The Journal of Musculoskeletal Medicine
May 1993 Volume 10 Number 5
Brian W. Nelson, MD

Study Outcomes & Clinical Relevance: At the initial visit of a patient with low back pain, the physician must set a positive tone, emphasizing that the problem is common in the human body and can be remedied. Initial treatment is 1-2 days of rest, a short course of analgesics, and stretches and other exercises. The 5% to 10% who do not improve within 3 months (chronic pain patients) or have a relapse frequently require an active functional rehabilitation program. Exercises are helpful only if they focus on the lumbar extensors. Patients may need encouragement at the beginning of the program to tolerate discomfort. Expensive imaging studies are reserved for patients who become disabled or show no improvement. Only when a lesion is identified in a patient who has seriously tried and failed conservative rehabilitation is surgery recommended.