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Low Back Pain

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.

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Low Back Pain

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  1. 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

  2. Risk Factors • Occupational factors • Lifting, pulling, pushing, twisting, sitting • Patient-Related factors • Age, Gender, Anthropometric, postural, spine mobility, Muscles strength, Physical fittness, Smoking, Psychological

  3. Etiology • Degenerative • Inflammatory • Infection • Metabolic • Neoplastic • Traumatic • Congenital/Developmental • Musculoskeletal • Viserogenic • Vascular • Psychologic • Post op.

  4. Normal posture • Line of gravity passes from C1 to C7 to T10 & lumbosacral junc. To hip joint

  5. Clinical Evaluation • Hx • P.E: • Inspection • Palpation • ROM(tape, inclinometers) • Neurological Exam • Gait • MSR • MMT • Sensory • Imaging • EMG/NCS • Bone Scan

  6. 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

  7. Osteoarthritis • O.A of vertebral body • O.A of facet joint

  8. O.A of facet joint • Localized pain • Epizodic • Usually abrupt onset • Limited extension • Pain increased with activity & relieved by rest

  9. 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

  10. Radiculitis & Radiculopathy • Common cause of acute, chronic or recurrent LBP particularly in young to middle aged mens • Mean age: early 40s

  11. Radiculitis & Radiculopathy • Bulging disk • Prolopsed disk • Extruded disk • Sequestered disk

  12. 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

  13. 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

  14. 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

  15. LBP(+/- radicular symptome) • Increased lumbar lordosis • Hamstring tightness(standing with flex knee)

  16. Imaging study • L.S x-ray(lat, oblique) • Flexion/extension view for segmental instability • MRI, CTS, EMG/NCV if: • Root symptoms • Neurological defect • pseudoclaudication

  17. 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

  18. Surgury : • Advance listhesis beyound grade 2 • Young patient with heavy sport or physical job • Severe symptomatic slip

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