low back p ain
DESCRIPTION
Low Back P ain. Back Pain. Back pain is second to the common cold as a cause of lost days at work . About 8 0% of people have at least one episode of low back pain during their lifetime . The most common age groups are the 30s - 50s. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/1.jpg)
Low Back Pain
![Page 2: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/2.jpg)
Back Pain
Back pain is second to the common cold as a cause of lost days at work .
About 80% of people have at least one episode of low back pain during their lifetime.
The most common age groups are the 30s - 50s.
It usually feels like an ache, tension or stiffness in your back.
![Page 3: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/3.jpg)
3 Broad Categories:
1 .Nonspecific low back pain ,
2 .Radiculopathy or spinal stenosis ,&
3 .Back pain potentially associated with another specific spinal cause
![Page 4: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/4.jpg)
Size in General PracticeCompression Fracture 4%
Spondylolisthesis 3%
Tumours 0.7%
Ankylosing Spondylitis 0.3%
Infections 0.01%
Non-specific LBP 90%
![Page 5: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/5.jpg)
Non-specific low back pain
•Is tension, soreness and/or stiffness in the lower back region for which it is not possible to identify a specific cause of the pain .
•Several structures in the back, including the joints, discs and connective tissues, may contribute to symptoms.
![Page 6: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/6.jpg)
Mechanical problems
A mechanical problem is a problem with the way your spine moves or the way you feel when you move your spine in certain ways.
The most common mechanical cause of back pain is a condition called intervertebral disk degeneration.
Muscle tension: happens when the muscle is over-stretched or torn, resulting in damage to the muscle fibers (also called a pulled muscle).
![Page 7: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/7.jpg)
•The lower back is commonly defined as the area between the bottom of the rib cage and the buttock creases .
•Some people with non-specific low back pain may also feel pain in their upperlegs, but the low back pain usually predominates.
![Page 8: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/8.jpg)
• spondylolisthesis (displacement):
is a condition in which one vertebra slip forward over the one below it.
Mechanical problems (4)
![Page 9: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/9.jpg)
Specific causes of low back pain
Degeneration
Of discs, joints
Inflammation Ankylosing spondylitis , rheumatoid arthritis
Infection Osteomylitis, abscess, tuberculosis
Neoplastic Myeloma, lymphoma, cancer
Metabolic Osteoporosis, osteomalacia, Paget’s disease
Others Sickle-cell disease, claudication
![Page 10: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/10.jpg)
Symptoms
80% to 90% of attacks of low back pain resolve in about 6 weeks.
Back pain can range from a dull, constant ache to a sudden, sharp pain.
Duration of pain:1. acute (less than 4 weeks).2. subacute (4 – 12 weeks).3. chronic (greater than 12 weeks).
![Page 11: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/11.jpg)
Red flags1. Onset age either <20 or >55 years.2. Bowel or bladder dysfunction.3. Spinal deformity.4. Wight loss.5. Lymphadenopathy.6. Neurological symptoms.7. History of HIV, corticosteroid therapy.8. Unexplained fever.9. Duration more than 6 weeks.
![Page 12: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/12.jpg)
Sciatica
If a bulging or herniated disk presses on the main nerve ( sciatic ) that travels down your leg, it can cause sciatica sharp, shooting pain through the buttock and back of the leg.
there may be numbness, muscular weakness, pins and needles or tingling and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.
![Page 13: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/13.jpg)
![Page 14: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/14.jpg)
Cauda equina syndrome
Rare but serious condition
It can cause weakness in the legs,
numbness in the "saddle" or groin area, and loss of bowel or bladder control.
![Page 15: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/15.jpg)
Diagnosis of back pain
(1)
History
![Page 16: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/16.jpg)
History Elements:
During taking history, you must cover the following:
1. the course of pain.2. Is there evidence of a systemic disease.3. Is there evidence of neurologic probloms.4. Occupational history.5. Risk factors.6. Red flags.7. Yellow flags.
![Page 17: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/17.jpg)
History Elements
Circumstances associated with pain onset.
Factors altering pain (stiffness at rest or at night, decrease with movement)
Is pain present continuously or otherwise?
Effect of pain on activities.
Effect of pain on sleep.
![Page 18: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/18.jpg)
Yellow Flags
1. If patient believe that the back pain is serious.
2. Fear avoidance behavior(apprehension about reactivation).
3. Work related factor.4. Prior episodes of back pain.5. Extreme symptoms.
![Page 19: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/19.jpg)
Mechanical back painDeep dull pain
Moderate in nature.
Relieved by rest , and increase by activity.
Diffuse and unilateral.
Intensity increase at the end of the day and after activity.
![Page 20: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/20.jpg)
Inflammatory back painGradually in onset.
Throbbing in nature.
Morning stiffness.
Exacerbates by rest and relived by activity.
