Low Backache,Mhjrc

8/4/2019 Low Backache,Mhjrc

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Low back ache

Capt Pramod


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Introduction

First, we will discuss the medical model:definition,

incidence,

aetiology,

diagnosis, and treatment.

Secondly we will look at prevention andthe Back Pain exercises


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IntroductionBack pain is one of the most commonailments of mankind. An estimated 80percent of people will experience backpain at some point in their lives, andslightly more men suffer from it than

women

Potent cause of absence from work


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What is spine, anatomically?

Bunch of joints (cushioned)

Designed for mobility and movement

Kinetic chain

Provide structural support for the upper body

Protection of the spinal cord

Shock absorber for the brain


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Lumbarvertebrae

Musclesof thepelvis

VertebraeDisk

SI JOINT


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Causes

Musculoskeletal

Degenerative

Rheumatic

Neoplastic

Referred

Infection

PsychologicalMetabolic

Traumatic


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Musculoskeletal

Ligamentous

Muscular

Facet jointSacroiliac strain

Prolapsed disc

FractureScoliosis


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Degenerative

Osteoarthritis

Spondylosis


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Rheumatic

Rheumatoid Arthritis

Ankylosing Spondylitis


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NeoplasticPrimarySecondary

Prostate

Lung

Renal

Breast

Thyroid


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Referred PainGynaecologicalRenal

Other abdominal


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Infection

TB

Osteomyelitis

Herpes Zoster


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Psychological

Depression

Malingering


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Metabolic

Osteoporosis

Pagets

Osteomalacia


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History

Sometimes a clear cause but often not

In a young, fit person then usually:

muscle or ligament strain

facet joint problem

prolapsed disc


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Muscle or ligament strain

Usually can give you the cause

Related to posture

EpisodicPain worse on movement, helped by rest


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Facet Joint

Sudden backache with a simplemovement I was just picking up a coin off

the floor

Often flexion with rotation

May have heard a click


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Prolapsed Disc

Shooting pain

Pain radiating downthe leg below the

kneeAggravated bycoughing/sneezing

Usually sudden onsetand often no trauma


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Red Flags in the History

Retention of urine or incontinence

Onset over age 55 or under 20

Symptoms of systemic illness - weightloss, fever

Morning stiffness

Severe progressive painA prior history of cancer

Intravenous drug use

Prolonged steroid use


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Examination

Observation

Palpation

MovementsStraight leg raising

Femoral stretch test

PowerSensation

Reflexes


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Dermatome


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Investigations

For simple backache, age 20-50


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Investigations

Plain x-ray with FBC and ESR to rule outtumour, infection if red flags suggest likely

If red flags present and plain x-ray normalthen bone scan, CT or MRI may still beindicated


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Imaging

Plain x-rays AP and lateral views

Oblique views

PA view of S.I. JointComputed tomography (with mylography)

MR imaging

Radioisotope scanningDiscography and facet joint arthrography


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Chronic low back pain

Pain that persists after 3 months

< 5% of patients with L.B.P develop

Ch.L.B.PMultiple factors Disc, facet joints, annulus fibrosis, ligaments

Psychosocial factorsSurgery is rarely helpful

Functional restoration programme


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Acute disc prolapse

Uncommon in very young and the very old

Nerve root pain follows the dermatome of

the involved nervePain is generally worse in the leg than inthe back

Exacerbation of leg pain by straining,sneezing or coughing

Localised neurological signs


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Cauda Equina Syndrome

Large midline discprolapse

Compresses several

nerve rootsSphincter disturbance

Saddle anaesthesia

Prompt surgicalintervention


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Treatment acute disc prolapse

Conservative

Bed rest for 48-72 hours

NSAIDs

Epidural steroids

85% relief rate

Surgical treatment

10-15% of patients ultimately require surgery More rapid relief but the ultimate end point is the same

regardless of treatment


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Spinal Stenosis

Commonest cause ofneurologic leg pain inolder patients

SymptomsNeurogenicclaudication -Vascular claudication

Treatment


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Spondylolysis

Spondylolysis

Also known as pars defect

Also known as parsfracture

With or withoutspondylolisthesis

A fracture or defect in thevertebra, usually in theposterior elementsmost

frequently in the parsinterarticularis


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Spondylolisthesis

Forward slippage of onevertebral body on another

Causes

Congenital Isthmic

Traumatic

Pathologic

Degenerative


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Spondylolisthesis

Forward slippage of onevertebral body on

another


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Discitis


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Spinal Deformity

Deformity may occur in either coronal or sagittal plane

Scoliosis - Lateral curvature of the spine

Structural

Nonstructural

Kyphosis - Sagittal plane deformity in the thoracic orthoracolumbar spine


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Scoliosis

Idiopathic Scoliosis

80% of all scoliosis

Adolescent - age 10 or overJuvenile - age 4 to 9

Infantile - age 3 or under


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Scoliosis - Cobb angle


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Adolescent idiopathic scoliosis

