Low back pain (lumbago)

Low back pain PPT

1. Low Back Pain (Lumbago): Management and Prevention

2. Objectives Understand chronic back pain and causes Touch on a few spinal injuries and mechanisms of injury How to determine some causes of lower back pain (LBP) Action after identifying cause of LBP Management and Prevention

3. Low Back Pain WELCOME

4. Understanding Chronic Back Pain and Causes What is Low Back Pain? jj Dr Sheriff Muideen Public Health Specialist RAK-PMD

5. Introduction and Definition Low back pain is pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, and is defined as chronic when it persists for 12 weeks or more.

6. Low Back Pain (Lumbago) Low back pain or pain in the lumbosacral region is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the lower spine.

7. Low Back Pain

8. WHY LOWER BACK? Typically, the commonest area of back pain is the low back (lumbar region) and sometimes it spreads to the buttocks or thighs. WHY THE LOWER BACK? Lumbar region because: It bears most of the body’s weight Most movements of the spine occur there .

9. Sources of Low Back Pain Damage to several structures in the low back can result in severe pain • vertebrae • thoracolumbar fascia • ligaments • joints - specifically sacroiliac joint • discs • muscle

10. Epidemiology of Low back Pain Prevalence 60-80% of people will have LBP sometime in their lives. 30% are referred to Ortho; 3% admitted; 0.5% operated. 90% LBP resolves in 6w, 75% may experience symptoms & disability one year after initial consultation. The prevalence of LBP has changed little over the years, but the associated disability has increased four fold.

11. Epidemiology of Low Back Pain

12. Epidemiology of Low Back Pain Low Back Pain (LBP) , most often affects people between the ages of 25 and 60 years and those aged between 50 and 60 years are likely to become disabled (Corbin et al, 2002). Up to 70%-85% of the population in the United Kingdom (UK) experience back pain at some point in their lives. In Ghana, over 60% of the adult population complains of back pain at one time or the other

13. Epidemiology Contd.

14. Epidemiology Contd. 60 – 90% of lifetime prevalence 80 – 90% have recurrence episode Second most common complain to prompt a medical evaluation Leading cause of long term work disability

15. Natural History of Back Pain 80 – 90% resolves within 1 month 20 – 30% remain chronic 5 – 10% causes disability in life

16. Causes of Low Back Pain

17. Causes of Low Back Pain Causes may be anatomical or even psychological Pain may be due to: Sitting for long periods of time (?)

18. Causes of Low Back Pain Sedentary behaviour has long been associated with neck and low back pain . Research has linked  sitting  for long periods of time (> 8 hrs/day) with a number of health concerns. These includes: ---- obesity and a cluster of conditions — increased blood pressure, ---- high blood sugar, --- excess body fat around the waist and --- abnormal cholesterol levels — that make up metabolic syndrome Sitting increases risk of death by 40%

19. Causes of Low Back Pain The most basic solution to avoid the risk of prolonged sitting at workplace is; Sit, Stand, and move around… One option is to switch to a stand up table and they are gaining popularity today An electric standing desk will give you the option of raising and lowering you desk quickly and easily throughout the day Sit up for 5 -10 mins every 1 hr But if this is not possible:

20. Causes of Low Back Pain Always keep your backbone straight whilst sitting.  By keeping your backbone as straight as possible you place less pressure on your internal organs  Do not get so involved with your job that you sit for long periods of time. If you stand up even for thirty seconds, you’re giving your muscles and entire body a much needed break from sitting and avoid prolonged sitting.

21. Causes of Low Back Pain

22. Causes of Low Back Pain Standing for long periods without moving Poor sitting or sleeping posture  The back is prone to a range of problems most of them caused by ; Obesity Lack of regular exercises Bad posture

23. Causes of LBP

24. Causes of Low Back Pain CAUSES: Lifting heavy objects incorrectly Carrying a heavy backpack on one shoulder Activities which involve excessive bending of the waist

25. Psychological Factors.

26. Socio-economic risk Factors Social Issues May Contribute to Chronic LBP Job dissatisfaction/loss of ability to work Pursuit of disability compensation Substance abuse Family dynamics Financial issues Loss of social identity or context Loss of ability to participate in recreational activities

27. Associated Risks

28. Associated Risk

29. Summary of its causes.

30. Diagnosis.

31. Assessing Back Pain

32. Assessing Low Back Pain

33. Symptoms of Low Back Pain

34. Symptoms Contd.

35. Symptoms Contd.

36. Symptoms Contd.

37. Implication: WORK AND PRODUCTIVITY LOSS

38. Investigation Investigations X-rays : bone spurs, decreased disc height and facet hypertrophy in older patients.  CT : more accurate and detailed picture of the bony anatomy – less accurate than MRI in estimating the degree of compromise of the soft tissue elements. – thus can underestimate the degree of stenosis – spinal canal < 10mm AP diameter = Absolute Stenosis

39. Investigations

40. Investigations Contd.  MRI : (without gadolinium) – currently represents the "gold standard" in the evaluation of central stenosis. – allows visualization of disc, neural elements, ligamentum flavum & thecal sac

41. Investigations Contd.

42. General Assessment!

43. Pitfalls! Up to 80% of patients cannot be given a definite diagnosis because of the poor co-relation between symptoms, clinical findings and imaging results High incidence of false negatives on imaging No diagnostic lab tests that reveal the cause of LBP Outcome of treatment difficult to quantify and predict

44. Management Pharmacological – NSAIDS – intolerance, cautions, gels, coxibs – Co-analgesics – TCA, anticonvulsants, ms –relaxants – Opioids & compound codeine preparations

45. Management  Injection Therapy – Epidural steroids – lumbar, caudal – Facet joint injection, Sacro -iliac joint injection, coccyx – Nerve root infiltration  Physiotherapy  Acupuncture & TENS  Pain management – psychological approaches

46. The Red Flag Signs

47. Surgical Intervention

48. Management. Surgical treatment Urgent operations are required in cases like progressive neural deficit, cauda equine syndrome, lumbar trauma with instability, tumours and infections (the red flags ) . The non-urgent operation operation is for persistent pain that does not respond to proper conservative measures or mechanical LBP with instability.

49. Management Contd.

50. Prevention of Low Back Pain It is quite difficult to prevent low back pain due to the typical wear and tear that occurs at the back Certain practices can however be used to minimize the occurrence of the condition such as:

51. Prevention of Low back Pain Regular Exercise:- Exercise such as swimming and jogging are very good in preventing low back pain. Lifting Items using the legs as the center of support, NOT THE BACK Maintaining a manageable body weight Standing and sitting using the right posture. etc

52. Prevention of low back pain

53. Prevention Tips!

54. References

55. Thank You!