Acute and Chronic Low Back Pain Treatment

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Active Solution Physiotherapy ​Montreal’s Active Solution Physiotherapy will develop a non-invasive treatment plan specific to your acute or chronic low back pain that empowers you to help eliminate pain from your life.


​Low back pain is very common affecting up to 84% of people (1). (1). An estimated 12 to 33% of adults currently experience low back pain (2). It is the most significant cause of activity limitation in those under 45 (3) (3)Despite the fact most patients stop consulting their doctor within three months (4,5)33% of patients still have at least moderate levels of pain one year after their episode and 20% report substantial activity limitations (6)If you are not satisfied with the improvement in your symptoms, consider consulting a healthcare professional.

Low back pain can be completely debilitating. Although 75 to 80% of the time you will be back to your regular activities within a month (6). Many guidelines (7,8) and scientific studies (9,10) show the importance of remaining as active as possible, because the faster you're able to return to regular activities, the less likely your pain will become chronic. When the pain isn’t improving as fast as you'd like or is debilitating, it's a good idea to consult a healthcare professional.

A single back pain episode lasting more than 12 weeks is considered chronic. Consulting a healthcare professional is important to make sure there isn’t a serious underlying condition causing your pain. Chronic low back pain has many causes. Mechanical, psychological, physiological and social factors all play a role. People with chronic low back pain often experience reduced range of motion (11)balance problems (12)posture issues (13) and reduced strength (14)These changes may be the result of your initial injury, but many are related to decreased physical activity as well. These changes can all affect your pain. Persistent pain has a physical effect on your nervous system by increasing its sensitivity. This can prolong pain (15) even after the original tissue injury has healed.

Pain is an experience that can cause fear, anxiety and stress. These emotions can affect your recovery from an injury (16) (16)therefore addressing emotions related to your back pain is important to your recovery.

Your attitudes, beliefs and behaviours are important factors in acute low back pain becoming chronic (17);examples include: expecting the worst, belief that pain is uncontrollable and harmful, a passive attitude towards rehabilitation and avoiding normal activities or social situations (16)Research shows that it is important to address these negative attitudes and beliefs within the treatment process (18,19) and those patients maintaining positive attitudes and beliefs function better (20)!

Low back pain can cause chronic problems due to recurrent episodes. The average rate of recurrence in the first year is estimated around 75% (21,22) Average time until it recurs is six months (23)Subsequent episodes tend to worsen over time (24,25)Frequent recurrences make identifying the causes of low back pain important, as addressing the causes may help avoid future episodes.


There are many different structures in the lower back that cause pain. Ligaments, muscles, facet joints, intervertebral discs, sacroiliac joints and nerves are potential culprits. Nerve compression can cause pain in the low back, down the leg and into the foot (sciatica). This can result in muscle weakness, reflex loss and changes in sensation including tingling & numbness. The low back, pelvis and hip can all cause pain in similar regions, so it's important to locate the actual source of pain.


If you have been referred to physiotherapy or if you decide that you want to treat your low back pain without medications, the physiotherapists at Active Solution Physiotherapy are here to help. Our qualified physiotherapists will do a thorough evaluation, which includes screening for serious medical pathology and identifying if further investigation is required. Our reliable assessment process allows us to determine the most effective individualized treatment to relieve your low back pain. Our goal is to understand your low back pain and determine specific exercises and positions that will enable you to gain control over your pain and help eliminate it from your life.

Our reliable evaluation process allows us to determine the most efficient way to treat your back pains. Our goal is to properly understand your lumbar pain and to determine which exercises and specific positions will help you best to regain control on your pain, and help you eliminate it from your day to day.

Most of our patients feel better after their first session and we're usually able to determine whether our approach is right for you within three sessions. The vast majority of our patients have less than six sessions.

In Montreal, the first healthcare provider many will see is a doctor who will ask you about symptoms, do a physical exam and order imaging if required. Diagnoses often include lumbar strain/sprain, degenerative disc disease, arthritis of the spine, bulging & herniated discs and pinched nerves. The doctor normally confirms there's no serious medical issue (fracture, infection, cancer, etc.). The doctor may suggest anti-inflammatories, muscle relaxants or pain-killers and inform you that your pain should go away within a few weeks. Therapy may also be suggested. If you've already seen a doctor or your condition has not improved as much as you would like, a therapist may be able to offer non-medication based treatments focused on improving pain and finding the root cause of the problem.

