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Haldemann (1977) 26 causes
Whyke (1976) 20 categories
IntroductionIntroduction
BACK ACHE BACK ACHE
DR.BHARAT PATEL M.S.(Ortho)
SAMVED HOSPITAL
DR.BHARAT PATEL M.S.(Ortho)
SAMVED HOSPITAL
IntroductionIntroduction
Hazleman and Bulgar (1979)
Disc prolapse over diagnosed
IntroductionIntroduction
Moorey and Robertson
Benign lumbar pain syndromes
Classification of low back pain
Classification of low back pain
Spondylogenic back pain
Neurogenic back pain
Viserogenic back pain
Vascular back pain
Psychogenic back pain
CAUSES OF BACK PAINCAUSES OF BACK PAIN
Causes of back painCauses of back pain
Poor Posture
Disturbed normal
“natural S” shape of
spine leads to back
pain.
Causes of back painCauses of back pain
Out of Shape
Your overall physical condition can affect your back.
Causes of back painCauses of back pain
Tension and Stress
Causes of back painCauses of back pain
Aging and Disease
Loss of muscle strength with aging.
“slip disc”
Osteoarthritis, a form of aging arthritis, can cause back pain.
Causes of back painCauses of back pain
Impact Trauma
Causes of back painCauses of back pain
Obesity
Causes of back pain
Adolescent acute backAdolescent acute back
12 to 14 yrs in girls
14 to 16 in boys
Disc space infection
Herniated lumbar disc
Spondylolysis or lysthesis
Lumbar InstabilityLumbar Instability
The tall young man
House wife
Post surgical patient
The keep-fit enthusiast
Young man in his 20’s with undetected lumbar
osteochondrosis.
Mature woman between 40-50 with degenerative
spondylolisthesis.
The man fearful of his backThe man fearful of his back
Over 40 and in past years suffered probably a
minor episode of back pain.
Because of this temperament, combined at the
time with a strongly worded caution from his
doctor to take care, the patient has lost all
confidence in the health and durability of the
low back.
Time dependent back acheTime dependent back ache
Particular movement aggravates the pain.
Particular time aggravates pain – rising in the morning.
Over stressed labourers backOver stressed labourers back
Strong solidly built man
Farmer
No sciatica
Insidious onset
The Equinox SyndromeThe Equinox Syndrome
Severe leg pain limb cold
Feel of numbness
Unless the neurological involvement is
multiradicular, normal muscle power regained
in 10 wks.
Spinal stenosisSpinal stenosis
Congenital stenosis.
Acquired stenosis – facet joint arthrosis,
ligamentum flavum thickening, disc trespass,
posterior vertebral lipping, spondylolisthesis,
venous congestion, isolated disc resorption,
degenerative stenosis, disc prolapse.
Chair bound back acheChair bound back ache
40 year old physically active in the past, but
risen professionally to assume
responsibility which entail much
administrative work.
Obese.
Lumbar stiffness on rising in the morning.
Low back pain in pregnant womenLow back pain in pregnant women
50% of the pregnant women.
Sweden is the highest 70% (9 wks of sick leave).
Common with multiparus women.
Mechanism :
Increased lumbar lordosis.
Hormone relaxing.
How to prevent by exercise programmeHow to prevent by
exercise programme
Before pregnancy & during 1st trimester.
Can be continued in 2nd and 3rd trimester.
Low back pain in childrenLow back pain in children
Rare complaint.
Often illusive – Delayed diagnosis because of rarity.
Must be investigated.
Causes :Mechanical DevelopmentalInflammatoryNeoplasticTethered cordPsychogenic
Sports related low back ache
Collapsed back with kissing spineCollapsed back with kissing spine
Women in late middle age
Lumbar ache on standing
Degenerated all joints
DISORDERS OF IV DISCDISORDERS OF IV DISC
Backache Leads To……
Pain
Disability to pursue activities of daily leaving
Absenteeism
Sexual dysfunction
Financial and psychological set back
Diagnosis of back painDiagnosis of back pain
Physical Examination&
Investigations
Diagnosis of back painDiagnosis of back pain
Physical Examination
Diagnosis of back painDiagnosis of back pain
Investigation :• Blood Ix
• Radiological Ix
- Plain X-ray- Myelography- CT scan- MRI
Management of back painManagement of back pain
Conservative Treatment
Operative Treatment
Preventive Treatment
Conservative treatmentConservative treatment
Medicines
Pain killers
Muscle
relaxants
Vitamins
Conservative treatmentConservative treatment
Bed rest
Conservative treatmentConservative treatment
Physiotherapy
Activity modification
Conservative treatmentConservative treatment
Manipulation of back
Conservative treatmentConservative treatment
–Orthosis- (belts)
Conservative treatmentConservative treatment
Weight reduction
Conservative treatmentConservative treatment
Injection therapy( epidural steroids)
Operative treatmentOperative treatment
Operative treatmentOperative treatment
WHY
WHEN? ?
WHERE
?
Preventive TreatmentPreventive Treatment
DO’S & DON’TSDO’S & DON’TS
Preventive treatmentPreventive treatment
While working in standing position, use a small stool under one foot to avoid back strain.
Preventive treatmentPreventive treatment
While carrying weights, divide the load into two equal halves
Preventive treatmentPreventive treatment
Always climb up to bring heavy object from height. Avoid stretching your back.
Preventive treatmentPreventive treatment
Sit with back straight & well supported while doing work. Avoid stooping.
Preventive treatmentPreventive treatment
Reduce weight keep slim &
active
Preventive treatmentPreventive treatment
Always carry weight near the body.
Preventive treatmentPreventive treatment
After a heavy day at work A good way to rest your back
Correct sleeping posture
A firm mattress, A small pillow under head & neckA small bolster under the knees
Preventive treatmentPreventive treatment
Simple exercises to keep the back fit
Preventive treatmentPreventive treatment
Follow this posture & avoid back, neck & shoulder pain
Reduce brightness to avoid strain
Elbow support
Back support
Low back support
Correct distance between table and chair
Foot support
Correct table height
THANK YOUTHANK YOU
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