Mechanical low back pain

1. MECHANICAL LOW BACK PAIN FAIQ AQLI RAZALI (46) AIZAT RUSLIN (42) MUHAMMAD FAHMI (84) MUHAMMAD HANIF (69)

2. Definition Low back pain originating from the disc, vertebral body, or posterior elements or might be unrelated to the spine. A common musculoskeletal symptom that may be either acute or chronic.

3. Pathogenesis/ Pathophysiology Many causes of mechanical low back pain exist . Musculoskeletal causes: Nerve root syndromes Musculoskeletal pain syndromes Skeletal causes

4. Nerve Root Syndromes Classic nerve root syndrome is characterized by radicular pain arising from nerve root impingement due to herniated discs. Impingement pain tends to be sharp, well localized, and can be associated with paresthesia, associated with a positive straight leg raising sign

5. Nerve Root Syndromes I mpingement syndrome is most commonly herniated discs, but it may also be caused by spinal stenosis, spinal degeneration, or cauda equina syndrome.

6. Musculoskeletal Pain Syndromes Musculoskeletal pain syndromes that produce low back pain include: Myofascial pain syndromes characterized by pain and tenderness over localized areas (trigger points), loss of range of motion in the involved muscle groups, and pain radiating in a characteristic distribution but restricted to a peripheral nerve.

7. Musculoskeletal Pain Syndromes Fibromyalgia Pain and tenderness on palpation of 11 of 18 trigger points, one of which is the low back area, Generalized stiffness, fatigue, and muscle ache are reported.

8. Skeletal Causes Osteomyelitis I nfectious processes involving the bones of the spine. Sacroiliitis I nflammatory changes in the sacroiliac joints. Malignancy P rimary or metastatic

9. Differential Diagnoses Aneurysm, Abdominal Appendicitis, Acute Ectopic Pregnancy Endometriosis Neoplasms, Spinal Cord Ovarian Cysts Pelvic Inflammatory Disease Perirectal Abscess Prostatitis Renal Calculi Urinary Tract Infection, Female Urinary Tract Infection, Male

10. Acute Mechanical Low Back Pain Most commonly caused by a sprain or muscle tear. The pain is usually localized, and there may be muscle spasms or soreness. The patient usually feels better when resting.

11. Chronic Mechanical Low Back Pain Caused by chronic strain on the muscles of the lower back may be caused by obesity; pregnancy; or job-related stooping, bending, or other stressful postures.

12. Treatment of Mechanical Low Back Pain

13. Bed Rest & Exercise One or two days of bed rest if necessary Advice to stay active: ‘There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica.’ Hurt does not equal harm Light activity, avoiding heavy lifting, bending or twisting ( ie . walking) No data on any particular exercises

14. Medications Anti-inflammatory medications (NSAID’s): Beneficial (relief pain) , watch side-effects Narcotic Pain Relievers: More effective than NSAID’s Many side effects Muscle Relaxants ( ie . Flexeril ® ): Can decrease pain and improve mobility 70% with drowsiness/dizziness

15. Chiropractic/Osteopathic Spinal manipulation Conflicting evidence on the effects of spinal manipulation ~75-90% improvement anyway within 4 weeks Greater patient satisfaction

16. Massage & Physical Therapy Might be beneficial Physical therapy modalities: TENS, ultrasound, hot packs, massage

17. THANK YOU