A Comprehensive Guide To Managing Back Pain

Back pain is defined as pain below the costal margins, especially in the lumbosacral region, associated with restricted movement and influenced by changes in posture and strain. Back pain is diagnosed in the absence of other underlying problems like fractures, metabolic diseases, trauma to the back, infections, tumors, vascular diseases, and spondylitis. [1]

Back pain with or without radiation to the legs (radiculopathy) is one of the leading health issues that causes disability in people younger than 45 years in the United States. 23% of the adult population suffers from back pain with a recurrence rate of 24-80% per year. The lifetime prevalence of back pain is 84% in the adult population worldwide. [2] Back pain is the most common reason behind medical leaves and lost work hours.

Acute Back Pain Definition:

It is one of the most common presenting illnesses in medical set-ups with an incidence rate of at least one presentation per week. Acute back pain refers to any pain below the costal margins and above the gluteal folds without any underlying pathology. Acute pain usually has mechanical causes. It occurs off and on and resolves on its own. A complete screening of acute back is crucial in the presence of “Red Flags.” Red flags are warning signs of an underlying pathology. Without red flags, acute back pain can be managed conservatively.

Chronic Back Pain:

Chronic back pain is lower back pain without any specific pathology that lasts more than 3 months. Symptoms of chronic back pain are different from acute back pain. It can not be considered acute back pain with extended duration. It disturbs the psychological, physiological, and social health of a patient. Yellow flags for back pain diagnose chronic pain.

Red Flags For Back Pain:

Red flags for back pain are a set of symptoms that indicate serious spinal pathology. [3]The following are the indicators for a complete workup to rule out serious illnesses:

  • History of fever and unexplained weight loss
  • Thoracic or chest pain
  • Bladder or bowel dysfunction (urinary retention, Urinary or fecal incontinence)
  • Patient age less than 20 years or more than 55 years
  • Any neurological deficits
  • Disturbed motor functions in different myotomes
  • History of cancer
  • Saddle anesthesia
  • History of comorbidities
  • Disturbed gait
  • Focal tenderness on palpation
  • History of spinal procedure
  • IV drug abuse
  • Long-term corticosteroid intake
  • Patient taking immunosuppressants
  • Osteoporosis

Yellow Flags For Back Pain:

  • Fear-avoidance behavior
  • Depression
  • Social withdrawal
  • Limited movement due to fear of a serious and disabling illness
  • Social problems
  • Low morale
  • Preference to passive rather than active management of back pain
  • Psychological assessment and treatment are also needed, if your patient has yellow flags.

Causes and Risk Factors:

The etiology of back pain is a broad topic. Hence, its etiology is subdivided into 5 categories: [4]

1- Mechanical

Mechanical causes of back pain include injury to the spine, soft tissues or muscles of the spine, and intervertebral discs. Disc herniation is the most common type of back pain due to trauma to the spine. Fractures like spondylolisthesis can cause acute and chronic back pain. Strain in the quadratus lumborum muscles can cause lumbago or acute back pain. Spasm in paraspinal muscles also causes back pain. Pregnancy is also associated with back pain.


Back pain may be a part of the inflammatory process. Ankylosing spondylitis and sacroiliitis cause back pain. Other causes are reactive arthritis, psoriatic arthritis, juvenile idiopathic arthritis, and enteropathic arthropathy.


Patients with oncologic etiology usually present with pathological fractures. Oncologic causes are lytic lesions in the spine, nerve compression due to space-occupying lesions, and malignant cancers of bone marrow.


Osteoarthritis is the most common cause of degenerative changes in the spine. It includes sacroiliac joint osteoarthritis, facet joint osteoarthritis, degenerative disc disease, and spinal stenosis. Osteoporotic fractures are also a part of degenerative processes causing back pain.


Infections in the spine, spinal muscles, paraspinal muscles, intervertebral disc, abscess formation in soft tissues, and epidural abscess may cause back pain.

Evaluation of Back Pain:

  • Ask about the nature of pain, onset, severity, duration, radiation, aggravating, and relieving factors.
  • Determine past treatment and medical and surgical history.
  • Investigation about the red and yellow flags to rule out the possibility of serious illness.
  • Ask about functional limitations.
  • Inspect for structural abnormalities, hairy patches, cafe au lait spots, scars, abrasion, and any change in skin color.
  • Palpate the lower back to check tenderness.
  • Palpate spinous process, sacroiliac joint, and L5.
  • Check range of motion, pain on movement, pain on bending, flexion, or leaning forward.
  • Perform Schober’s test and straight leg raise test.
  • Complete a thorough neurological examination in all dermatomes.

