sharp feeling. Fourteen contributors in the fields of exercise science and physical therapy make the text a comprehensive, well-rounded overview of therapeutic exercise techniques. https://www.physio-pedia.com/index.php?title=Non_Specific_Low_Back_Pain&oldid=285340. Note that we still determine that acupuncture for treatment of fibromyalgia or osteoarthritis isnt considered ’ reasonable and necessary and remain non-covered by Medicare. Low back pain (LBP) or lumbago is a common disorder involving the muscles, nerves, and bones of the back. This book will teach you how to: • Understand the effect of Asperger’s syndrome on your partner • Practice effective communication skills • Constructively work through frustrations and fights • Establish relationship ground rules ... [99] The overall quality of the evidence was low and the authors conclude that massage therapy is generally not an effective treatment for low back pain. The Cochrane Library (2016). PloS one 10.8 (2015): e0134192. 90% of people with LBP will recover in 3-4 months with no treatment. [23], For persistent low back pain, the short-term outcome is also positive, with improvement in the first six weeks but very little improvement after that. "Comparison of risk factors predicting return to work between patients with subacute and chronic non-specific low back pain: systematic review." Nele Beeckmans, ... Lotte Janssens. In the 2010 Global Burden of Disease study the global age-standardised point prevalence of LBP (from 0 to 100 years of age) was estimated to be 9.4%[8]. Journal of Orthopaedic and Sports Physical Therapy, 2012, 42(4) level of evidence 1A, Savage, R.A., G.H. Tricyclic and serotonin reuptake inhibitor antidepressants and anticonvulsants are no longer recommended for pain relief, due to low evidence available[27][28]. These include biological factors (eg. Patients … [115] The discussion subsided as research showed disc problems to be a relatively uncommon cause of the pain. The use of these different stratification approaches vary around the world and there are overlaps between these three different approaches. [7][8] Difficulty most often begins between 20 and 40 years of age. Note: the spinal cord ends by the first lumbar vertebrae and then from the second lumbar vertebrae the spinal nerves forms the cauda equina. [115], Emerging technologies such as X-rays gave physicians new diagnostic tools, revealing the intervertebral disc as a source for back pain in some cases. The following physical therapy management strategies are from the NICE guidelines[33]. Eur Spine J 2007;16:1539–50.level of evidence 1A, Koes BW, van Tulder M, Lin C-WC, Macedo LG, McAuley J, Maher C. An updated overview of clinical guidelines for the management of non-specific low back pain in primary care. This Paper. In fact, evidence suggests that decreasing musculoskeletal pain may be one of the most important roles for manual therapy. Recent NICE guidelines[27] do not recommend analgesia or imaging, unless changing the management protocol. [100] The herbal treatments Devil's claw and white willow may reduce the number of individuals reporting high levels of pain; however, for those taking pain relievers, this difference is not significant. The description of the symptoms may range from tenderness at a particular point to diffuse pain. Manual (DeMarce, Gnys, Raffa, & Karlin, 2014) provided helpful guidance in the organization and structure of this manual. Disabil Rehabil. Consider offering a course of manual therapy, including spinal manipulation, comprising up to a maximum of nine sessions over a period of up to 12 weeks. 2013 Jul; 17(6): 916–928. Nele Beeckmans, ... Lotte Janssens. [118] There should be no legal reason for encouraging people to have tests which a health care provider determines are not indicated. [86], Antidepressants may be effective for treating chronic pain associated with symptoms of depression, but they have a risk of side effects. BMC musculoskeletal disorders 15.1 (2014): 1. [17], Behavioral therapy may be useful for chronic pain. 27 Full PDFs related to this paper. Full PDF Package Download Full PDF Package. Treatment Based Classification Approach to Low Back Pain, https://www.youtube.com/watch?v=0qR-Yfw9fOI. Found insideActive contraction of the thoracolumbar fascia—Indications of a new factor in low back pain research with implications for manual therapy. Proc. 5th Interdisciplinary World Congress on Low Back and Pelvic Pain, ... That is usually the journal article where the information was first stated. KCE report 287Cs. "Failed back surgery: etiology and diagnostic evaluation." Distress, previous low back pain, and job satisfaction are predictors of long-term outcome after an episode of acute pain. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Download a PDF copy. [4] Pain can vary from a dull constant ache to a sudden sharp feeling. The typical pain management team includes medical practitioners, pharmacists, clinical psychologists, physiotherapists, occupational therapists, physician … Since then, physicians have come to realize that it is unlikely that a specific cause for low back pain can be identified in many cases and question the need to find one at all as most of the time symptoms resolve within 6 to 12 weeks regardless of treatment.
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