Upload
julianna-waters
View
219
Download
0
Tags:
Embed Size (px)
Citation preview
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