In most cases, back pain is self-limiting once red flags like Cauda Equina Syndrome are ruled out. There is enough evidence to suggest that all disc bulge cases are not complicated and most may not lead to complications. 

This may raise a question. Why do we need an assessment?

Physical examination and other referrals are required to confirm that there is nothing more than the usually suspected causes. There are conditions such as Pott’s Spine (Tuberculosis), Ankylosing Spondylitis, Haemangioma and Spondylolisthesis among others that need to be ruled out first. 

Once it is determined that origin of back pain is not from an extremely serious cause, it leads to a less treatment and more guidance-oriented approach. High pain intensity is commonly not a direct indicator of complexity. Pain perception and recovery pattern may have a dependence on other factors such as psycho social status and the support system around the patient. 

Fear of disability may lead to fear of movement that is Kinesiophobia. Restricting movement unless extremely essential is not the right thing to do. Gradual progression of exercise under guidance ensures that further worsening of the condition can be avoided or slowed down. 

This leads to another question. Do all cases require treatment? 

Treatment of any specific kind can only be determined as per case specific requirements. Advice regarding lifestyle changes, exercise prescription and follow ups with a physiotherapist, counselling in case of chronic pain and medication prescribed by a physician are not the same for every case. To understand which of the above is required and which is not, is the main reason why initial assessment is more important even though pain is self-limiting. 

Physical therapy treatment in most such cases should be directed towards best use of the available capacity of movement which doesn’t essentially require focus on modalities and techniques for instant pain relief. Multiple visits to a physiotherapist are usually not required in the acute phase and in chronic phase visits are directed only towards improvisation of rehabilitative exercise routines.