Download Causes of Low Back Pain

Presented by : Chathura Karunarathna
DPHY 01/09/001
Content
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Introduction
Anatomy
Causes
Symptoms
Red and Yellow Flags
Investigation
Treatments
Prevention
Introduction
• Low back pain affects over 80% of persons at some
point in their life.
• 90% of the time low back pain is recurrent.
• The peak age of incidence of low back pain is 30 to
50 years old.
• The most common cause of disability of a persons in
more than 45 years.
• Second most common reason for physician visit.
Anatomy
• 5 lumbar vertebra
• Sacrum
• Coccyx
Anatomy
• Lumbar Intervertebral Disc
Anatomy
• Lumbosacral Joint
Anatomy
• Lumbar ligaments
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Anterior longitudinal ligament
Posterior longitudinal ligament
Ligamentum flavum
Facet capsulary ligaments
Interspinous ligaments
Supraspinous ligaments
Anatomy
Anatomy
• Nerve supply
Low Back Pain
• Back pain is described by the length of time
symptoms persist:
Acute LBP
• lasts less than 6 weeks
Sub acute • lasts between 6 and 12 weeks
LBP
Chronic LBP
• persists for more than 12 weeks
Causes of Low Back Pain
Mechanical Causes
Muscle or soft tissues sprain or
strain
Back pain most often occurs from strained muscles and
ligaments.
• From improper or heavy lifting.
• After a sudden awkward movement.
Lumber Disc Herniation
• The jellylike central portion of the disc bulges out of
the central cavity and pushes against a nerve root.
• 95% of disc herniations occur at the level between
the fourth and fifth lumber vertebrae in the low
back.
Other Mechanical Causes
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Kyphosis
Fractures
Leg length difference
Restricted hip motion
Lumbar spinal stenosis
Osteoporosis
Causes of Low Back Pain
Inflammatory Causes
Ankylosing spondylitis
• Ankylosing spondylitis is a form of chronic
inflammation of the spine and the sacroiliac joints.
• Characterized by pain and progressive stiffness in
and around the spine.
• Over time, chronic inflammation of the spine
(spondylitis) can lead to a complete cementing
together (fusion) of the lumbar
vertebrae.
Lumbar Spine Arthritis
• Lumbar spine arthritis is most commonly seen in
older patients, but can be seen in all age groups.
• Patients with degenerative changes resulting in
spinal stenosis (narrowing of the spinal column) may
experience numbness, tingling, or weakness in the
legs due to irritation of the lumbar nerve roots.
Symptoms
Symptoms are depend on the affected cause of lower
back.
Back sprain or strain
• Muscle spasms, cramping, and stiffness.
• Pain in the back and buttocks.
Nerve-root pressure
• Leg pain
• Tingling, Numbness, or Weakness along the leg.
• Loss of bladder and/or bowel control.
Symptoms
Arthritis of the spine
• Usually causes pain that is worse in the back and hip
region.
• Starts gradually, gets worse over time.
Other conditions
• Fever
• weight loss
• Progressive weakness in the legs (cauda equina
syndrome)
Red Flags of Lower Back Pain
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Weight loss, fever, night sweats
Infection (current/recent)
History of cancer
Prolonged use of corticosteroids
Older age
Major Trauma
Osteoporosis
Back pain at rest
Bowel or bladder dysfunction
Yellow Flags of Lower Back Pain
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Environmental factors
Societal factors
Stressors in relationships
Mental health
The belief that pain is harmful or severely disabling
Job dissatisfaction
Yellow Flags of Lower Back Pain
Investigations
Method
Mainly use for identify
X-rays
Osteoporotic fractures,
Dislocations.
Infection, Paget disease.
Bone scan
CT
MRI
Dexa Scan
Bone tumours, Fractures, Spinal
stenosis.
Spinal cord, Nerve roots, Discs,
Haemorrhage problems.
Bone density
Treatments
• Although for many years there was no agreement
among health professionals on how to best treat
back pain.
• The treatment are very specific to the cause of the
low back pain.
Treatments
Surgical
Microdiscectomy
Discectomy
Laminectomy
Spinal fusion
Disc replacement
Manual Physical
Therapy
Back Brace
TENS
Ultrasound
Hot or Cold packs
Traction
Massage
Physical Therapy Treatments
Back Brace
• braces for the lower back are built to support
abdominal muscles by restricting motion, they can
take pressure off the lower back, relieving back
pain and in many cases improving posture.
Physical Therapy Treatments
Transcutaneous Electrical Nerve Stimulation
• TENS is a therapy that uses low-voltage electrical
current for pain relief.
• The electrodes are often placed on the area of pain
and creating a circuit of electrical impulses that
travels along nerve fibers.
Physical Therapy Treatments
Ultrasound
Micro massaging effect
Brings more blood to the area
sound waves
Improve Healing
Reduce Pain
Physical Therapy Treatments
Ice Packs
Apply ice packs in every one or two hours to reduce
inflammation and pain in acute stage.
Hot Packs
Heat therapy dilates the blood vessels of the
muscles surrounding the lumbar spine. This process
increases the flow of oxygen and nutrients to the
muscles, helping to heal the damaged tissue.
Physical Therapy Treatments
Traction
Increase joint space
and
Stretch soft tissues
Increase
Reduce pressure Decrease
Provide
Circulation on spinal cord Inflammation relaxation
Treatments
Other Treatments
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Acupuncture
NSAIDs for pain relief
Thrust Manipulation
Yoga
Outcome of Treatments
Aim: To relieve symptoms and mobilise early.
• Pain Control.
• Manage tissue injury.
• Motion in Pain-free range.
• Restore Full pain free range of motion.
• Restore Muscle endurance.
• Restore Functional movements.
• Improve propriocetion.
Exercises For Lower Back Pain
• The goals of performing these exercises were to
reduce pain and provide lower trunk stability by
actively developing the "abdominal, gluteus
maximus, and hamstring muscles as well as passively
stretching the hip flexors and lower back muscles.
Low Back Extension Exercises
Prone, or lying on your stomach on the floor or bed, is the
best position in which to do extension exercises.
Low Back Flexion Exercises
• Pelvic tilt exercise increases the strength of the
lower back muscles and help to improve full range of
motion in both the pelvis and lower back vertebrae.
This move loosens up any stiffness and can improve
posture.
More Exercises For Lower Back
Prevention
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Lose any excess weight
Wear flat shoes
Avoid sudden movements
Stop smoking
Maintain healthy diet
Avoid lifting heavy objects
Maintain Correct Posture
Standing
Sitting
Maintain Correct Posture
Sleeping
Lifting
Maintain Correct Posture
Driving
Use Correct Body Mechanics