Structural scoliosis presenting at or about the onsetof puberty and before maturity

80 % of cases of idiopathic scoliosisMostly (90%) in girls

Predictors of progression

very young agemarked curvature

Risser sign


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Neuromuscular scoliosis

CausesPoliomyelitis

Cerebral palsy

SyringomyeliaFriedrichs ataxia

Muscular dystrophies

Typical paralytic curve is long, convex towards

the side with weaker muscles


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Kyphosis

Postural (Round back)

Compensatory

Structural


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Scheuermanns disease

Excessive thoracic kyphosis (Cobb angle >45with wedging of 5 or more) of at least 3

adjacent apical vertebrae and vertebral endplate irregularities

Aetiology unknown

Incidence 1% of general population

with slight femaledominance


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Treatment

Orthotic treatment

Skeletally immature - Milwaukee brace(poor compliance)

Surgical

Severe deformity in skeletally mature

Severe deformity and neurologic signs


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S curvePOSTURE:

The neck has a slightnatural curve, which sitson top of the two curves inthe middle and lower back.

Correct posture maintainsall three curves andprevents undue stress and

strain by distributing bodyweight evenly


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STANDING POSTURE

In correct, fully erect posture,a line dropped from the earwill go through the tip of theshoulder, the middle of thehip, the back of the kneecap

and the front of theanklebone.


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SITTING POSTURE


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SITTING POSTURE

When sitting in anyposition, the threeback curves need tobe maintained.

If you cannot sitwithout slouchingforward or backward,you need to supportyourself with hands

and arms or leanagainst a wall orchair back.


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SITTING POSTURE


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SITTING POSTURE:


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LYING POSTURE:

Avoid proppinghead or upper body

up on an arm andhand.

Head shouldremain relaxed.Legs should betogether.


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Th 5 L f Lifti


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The 5 Ls of Lifting

L1, LoadAlways test the weight of the loadbefore lifting. get help.L2, Lungs, inhale,and as you lift, breath out

through pursed lips.L3, Leverload close to you body,thereby reducing the lever effect.

L4, LegsAlways use your legs and not yourback while lifting.L5, LordosisMaintain the hollow (S curve) inyour back throughout the lift.


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BackacheEXERCISES:

Cat Back

Fetal Position

Arm exercises


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Alternate LegSlides

Alternate LegRaises


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RELIEVE STRESS

Yoga

Meditation


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SURGERY

Only considered if:

Conservative management fails

Patient develops neurological deficits(weakness, numbness, change in reflexes)

Diskectomy


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Diskectomy

the removal of aherniated disk torelieve pressure on anerve root

Window in the lamina-retract nerve-removalof herniated discmaterial-healing by

scar tissue

Laminectomy


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Laminectomy

derived fromlamina (part of thespinal canal's bonystructure) and -ectomy (removal).

The operation isperformed torelieve pressure onone or more spinalnerve roots
http://www.augustaortho.com/


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Posterior Lumbar Fusion

Posterior lumbar interbody fusion (PLIF)

Usually includes the use of screws/rods for stabilization until thefusion occurs

Bone graft

Cages


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Lumbar Arthroplasty

Total disc replacement (TDR)

DDD

Contraindicated for spondylolisthesis and

spondylolysis


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exercises to strengthen the core

Exercise 1 Hip Rolls:


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Exercise 1 Hip Rolls:

Stand back away fromyour support and standwith legs at shoulder-width apart.

Tighten your abdominalmuscles and put yourhands on your hips.

rotate your hips

clockwise 5 times, thenrotate them counter-clockwise 5 times.

Exercise 2 Waist Twists:


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Exercise 2 Waist Twists:

With your handsrelaxed at your sidesand with feet ashoulder-width apart,

simply start swingingyour arms right thenleft, patting both handson your lower back as

they reach around.

Simply do a count of10, and then relax. .


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Exercise 3 Knee Bends

gentle, relaxed kneebends, best to do themwith the assistance of a

chair, table or desk.Tighten your stomachmuscles and exhale whilebending your knees

. Inhale while standingup.

Do 10 of these to finishthis quick exercise circuit.


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Prevention is the key!

Proper posture and body mechanics Lifting technique

Activities modification

Workplace ergonomics evaluation; occupational specific

trainingLow impact exercises to strengthen the core Yoga, swimming


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Thou shalllearn

low backexercise

THANK YOU

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Low Backache,Mhjrc