Sudden Onset
Acute low back pain is usually of sudden onset and is often triggered by a relatively minor movement such as bending to pick up an object. This minor incident may be more indicative of fatigue or lack of control, rather than tissue overload. The pain may develop over a period of hours due to the development of an inflammation. Patients with chronic low back pain may also have acute episodes that may become more frequent and require less initiation over time. The pain is usually in the lower lumbar area and may be central, bilateral or unilateral. It may radiate to the buttocks, hamstrings or lower leg. Sharp, lanciating pain in a narrow band down the leg is radicular pain and is associated with nerve root irritation, commonly as a result of intervertebral disk prolapse. More commonly, the pain the patient feels in the buttock and hamstring is referred from the lumbar spine – with the patient complaining of a deep seated ache.

Management of Severe/Acute Low Back Pain
Initially the patient should always adopt the position of most comfort. Movements that aggravate the pain should be avoided, while movements that reduce or have no effect on the pain should be encouraged. Bed rest in the position of most comfort may be continued for up to 48hours depending on the amount of pain. However, we encourage our patients to remain as mobile as possible as we have found this results in more rapid resolution of symptoms. Analgesics and anti-inflammatories should be taken to control that pain and reflex muscle spasm. Exercise in a direction away from the movement that aggravates your symptoms should be commenced as early as possible. Exercises should be immediately discontinued if symptoms into the legs or buttocks develop. Prolonged posture involving flexion (such as sitting) should be avoided.

Management of Acute Low Back Pain after 48 hours
Once the acute phase (up to 48hours) of sever low back pain has passed with reduction in pain and muscle spasm, more intensive therapy can be commenced. Those patients whose initial presentation is with mild to moderate low back pain do not require such a period of rest and treatment can commence immediately.

The initial injury will normally be joint related e.g. disk or apophyseal joint. However, in response to the injury, there may be associated muscle irritation and spam as well as nerve irritation. The longer the duration of the injury the greater the contribution to the pain from muscles and nerves.

Patients' with mild low back pain complain of an aching pain that may be constant or intermittent. The pain is often described as a 'band across the lower back'. The pain is usually aggravated by certain movements and there is often referred pain to the buttock and/or hamstring.

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