Lower Back Pain : Clinical Features, Prevention, Treatment & Exercise

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Lower back pain is a very common  complain to visit health care provider or seek medical advice . The number of visits to primary care providers resulting from low back pain is second only to the number of visits for upper respiratory illness.

Most of the lower black pain is caused by

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  • Musculoskeletal problems including acute lumbosacral strain, unstable lumbosacral ligaments and weak muscles
  • Osteoarthritis of the spine
  • In vertebral discs protrusion and discs degeneration
  • Spinal stenosis and unequal leg length
  • Other causes include stress and occasionally depression may contribute to lower back pain
  • Obesity, postural problems, structural problems and overstretching of spinal supports may result in back pain
  • Kidney disorders and pelvic problems and pelvic inflammatory infections
  • Retroperitoneal tumours
  • Abdominal aortic aneurysms
  • Spinal tumours and infection
  • Direct Trauma to the spine or fractures (fall injury or road traffic accident)

Back pain due to the musculoskeletal disorders usually is aggravated by either light or strenuous activity, whereas pain due to other conditions is not.

Elderly people may experience back pain associated with ageing process, osteoporotic vertebral fractures, osteoarthritis of the spine and spinal stenosis.

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Anatomically, its (spinal column) unique construction of rigid units (vertebrae) and flexible  units (intervertebral discs) held together by joints, multiple ligaments and paravertebral muscles allows for flexibility while providing maximum protection for spinal cord. The spinal curves absorb vertical shocks from running and jumping. The trunk muscles help stabilize the spine whereas the abdominal and thoracic  muscles are important in lifting activities, working together to minimize stress on spinal units.

CLINICAL FEATURES

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According to the reports of typical patients, lower back pains are either acute back pain (lasting less than 3months) or chronic back pain (lasting more than 3months without a significant improvement) and fatigue.

  • Pain radiating down the leg, which is known as SCIATICA ; presence of this symptoms suggests nerve root involvement.
  • Gait, spinal mobility, reflexes, leg length, leg motor strength and sensory perception may be affected
  • On physical examination greatly increased muscles tone of the back postural muscles with loss of the normal lumbar curve and possible spinal deformity may disclose
  • Clinical signs from inflammation are:
  • Fever
  • Pain moderate to severe
  • Swelling in back
  • Pain radiating down to knees and legs
  • Weight loss
  • Difficulty in urinating
  • Numbness below the torso
  • Limited activity
  • Bedridden or persistent lying down in bed

Diagnostic assessment and procedures

The assessment includes initial evaluation of acute and chronic low back pain includes

    • History and physical examination
    • Neurologic testing ( reflexes, sensory impairment, straight-leg raising, muscle strength and muscle atrophy)

The findings from diagnostic assessment discloses either nonspecific back pain symptoms or potentially serious underlying problems such as Sciatica, spine fracture, cancer, infection or rapidly progressing neurologic deficit. If the initial examination does not  suggest serious problem, no additional testing is performed during the first 1month of symptoms.

The diagnostic procedures below may be indicated for people with potentially serious or prolonged low back pain.

    • X-ray of the spine may demonstrate a fracture, dislocation, infection, osteoarthritis or scoliosis
    • Bone scan may detect bone marrow abnormalities and ingrowing tumour whereas haematological studies may disclose infection
    • Computed tomography  (CT) is useful in identifying underlying problems such as soft tissue lesions adjacent to the vertebral column and problems of vertebral discs
    • Magnetic resonance imaging (MRI) permits visualisation of the nature and location of spinal pathology
    • Electromyogram (EMG) and Nerve conduction studies are used to evaluate spinal nerve root disorders
    • Myelogram permits visualisation of segments of the spinal cord that may have herniated or may be compressed
    • Ultrasound is useful in detecting tears in ligaments, muscles, tendons and soft tissue in the back

Some of the strategies for treating and preventing low back pain

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Treatment

  • Limit bed rest; keep your knees flexed to decrease strain on your back.
  • Try non medicinal approaches likewise application of superficial heat or chiropractic therapy.
  • Medicinal approaches or Medical management: most back pain is self limited and resolves within 4weeks with analgesic agents, rest, and relaxation. Based on the assessment findings. Management focuses on relief of pain and discomfort, activity modifications and health education. Take nonsteroidal anti-inflammatory drugs, acetaminophen and muscle relaxants as prescribed.
  • Surgical management: It is only applicable in chronic cases of diagnosis such as invertebral disc problems, spinal tumors or stenosis, spinal fracture or underlying lumber diseases. Laminectomy, micro discectomy, instrument fixation, etc. Can be done
  • Weight reduction as needed: modify diet to achieve ideal body weight.

Prevention

EXERCISE

  • Stretch to enhance flexibility. Do strengthening  exercises.
  • Perform prescribed lumbar exercise to facilitate  function, gradually increasing time and repetitions.
  • Do not practice wrong exercise. A malpractice can lead to serious musculoskeletal problems.

Body mechanics

  • Practice good posture
  • Avoid twisting your body
  • Push objects rather than pull them
  • Keep load close to your body when lifting
  • Bend your knees and tighten abdominal muscles when lifting
  • Avoid over reaching
  • Use a wide base of support.

Work modifications

  • Adjust work area to avoid stress on back
  • Adjust height of chair or work table
  • Use lumbar support in chair
  • Avoid prolonged standing and repetitive tasks
  • Avoid work involving continuous vibrations.

Activities to promote healthy back

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Standing

  • Avoid prolong standing and walking
  • When standing for longer period of time, rest one foot on a small tool or box to relieve lumbar lordosis
  • Avoid forward flexion work positions
  • Avoid high heels and use comfortable shoes

Sitting

  • Avoid sitting for longer period of time
  • Sit in a straight-back chair with back well supported and arm rests to support some of the body weight; use a footstool to position knees higher than hips if needed
  • Maintain back support; use of soft support at the small of the back
  • Avoid knee and hip extension. When driving a car, have the seat pushed forward as far as possible for comfort
  • Guard against extension strains- reaching,  pushing, sitting with legs straight out
  • Alternate periods of sitting and walking

Lying

  • Rest at intervals; fatigue contributes to spasm of the back muscles
  • Place a firm bed board under the mattress
  • Avoid sleeping in prone position
  • When lying on the side, place a pillow under the head and one between the legs flexed at the hips and knees
  • When supine use a pillow under the knees to decrease lordosis.

Lifting

  • When lifting, keep the back straight and hold the load as close to the body as possible
  • Lift with the large leg muscles not the back muscles
  • Use trunk muscles to stabilize the spine
  • Squat while keeping the back straight when it is necessary to pick something off the floor
  • Avoid twisting the trunk of the body, above waist level, reaching up for any length of time.

Exercising

  • Walk daily and gradually increase the distance and pace of walking
  • Perform prescribed back exercise twice daily increasing exercise gradually
  • Avoid strenuous exercises such as jumping and jarring activities.

 

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