Typically, medical history, physical examination, and standard radiology studies are required to diagnose low back pain. In some cases, individuals who do not respond to initial physical therapy may undergo specialized radiographic tests, such as magnetic resonance imaging (MRI) or computerized tomography (CT) to screen for additional involvement of soft tissues, ruptured discs, spinal stenosis, tumors or nerve injuries.
When treating back pain bed rest should be kept to a minimum. Instead, patients should continue their activities of daily living, as tolerated. Referral to a physical therapist to develop an individualized exercise program and receive low back education will be beneficial for patients with back pain.
While excessive exercise should be discontinued until the pain is relieved, there are exercises that can help reduce pain. Pain management exercises may include flexion exercises (bending forward) and extension exercises (bending backwards), stretching, and strengthening.
Five to ten-minute ice massages applied to a painful area within the first 48 hours of pain onset can help relieve pain. Heat may help to relax the muscles. Heat should also be used to treat back pains that last longer than 48 hours. Over-the-counter pain relievers such as aspirin, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDS) are frequently adequate to control episodes of back pain, and muscle relaxants may help those with limited motion secondary to muscle tightness.
Massage therapy has proven helpful for those with chronic muscular pain, and some patients with mechanical back pain of the cervical, thoracic and/or lumbar spine have been known to benefit from manipulation of the spine.
A small minority of low back pain patients, particularly those with leg pain due to a herniated intervertebral disc, spinal stenosis, or tumors affecting structures in the spine may require surgery.