Lower Back PainPresented by : Chathura Karunarathna

DPHY 01/09/001

Content

• 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

1. Anterior longitudinal ligament2. Posterior longitudinal ligament3. Ligamentum flavum4. Facet capsulary ligaments5. Interspinous ligaments6. 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 LBP •lasts between 6 and 12 weeks

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

• 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

• 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

• 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.

Bone scan Infection, Paget disease.

CT Bone tumours, Fractures, Spinal stenosis.

MRI Spinal cord, Nerve roots, Discs, Haemorrhage problems.

Dexa Scan 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

MicrodiscectomyDiscectomy

LaminectomySpinal fusion

Disc replacement

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

sound waves

Micro massaging effect

Brings more blood to the area

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 PacksHeat 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

IncreaseCirculation

Reduce pressure on spinal cord

DecreaseInflammation

Providerelaxation

Treatments

Other Treatments• 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

• 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