Acute back pain

Acute back pain

by Thomas Lemon, Cardiff University

AimsClassification of acute back painImportance of acute back painIdentify common aetiology of acute back painIdentify RED FLAG symptomsIdentify treatment possibilitiesWays to avoid re- injury

ClassificationAcute less than 4 weeksSub acute 4-12 weeksChronic greater than 3 months

ALSO anatomically - Neck pain- Upper back pain- Lower back pain

Leading cause of disability in American under 45s

Bigger picture things to considerEconomical aspects disability of workforce

Sick days

Quality of work carried out when suffering pain

Common causesSleeping position Poor postureCarrying a heavy backpackStress and muscle tensionIncorrect liftingSudden physical exertionAccidental

Backpacks

AlsoLack of muscle tone

Excess weight

Pregnancy

Arthritis ( Chronic)

RED FLAGSNumbness or difficulty moving extremitiesImpaired bladder controlFever or severe headache60+ and history of long term steroid useMI or angina symptomsPregnancyNo improvement within 72 hours

TreatmentHome remedies

Hot and cold compresses

NSAIDS, aspirin, ibuprofen, acetaminophen or naproxen sodium

Bed rest IS NOT bestSlow movement is important to good recovery

Preventing re-injuryExercise

Cardiovascular

Stretching

Core strengthening

A Healthy Lifestyle

Nutrient rich diet

Avoid smoking and excessive alcohol

Maintain a healthy BMI

Drink lots of water

QuizA 39 year old care worker presents with acute back pain and right sided buttock pain following lifting a patient. O/E he has reduced R leg raising. Neurological examination normal.

A- Spinal stenosisB-Ankylosing spondylitisC- Prolapsed interverbebral disc

QuizAnswer - Prolapsed intervertebral disc

Why?Neuro signs after examination are present sometimes - otherwise only localised pain due to neural root irritation leading to pain in affected dermatome.

Pain would usually be L4/5 or L5/S1 as most common sites of injury.

Posterior herniation = Cauda Equina compression

Key ReferencesBorenstein DG, O'Mara JW, Boden SD,et al.(2001). "The value of magnetic resonance imaging of the lumbar spine to predict low-back pain in asymptomatic subjects: a seven-year follow-up study".J Bone Joint Surg Am83-A(9): 130611.

Burke,G.L.,MD, (1964). Backache: From Occiput to Coccyx. Vancouver, BC: Macdonald Publishing. "Back Pain Exercises Routine Benefits". Retrieved June 18, 2012

^Hayden J, van Tulder M, Malmivaara A, Koes B (2005). "Exercise therapy for treatment of non-specific low back pain.".Cochrane Database Syst Rev(3): CD000335.DOI:10.1002/14651858.CD000335.pub2.PMID16034851.

Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS (1994). "Magnetic resonance imaging of the lumbar spine in people without back pain".N Engl J Med331(2): 6973

Patel, A.. "Diagnosis and Management of Acute Low Back Pain".American Academy of Family Physicians. Retrieved July 12, 2012

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW (2008). "Non-steroidal anti-inflammatory drugs for low back pain.".Cochrane Database Syst Rev

Savage RA, Whitehouse GH, Roberts N (1997). "The relationship between the magnetic resonance imaging appearance of the lumbar spine and low back pain, age and occupation in males".Eur Spine J6(2): 10614.

White AA, Gordon SL (1982). "Synopsis: workshop on idiopathic low-back pain".Spine7(2): 1419.

Author does not own rights to any images in the presentation.