Laboratory Investigations:

If the patient has mechanical back pain without any serious pathology, no laboratory Investigations are required. If inflammation, infections, or connective tissue disorders are suspected, CBC and ESR are appropriate. If ESR indicates an infection or systemic problem, further investigations like RA factor are helpful.

Imaging Modalities:

No imaging is required in the absence of red flags.

1- X-ray

In 50 years < old patients with
chronic lower back pain, X-ray (AP and lateral lumbosacral) is an investigation of choice.


Magnetic resonance imaging is preferred when back pain radiates to the legs. MRI is required to diagnose radiculopathy (over 4 months), cauda equina, and malignancy.

3-CT Scan

A CT scan is an investigation of choice in multi-segmental bony stenosis.

4-Bone scan

It is a valuable test used to investigate spondyloarthropathy, osteomyelitis, and neoplastic activity. It is the most sensitive test for bone tumors and infections. It can be a false positive and a false negative.


It is the most common imaging modality used to investigate the other causes of back pain such as pain due to kidney stones, pain due to fibroids, and pain due to Pelvic abnormality.

Differential Diagnosis For Back Pain:

There are multiple causes of lower back pain. Whenever patients come with lower back pain, they should not be treated straight away for back pain. Doctors make multiple differentials to rule out the main cause of the disease. The differential diagnosis for lower back pain is categorized according to the system:
Spine-related disorders:

Spine-related disorders are the most common
cause of lower back pain. These disorders are :

  • Mechanical lower back pain
  • Disc herniation
  • Disc prolapse
  • Fracture of the vertebra
  • Disc sequestration
  • Fracture of the vertebra
  • Spinal stenosis
  • Ankylosing spondylitis
  • Spondylolisthesis
  • Spondylolysis
  • Nerve root compression
  • Radiculopathy
  • Plexopathy
  • Claudia equina syndrome
  • Facet joint pain
  • Fibromyalgia
  • Sacroiliac joint dysfunction

Systemic causes:

Systemic disorders can also cause lower back pain. These disorders are characterized by the following diseases:

  • Inflammatory spondyloarthropathy
  • Malignancy
  • Osteoporosis
  • Connective tissue disorder
  • Spinal osteoarthritis
  • Rheumatoid arthritis
  • Spinal osteomyelitis
  • Epidural abscess

Referred pain:

Referred pain is a type of pain that is perceived away from the stimulus. Referred lower back pain can occur due to the following:

Abdominal aortic dissection

  • Abdominal aortic aneurysm
  • Peptic ulcer disease (PUD)
  • Cholecystitis
  • Pancreatitis
  • Pancreatic cyst (pseudocyst)
  • Nephrolithiasis (kidney stones)
  • Pyelonephritis
  • Pelvic inflammatory diseases
  • Fibroids
  • Endometriosis
  • Prostatitis

Prevention of Lower Back Pain:

Low back pain is the most common disease affecting many people around the globe. You can advise your patients to avoid low back pain by adopting the following preventive measures:

  • Weight reduction
  • Eat a healthy diet
  • Avoid strenuous exercises that make you feel sick
  • Wear belts if you feel persistent pain
  • Regular exercises (stretching and strengthening exercises)
  • Avoid heavy weight lifting
  • Avoid claiming upstairs
  • Maintain your sitting and standing posture
  • Use ortho mattress
  • Use heat packs cold packs
  • Avoid smoking
  • Avoid drinking alcohol
  • Good sleep pattern
  • Avoid high heels

Management Of Back Pain with ANF Therapy®️:

ANF Therapy®️ is a groundbreaking approach to treating back pain. Instead of treating symptoms only, it focuses on exploring the root cause. This therapy uses different ANF Devices that emit specific neurological frequencies. These signals help normalize weakened or damaged neurological frequencies.

The Principles of ANF Therapy®️

ANF Therapy®️ operates on the principles of neuro-frequency modulation. It aims to identify and correct imbalances within the body’s nervous system. By placing ANF Devices on specific points of the body, the therapy stimulates neuroreceptors, promoting optimal communication between the nervous system and other body systems.

How an ANF Certified Neuro Orthopedic Practitioner Will Approach BACK PAIN:

An ANF Neuro Orthopedic Consultation involves a health questionnaire, a specific interview according to the LBP complaint, ANF Assessment, including palpation and neurological examination, ANF Therapy®️ Devices application, outcome, and a tailormade ANF Protocol.

Personalized History Taking:

The ANF Neuro Orthopedic Practitioner will get information about the current complaint and collect information about past medical and surgical history and family history.

Additional questions will be asked such as ones regarding stress, digestive issues, what triggers, what makes it better, when did it start, pelvic floor issues, if female (birth, number of kids, menstruation), pattern of the LBP pain, intensity, frequency, nature of the pain.


