Low back pain of muscular origin

Low back pain (LBP) is a common problem that has a lifetime incidence of 60% and a point prevalence of about 12-14%. It is the cause of disability in 4-6% of those who have back pain. Recurrence in the first 6 months is a problem. All ages and both sexes are susceptible to acute and chronic LBP. There is a major occupational component to LBP, in terms of exposure both to increased risk of injury and to physically strenuous activity. Muscular causes of back pain, or regional, low back myofascial pain syndromes, are important causes of pain and disability, but are often overlooked because they are not accompanied by structural abnormalities that can be seen on imaging studies of the back. The diagnosis must be considered, and the patient's muscles must be examined, in addition to the usual assessment of movement and of neurological function. Many reviews of LBP omit discussions of myofascial pain, for example. Treatment of myofascial LBP involves the nondirect use of cognitive-behavioral therapy that addresses fear of movement and the problems with lack of readiness to make a change, and (in occupational injuries) anger. Physical therapy is employed to restore movement and function, and to relieve pain. Pharmacologic treatment can provide analgesia that allows physical therapy to proceed. Trigger point dry needling or injection of a local anesthetic into trigger points can facilitate physical therapy. Attention must be paid to articular dysfunction that is either a comorbidity of the trigger point syndrome, or a consequence of it.