low back pain
DESCRIPTION
Low Back Pain. Second cause of pain in body Leading cause of sick leave Is a symptom not disease 50-80% of adult will have LBP during their life M=F but after 60 yrs F>M Only 1% of acute LBP is due to lumbar radiculopathy Lumbar radiculopathy often occur during 4 th &5 th decades. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/1.jpg)
![Page 2: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/2.jpg)
Low Back Pain• Second cause of pain in body• Leading cause of sick leave• Is a symptom not disease• 50-80% of adult will have LBP during their life• M=F but after 60 yrs F>M• Only 1% of acute LBP is due to lumbar
radiculopathy• Lumbar radiculopathy often occur during 4th &5th
decades
![Page 3: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/3.jpg)
Risk Factors• Occupational factors
• Lifting, pulling, pushing, twisting, sitting
• Patient-Related factors• Age, Gender, Anthropometric, postural, spine
mobility, Muscles strength, Physical fittness, Smoking, Psychological
![Page 4: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/4.jpg)
Etiology• Degenerative• Inflammatory• Infection• Metabolic• Neoplastic• Traumatic• Congenital/Developmental• Musculoskeletal
• Viserogenic• Vascular• Psychologic• Post op.
![Page 5: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/5.jpg)
![Page 6: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/6.jpg)
![Page 7: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/7.jpg)
Normal posture• Line of gravity passes
from C1 to C7 to T10 & lumbosacral junc. To hip joint
![Page 8: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/8.jpg)
![Page 9: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/9.jpg)
Clinical Evaluation• Hx• P.E:
• Inspection• Palpation• ROM(tape, inclinometers)• Neurological Exam
• Gait• MSR• MMT• Sensory
• Imaging
• EMG/NCS• Bone Scan
![Page 10: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/10.jpg)
Mechanical LBP• Nondiscogenic LBP, provoked by activity
& relieved by rest• Often due to stress or strain on back
muscles, tendon, lig. • Chronic, dull aching pain spreed to buttock• No assosiated with neurologic symp. • Not increased with cough or sneeze• Deconditioning & decompensation
![Page 11: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/11.jpg)
Osteoarthritis• O.A of vertebral body• O.A of facet joint
![Page 12: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/12.jpg)
O.A of facet joint• Localized pain• Epizodic• Usually abrupt onset• Limited extension• Pain increased with activity & relieved by rest
![Page 13: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/13.jpg)
O.A of facet joint(cont.)• Treatment:• Weight control• Rest• Analgesic or NSAIDs• Manipulation • Exercise(Q.L ex., pelvic tilt, flexibility ex.,
avoid ext.) • Avoid prone sleeping
![Page 14: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/14.jpg)
Radiculitis & Radiculopathy• Common cause of acute, chronic or
recurrent LBP particularly in young to middle aged mens
• Mean age: early 40s
![Page 15: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/15.jpg)
Radiculitis & Radiculopathy• Bulging disk• Prolopsed disk• Extruded disk • Sequestered disk
![Page 16: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/16.jpg)
• L5,S1: radiated pain often to buttock, post. Thigh, lateral culf, med. Or lat. Maleoli
• L3,4: radiated pain to ant. Thigh• When disk extrude LBP is decrised & leg
symptoms are more prominent• In upper lumbar radiculopathy: other cause
(eg: neoplastic) should be R/O.• Provocative maneuver• P.E• Lab test
![Page 17: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/17.jpg)
![Page 18: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/18.jpg)
Treatment• Conservative • Surgery if:
• Progressive neurological deficit• Sphicter compromised• Large midline disk protrusion with cauda
equina syndrome• Unresponce to 4-6 weeks comprehensive
conservative treatment
![Page 19: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/19.jpg)
Spondylolysis & Spondylolisthesis• Spondylolysis: bony defect in pars interarticularis• Spondylolisthesis : Bilateral lysis lead to ant. Slipping
• Listhesis:• Dysplastic• Isthmic (lytic, elongated, acute Fx)• Degenerative• Traumatic• Pathologic
![Page 20: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/20.jpg)
• LBP(+/- radicular symptome)• Increased lumbar lordosis• Hamstring tightness(standing with flex knee)
![Page 21: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/21.jpg)
Imaging study• L.S x-ray(lat, oblique)• Flexion/extension view for segmental
instability• MRI, CTS, EMG/NCV if:
• Root symptoms• Neurological defect• pseudoclaudication
![Page 22: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/22.jpg)
Treatment• post traumatic: 10-12 weeks immobilization• Chronic LBP: strengthening ex.• In persistant pain: L.S corset• Grade1&2 & in older patient: non surgical
• Modality• Massage• Stretching ex.• Flexion ex.• Abdominal binder
![Page 23: Low Back Pain](https://reader035.vdocuments.mx/reader035/viewer/2022062813/568165bc550346895dd8b9be/html5/thumbnails/23.jpg)
• Surgury : • Advance listhesis beyound grade 2• Young patient with heavy sport or physical job• Severe symptomatic slip