If pain has persisted beyond 6 to 12 weeks your doctor may consider other alternatives. They may order imaging or refer you to a physiatrist, orthopaedist or neurologist. These specialists will determine if you're a candidate for more aggressive medical treatment. This can include pain-killers, nerve pain medication and antidepressants for their effects on chronic pain. More invasive options include injections, nerve blocks, epidurals and sometimes surgery. Surgery may be an option for patients who've exhausted conservative options and have significant symptoms of nerve compression from the disc or from stenosis (a narrowing of the opening that nerves pass through in the vertebral column) (6). Surgery does not achieve considerably better long term results than conservative treatment, however there may be faster short term improvements (26,27,28).

The McKenzie Method/Mechanical Diagnosis and Therapy (MDT) is an active treatment approach supported by extensive scientific evidence. It has built in safety mechanisms and the goal of empowering you to take control of pain in as few visits as possible. The McKenzie Method/MDT focuses on classifying your low back problem to identify the most effective treatment, rather than theorizing about the exact structure responsible. Despite the focus on treatment, the McKenzie Method/MDT is useful to differentiate between problems with the intervertebral discs (34)facet (zygapophyseal) joints (35) and the sacroiliac joints (36). The advantages of the McKenzie Method/MDT assessment over other diagnostic testing include: it's significantly cheaper; it doesn’t require invasive techniques; and it can determine the most effective treatment. Before considering other options, you should consider our active treatment approach. It's proven effective in patients with acute and chronic low back pain (37,38,39,40,41)and even in surgical candidates (42,43). The McKenzie Method/MDT is also effective in preventing back problems (44).

Physiotherapy treatment of low back pain in the McKenzie method/MDT focuses on education and exercises with the addition of mobilizations as needed. We normally do not use treatments like ultrasound and electrical stimulation (TENS) because evidence of their beneficial effects is poor (45,46)and because of the strong evidence supporting education, exercises and mobilization (7,8)  Our goal is to empower our patients to take control of their pain.

The exercises given in the McKenzie method/MDT are based on the response they provoke, with the aim of decreasing pain and/or increasing movement. Exercises that have a clear and tangible effect on your symptoms are preferred because you're much more likely to do them when they have the immediate effect of reducing pain. By ensuring that you understand the many different positions and movements that irritate your condition and providing you with solutions to relieve your symptoms, rapid improvements are common and help put you back in control.

It has been shown that the McKenzie method/MDT can rapidly improve symptoms in approximately ¾ of patients with acute low back pain and approximately ½ of patients with chronic low back pain (47)We are usually able to determine if you are a rapid responder within the first three sessions. For those who do not respond as rapidly, we can also determine: whether a conditioning program is more likely to be of benefit, if stretching is going to be an essential element or if there is a postural component to your pain. These treatments can be just as effective as those used for the rapid responders, but the results are not as fast. In all cases, we'll provide advice on which activities are likely to be beneficial and which are likely to be detrimental. The key factor is your involvement in the treatment process. Our specialized approach provides you with the tools to reduce and even eliminate your acute and chronic low back pain.

You can see a therapist with or without a referral from a doctor (although some insurance plans require a doctor’s referral). Therapy options for low back pain treatment include acupuncture, osteopathy, massage, chiropractic or physiotherapy. Most of these therapies focus on passive techniques where the therapist performs the corrective treatment and you are not actively involved. Active therapy focuses on exercise, education and involves the patient in the treatment process. There's substantial evidence supporting the benefits of exercise and active therapy in treating low back pain (1,2,3). The vast majority of medical guidelines around the world support the use of an active approach, including exercise and education for low back pain (4).


Imaging such as Magnetic Resonance Imaging (MRI), Computed Tomography (CT), and even X-Rays are not recommended by the American College of Physicians/American Pain Society (7) and worldwide (10) unless you have the following characteristics:

1. there are signs or symptoms of serious medical pathology or of progressive nerve compression, or

2. if surgery or injections are being considered.

and for those over 60 it increases to 57% (32)Because there is such a high rate of abnormalities in the general population, it becomes very difficult to determine whether or not any abnormalities are actually relevant to your current low back pain. The use of advanced imaging is expensive, does not identify a precise cause and does not increase your odds of a successful outcome (7). It is through a complete clinical evaluation that the factors relevant to your problems become apparent.

The addition of imaging when only non-surgical interventions (medications and therapies) are being considered has proven to be detrimental (29,31,31) This is because of the high rate of abnormalities with imaging in those people that have never had low back pain or sciatic-type symptoms. 20% of people under the age of 60 without back pain have significant abnormalities (for example herniated discs and nerve compression) and for those over 60 it increases to 57%(32)

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