Intensity increase in night and early morning.
It is chronic backache.
![Page 21: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/21.jpg)
Nerve root compression
Intense sharp or stabbing pain.
Numbness and paraesthesia in same distribution
Radiation to dermatome like : foot or toe.
![Page 22: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/22.jpg)
Diagnosis of back pain
Examination
![Page 23: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/23.jpg)
Video
![Page 24: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/24.jpg)
General :◦Permission ◦Explain◦Privacy
Vital signs
Patient should be standing with the whole trunk exposed.
![Page 25: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/25.jpg)
Examination Steps
look
feel
movement
Neurological
test
![Page 26: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/26.jpg)
Straight leg raising (SLR)raise the patient's extended leg with
the ankle dorsiflexed.Normally 80 – 90 degrees no painIt will be limited by sciatica pain in
lumbar disc prolapse. ( <70 ) ( exactly from 30 to 70 )
![Page 27: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/27.jpg)
Neurologic testing We should focus on the L5 and S1 nerve roots 98% of disc herniation occur at L4-5 and L5-S1Then we test the Reflexes:L4 – The knee reflex.S1 – The ankle reflex.
ReflexesMotor sensory
![Page 28: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/28.jpg)
Reflexes
Knee (L3-4)
Ankle (S1-2)
![Page 29: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/29.jpg)
Motor
Ankle plantar flexion
Ankle dorsiflexion
![Page 30: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/30.jpg)
Motor
Walking on toes
Walking on heelsS1 L5
![Page 31: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/31.jpg)
SensorySciatic nerve (L4,5,S1,2)
•Sensory distribution of the sciatic nerve
![Page 32: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/32.jpg)
Role of Primary Health Care in Management
![Page 33: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/33.jpg)
Goals for treatment :
Educate patient about the natural history of back pain.
Ask about and address the patient’s concerns and goals.
Reduce pain. Maximize functional status and increase quality of
life. Exercises: to help them return to normal activities
and work. These exercises usually involve stretching maneuvers.
The management is according to the cause
![Page 34: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/34.jpg)
Pharmacological Pharmacological
Oral drugs Local injection Non-drug
NSAID“Ibuprofen”Analgesics
Antidepresent
Muscle relaxant
Epidural Steroid
Trigger point and ligaments
Heat therapyPhysiotherap
yAcupuncture
![Page 35: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/35.jpg)
When should patients be referred to a specialist?
![Page 36: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/36.jpg)
Cauda equina syndrome. (Immediate referral)
Severe or progressive neurologic deficits.
Infections.
Tumors.
Fractures compressing the spinal cord.
No response to conservative therapy.
![Page 37: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/37.jpg)
Prevention of
Back Pain
![Page 38: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/38.jpg)
Recommendations for the General Population:
Explain non specific causes of low back pain.
Encourage active life style and to make exercise such as, walking, jogging, swimming… etc.
Occupational health must be emphasized on to prevent lots of diseases and one of them is back pain.
![Page 39: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/39.jpg)
Tips and advice on how to protect
your back:
In sitting: support your back against a hard
chair. Make sure your hips level is higher than
your knees.
In standing: Never lean forward without
bending your knees.
Sleeping: Don’t sleep on your stomach.
Lifting: Avoid sudden movements. Bend both
knees with leg muscles to lift them up. Keep
the load closer to your body and try not to lift
anything higher than your waist.
![Page 40: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/40.jpg)
POST TEST
![Page 41: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/41.jpg)
Which of the following is not a risk factor for back pain:
A. Obesity.B. Heavy physical work.C. Ethnicity.D. Stress and distress.
![Page 42: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/42.jpg)
A patient came with lower back pain with morning stiffness exacerbates by rest and relived by activity :
A. Mechanical back painB. Inflammatory back painC. Tumor D. Nerve root compression
![Page 43: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/43.jpg)
All of the following is a red flag signs of back pain except :
A. Onset age either <20 or >55 years.B. Duration less than 6 weeks. C. Bowel or bladder dysfunction.D. Spinal deformity.
![Page 44: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/44.jpg)
30 year old women had low backache 3 days ago, while taking further history, she said that they were moving to a new house and she was lifting heavy objects, the most probable diagnosis is:
A. Spinal stenosis.B. Prolapsed disc.C. Rheumatoid arthritis.D. Fracture.
![Page 45: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/45.jpg)
Most common site for disk prolapsed is:
A. L4 and L5B. S1 and S2C. C4D. L1 and L2
![Page 46: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/46.jpg)
Which One of the following cancers, the spine is not a common site for metastasis:
A. Prostate cancerB. Breast cancerC. Liver cancerD. Lung cancer
![Page 47: Low Back P ain](https://reader036.vdocuments.mx/reader036/viewer/2022062408/568135f2550346895d9d6253/html5/thumbnails/47.jpg)
Thank you