During inspection, the ANF Therapist will first look at the body for compensations, body position, and muscular tone difference, then ask to do some movement that could recreate, intensify, decrease, or alleviate the pain. He may perform some physical tests too.


The Neuro Orthopaedic Practitioner will examine the body, searching for the root cause of the injury, the inflammation, or the pain through a detailed palpation examination.

In other words, spot the weaknesses in the tissue during a thorough examination, which may be uncomfortable due to inflammation. He/she may palpate the gluteal nerves, sacroiliac joint, adductor muscle, hamstring muscles, pelvic floor, psoas muscle, quadratus lumborum muscles, gut, nervous and lymphatic system (invisible inflammation), kidneys, ovaries, neurological stress, lumbar spine, gluteal muscles to name a few.

The examination may include the nervous, cardiovascular, lymphatic, and musculoskeletal systems. The Neuro Orthopaedic Practitioner can also perform different health tests to verify the functionality of the different systems.

A personalized ANF Protocol will be designed to target the root cause using devices from different categories: P&I, antioxidants, MC, and probably energy devices.

Expected outcome:

ANF Therapy®️ aims to normalize the weakened frequencies in the impaired tissues and systems, reduce inflammation and oxidative stress, and promote self-healing.

Most patients respond within 10 to 60 minutes to the ANF Therapy®️ treatment after applying the ANF Devices. The possible orthopedic outcome following the ANF Therapy®️ treatment could be a reduction of pain by 50% within 20 minutes, improvement of the movement in range or fluidity, better quality of the tissue such as less edema, more resistance in the muscle tissue or ligaments, reduction of inflammation in the musculoskeletal tissue, increased quality of life or improved strength.

A low percentage of the patients may experience some detox symptoms. Less discomfort, less pain, and greater well-being are experienced as the patient progresses with the ANF Therapy®️ Treatment. The treatment can take a few days to several months; the number of ANF Devices applied can also vary.

A Certified Neuro Bio Holistic Practitioner can also take care of back pain when the root cause is due to a more holistic issue or a disease.

ANF Therapy®️ Benefits for Back Pain:

  • Pain Relief: ANF Therapy®️ provides effective pain relief by addressing the root causes of back pain rather than just masking the symptoms. It helps reduce inflammation, promotes tissue regeneration, and improves circulation, leading to long-term pain relief.
  • Enhanced Healing: ANF Therapy®️ stimulates the body’s natural healing mechanisms, accelerating the recovery process. It strengthens the neurological frequencies of the body and enhances the body’s ability to repair damaged tissues.
  • Improved Functionality: By restoring the balance of the nervous system, ANF Therapy®️ improves muscle coordination, flexibility, and overall mobility. This enables individuals to regain their functionality.
  • Non-Invasive Approach: Unlike surgical, ANF patients regain functionality and engage in their daily activities without discomfort. ANF Therapy®️ is a non-invasive treatment option that does not involve any incisions or the use of medications, reducing the risks associated with invasive treatments.

Join ANF Therapy®️ As a Healthcare Professional:

As a healthcare professional, you can step into the realm of limitless possibilities and unlock a new era of pain management.

Imagine having the power to transform the lives of your patients with a single therapy. ANF Therapy®️ is your ticket to becoming a true champion in pain management. It’s time to break free from the shackles of conventional methods and embrace a cutting-edge approach that will leave your patients in awe.

Join ANF Therapy®️ and become the unstoppable force that transforms lives, redefines pain management, and leaves an indelible mark on the world of healthcare.

Visit www.anfacademy.com to learn more about ANF Therapy®️ and ANF Academy education.


CORDIS | European Commission. Europa.eu. Published 2023. Accessed April 29, 2023. https://cordis.europa.eu/project/id/B13

Casiano VE, Gurpreet Sarwan, Dydyk AM, Varacallo M. Back Pain. Nih.gov. Published February 20, 2023. Accessed April 29, 2023. https://www.ncbi.nlm.nih.gov/books/NBK538173/#:~:text=Some%20studies%20have%20shown%20that,the%20adult%20population%20%5B12%5D.

3-Samanta J, Kendall J, Samanta A. 10-minute consultation: chronic low back pain. BMJ. 2003 Mar 8;326(7388):535. doi: 10.1136/bmj.326.7388.535. PMID: 12623915; PMCID: PMC150466.

4-Patrick N, Emanski E, Knaub MA. Acute and chronic low back pain. Med Clin North Am. 2014 Jul;98(4):777-89, xii. doi: 10.1016/j.mcna.2014.03.005. PMID: 24994051.

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