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 features

• Pain in lumbosacral region, buttocks and thighs
  • Leg pain will be referred in nature (dull, gnawing, 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