Mechanical Back Pain

Recurrent relapsing and remitting back pain with no neurological symptoms

Aetiology

  • Presents 20-55
  • Obesity
  • Poor posture
  • Poor lifting technique
  • Lack of physical activity
  • Depression
  • Facet joint OA
  • Degenerative disc prolapse
  • Spondylosis - where the IV discs lose water content with age, resulting in less cushioning and increased pressure on the facet joint which can lead to secondary OA

Clinical presentation

  • Pain in lumbosacral region, buttocks and thighs
    • Leg pain will be referred in nature (dull, knawing, ill-defined) and rarely below the knee
  • Mechanical pain - varies with time and activity
  • Patient well with no 'red flag' symptoms
  • Patient tends to have had several previous 'flare ups'

Management

  • Advice:
    • Try walk 30 mins a day
      • If not possible - comfortable period of time, repeated to try and build up to 30 mins
    • Try to stay at work
    • Restrict rather than avoid activity
    • Weight control if overweight
  • Analgesia - NSAIDs first line, add weak opiates if needed
  • Physiotherapy
  • Prognosis good - 90% better in 6 weeks
  • Spinal stabilization surgery is controversial