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Schematic cross-section of an inter-vertebral discHerniated disc
Causal factors for back pain
Spinal fracture Herniated disc TB spine Mechanical low back pain - Diagnosis of exclusion 75-80% of cases.
Spinal FractureHerniated DiscTB Spine
Trigger factors Excessive load on normal back Long / erratic hours Poor workplace ergonomics Stress: Physical, mental and emotional Travel
Normal load on weak or unprepared back Fatigue Improper posture/ chronic malpositioning Lack of exercise, poor physical conditioning Weight control problems
Poor postureTrigger factors (contd)
Three phases of management strategy Treatment of acute episodes. Amelioration of chronic condition. Prevention of exacerbation/ reinjury.
The case against protracted rest Deconditioning: Loss of muscle strength and endurance Chance of micro traumatic injury Protracts recurrent episodes Maintains chronic disability Decreased flexibility Adversely modifies spinal biomechanics Physiology of disc hydration affectedAvoid pill popping
Exercise - for which patients? Central focus in 95% cases
YES in mechanical causes NO in non-mechanical causes
Exercise types Back-specific exercises Peri-pelvic and LL flexibility and strengthening Aerobic conditioningDouble knee to chest stretch
Pelvic tiltSome exercises for the backLower trunk rotation stretch
Trunk Flexion StretchTrunk flexion stretchProne lumbar extensionSome exercises for the back
Alternate Prone Leg ExtensionAlternate prone leg extensionAerobic conditioning
Abdominal StrengtheningAbdominal strengthening
Lower Limb StretchesLower limb stretches
Complementary therapy Back hygiene and back school Correction of biomechanical factors Posture Weight control
Weight trainingYoga
YogaThe right chairCounter height
Working Posture
Posture at workThe right posture
Sitting Posture
Sitting postureForward bending
Pulling an Object
Pulling an object
Thank you
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