A-specific low back pain (LBP) occurs in 90% of low back patients (KNGF, 2003). Physiotherapists, along with other healthcare practitioners, play a significant role in the management of LBP. Their attitudes and beliefs influence their decisions for the patient in terms of prescribed time off work or taking their patients seriously (Derghazarian et Simmonds, 2011). Patients with low back pain may be separated into two groups, a-specific and specific. Specific LBP are back complaints caused by a specific pathophysiological mechanism involving the structures of the spine (KNGF, 2003). In a-specific LBP, no apparent cause can be found, with patients experiencing tension, soreness and stiffness (NHS 2009). Therefore, diagnostic procedures should focus on the patient’s participation and level of disability (KNGF, 2003). A-specific LBP is associated with high costs in the western world, due to healthcare costs and disability related work losses (Heneweer et al. 2007). Many guidelines and articles focus on prevention during the acute and subacute stages to prevent chronicity, and thereby being more cost-effective and easier to perform (Heneweer et al. 2007). Malingering, or somatization of symptoms may occur in patients with psychosocial constructs and may affect functional status (FS) outcomes (Hart et al. 2011).
Only in about one third of LBP cases is linking a specific event to the onset of pain (ICSI 2012). The KNGF guideline (2003) also concentrates on a bio-psychosocial model consisting of the following:
- Biomedical factors, e.g. reduced mobility, reduced muscular strength/stability or a reduced coordination;
-
Psychological factors, e.g. fear to move or imaginary ideas about low back pain,
-
Social factors, e.g. working conditions or the lack of support and/or acceptance of the environment, compensation, time off work
These factors are considered ‘yellow flags’ which may alter the natural course of the LBP, causing chronicity (KNGF, 2003). The most important symptoms of non-specific low back pain are pain and disability (Koes et al. 2006).
A-specific low back pain can be classified into durations (KNGF, 2003):
-
0-6 weeks: Acute low back pain
-
7-12 weeks: Sub acute low back pain
-
>12 weeks: Chronic low back pain
Lumbar Spine Assessment 