• X-Ray; can show vertebral spaces, degeneration or fracture
• MRI; reveals disc bulge, muscle tear, lesion, etc.
• CT Scan
• Blood test; for finding of any specific marker like HLA B27 in AS or any bacterial infection in Tb
• NCV test for neurological purposes
• Physical Examinations

• Conservative management – Absolute bed rest except in AS, Traction, Use of lumbar belts
• Medical treatment – Epidural steroids, NSAIDs, muscle relaxant, etc.
• Surgical treatment – It is done for severe cases only. However, in case of neurological deficits it becomes an emergency option. Surgeries like;
• Micro discectomy, Laminectomy, Foraminectomy, Lumbar spinal fusion, are done according to their indications.
• Physiotherapy Treatment

• Bed rest – Acute LBP can be treated with some positions of bed rest foe short period of time as in discal pain it get increases with sitting and standing. Supine lying with pillows under your knees, side lying with knees and hip flexed are some suggestive positions.
• Cryotherapy – Cold pack are best advised in acute LBP for initial 2 days as they decrease your spasm and inflammation better than heat.
• Thermotherapy – It also reduces pain, inflammation and muscular spasm by increasing your circulation but in later stages or in chronic conditions. Moist heat packs or whirlpool can be used for about 20 minutes to relieve back pain.
• Electrotherapy modalities – US, TENS, IFT, Infrared rays or Ultraviolet rays can also be used for deep heat or penetrations to your muscles or nerve ending to reduce your pain in both acute and chronic conditions. LASER treatment is also kept reserved for later stages of pain.
• Traction – Manual and mechanical Traction for various conditions prove to be very effective treatment used for stretching spinal muscles and thus decreasing pressure, distracting the vertebral bodies and for straightning the spinal curve. It is used in conditions like; Disc protrusion, Spondylolisthesis, Scoliosis, Lumbar Spondylosis, etc.
• Lumbar belt or braces – It is also advised to patients for additional support, to recover the mobility of spine, to maintain the curvature of spine as in scoliosis, or to maintain the faulty posture and relieve pain.
• Spinal manipulations – It can be done once in a while to correct the malalligned vertebral segments and can be done by various techniques. It is completely contraindicated in severe osteoporosis, malignancy or fractures.
• IASTM or STM – Soft tissue manipulation is also done either manually or instrument assisted to relax the spasm muscle or to increase blood circulation in the desired area.
• Proper postural habits or back ergonomics for work environment and proper use of chair is also taught.

There are different type of exercises like flexion, extension or rotation exercises and every exercise is not advised in all conditions so they are done and advised very precautiously. Each exercise is done with 5 repetition once or twice daily.

1. Flexion Exercises – Done in cases like anterolisthesis, increased lumbar lordosis, AS, or if the patient feels pain while standing, walking or backward bending. Some of the flexion exercises are:-

• Partial sit ups in lying position with legs straight
• Partial sit ups in lying position with both knees bent
• Partial curl ups
• One knee to chest stretch
• Both knee to chest stretch
• Toe touch in long sitting position
• Back press in lying position
• Cat n cow stretch
• Lion stretch
• Bilateral Straight leg raise
• Single straight leg raise

2.  Extension Exercises – These exercises are prescribed in cases like PIVD, Retrolisthesis, to maintain or decrease lumbar lordosis, to maintain mobility of spine, AS, to decrease pressure on Sciatic nerve. Some of the extension exercises are:-

• Prone on hands or prone on elbows
• Straight leg raise in prone lying
• Hand and leg raise in prone lying
• Superman pose in quadripod position
• Pelvic bridging
• Plank or knee plank
• Side plank
• Swiss ball exercises

All these exercises are progressed according to the patient.

3. Rotation exercises – These exercises help in relieving the overall side muscles and stretch or strengthen the oblique muscles of your abdominals, like;

• Partial diagonal curl ups
• Trunk rotations with both the knees bent
• Side crawling in lion’s pose
• Mobility Exercises – It also induces relaxation on overall spinal muscles and increase the mobility of your spine, like;
• Pelvic rotations in lying and sitting
• Chest roll on either side
• Dead bugs, they can be done in various forms

4. Stretching exercises – To relieve the contracted or spastic muscles;

• Gluteal stretch
• Piriformis stretch
• Hamstring Stretch
• Quadriceps Stretch
• QL stretch
• Paraspinal muscle stretch
• Iliopsoas stretch
• IT Band stretch