Vertebral dysfunction with non-radicular pain (non-specific LBP)

Question 1

Typical features

Answer 1

The common cause of LBP

Usu. due to dysfunction (injury) of the pain-sensitive facet joint ± a minor disc disruption

Pain usu. unilateral; can be central or bilateral

No investigations needed for acute pain <2 wks if no red flags

Question 2

Management—acute LBP (only) without spasm

Answer 2

• *No bed rest**—normal daily activities; keep active, return to work if possible
• *Back education:** explanation and reassurance; consider cognitive therapy
• *Regular simple analgesics** (e.g. paracetamol, ibuprofen); avoid opioids
• *Exercise program** (when exercises do not aggravate)
• *Swimming** (if feasible)
• *NSAIDs:** 14 d (only if evidence of inflammation)
• *Physical therapy:** Spinal stretching, mobilisation or manipulation if appropriate after review in 4–5 d

Most of pts can expect to be relatively pain free and able to return to work within 14 d

Question 3

Examples of exercises for LBP: (a) rotation exercise; (b) flexion exercise

Answer 3