Low Back Pain in the Adult Population
“Lower back pain is a major burden to society” that “many people will experience during their life” (Tulder, Koes & Bombardier, 2002, p.761). In Australia, “Eighty-percent of Australians experience lower back pain [with] ten-percent [resulting in] disability” (Briggs & Buchbinder, 2009, p.499). With such a high prevalence of low back pain in adults, it is recognized as one of Australia’s “major health and socioeconomic problems” (Tulder, Koes, & Bombardier, 2002, p.761). This major problem has caught the attention of the National Health Priority Area (NHPA) and they have set up guidelines for Australians on how to manage low back pain. Although “ninety-five percent of cases [doctors are unable to] pinpoint the cause of the pain,” it is “not necessary to know the [origin] in order to deal with the pain effectively” (NHMRC, 2003, p.1).
Lower back pain (LBP) can be defined as “pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without leg pain.” (Tulder, Koes & Bombardier, 2002, p.762). Affecting more men than women, “prevalence rates increase in middle [aged adults];” becoming the “second [highest] cause of activity limitation in [the] adult [population]” (Loney & Stratford, 1999, p.385, 393). Low back pain is classified as acute, chronic, specific or non-specific, depending on the length of time it has persisted and the origin of the pain. Acute low back pain (ABP) is defined as an “acute muscular ligament strain and pain between the iliac crest and lower lumber spine that is not attributed to a medical condition,” (Xu, Bach, Orhede, 1996, p.132) and persists “less than six weeks” (Tulder, Koes & Bombardier, 2002, p.763). Although little is known about the risk factors for the transition from acute to chronic LBP, it consistently originates as acute back pain and transitions into chronic if the pain lasts longer than 3 months. While there is a higher percentage of men afflicted with LBP, more women, “twenty three percent [compared to] eighteen” experience chronic low back pain (Tulder, Koes & Bombardier, 2002, p.764). All together LBP is most often recognized by physicians as being either specific or non- specific. Specific low back pack is caused by “specific patho-physiological mechanisms,” but the majority, “ninety-percent,” of LBP patients experience non-specific LBP; meaning that the cause of the symptoms are unknown (Tulder, Koes & Bombardier, 2002, p.762).
While lower back pain causes the majority of the Australian adult population physical agony, it causes the Australian government significant financial pain. “Low back pain is associated with high indirect and direct costs [of] heath care utilization, work absenteeism, and disablement” (Tulder, Koes & Bombardier, 2002, p.769). The annual direct cost that LBP levies Australia is 1.02 billion. “Seventy-one percent of [that] amount [goes towards] treatment by chiropractors, general practitioners, massages therapists, physiotherapists, and acupuncturists.” (Walker, Muller & Grant, 2003, p.79). However, the direct costs are minor compared to indirect costs. The majority of the total cost of low back pain consists of indirect costs, totalling “8.15 billion”; with an overall cost of” 9.17 billion” (Walker, Muller & Grant, 2003, p.79). “Ninety-percent of the indirect costs are due to work absenteeism and disablement,” with employers financing “three to four months of sick leave” (Tulder, Koes & Bombardier, 2002, p.769). This massive amount of money being expended on a preventable health condition represents a “huge health problem with a significant economic burden” that needs to be addressed promptly and properly, to reduce the enormous suffering and related high costs (Walker, Muller & Grant, 2003, p.79).
Predominantly the indirect costs of LBP are work related; therefore the individuals’…