Helping patients relieve low back pain

Journal of Family Practice, August, 2004

When examining patients who complain of low back pain, have them do a straight leg-raising test (SLR) while sitting. Engage them in conversation or appear to be examining the knee. Doing the SLR in this manner helps differentiate between malingers and persons truly suffering from radiculopathy

Teach patients with back pain to "get set" before lifting (just short of a valsalva--tighten abdominals and gluteals). They should always lift with the powerful leg muscles instead of using the back as a crowbar.

Have the patient indicate the location of the pain at each visit on a drawing. Compare successive drawings to see if the location changes or stays the same.

The lumbar curve is the culprit and the abdominal muscles are the potential saviors. Strengthen the abdominals. Have patients use leg lifts (not high), shoulder lifts (not sit-ups), and knee-to-chest grabs.

Adapted with permission from Ricer R (ed). Wisdom of the Ageds, 2002.

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