Dr.Aman Sachdeva

Senior Physiotherapist

SitaramBhartia Institute of Science and Research

LOW BACK ACHE

BACK ACHE AND MOTHER IN LAW

• Most people have got it

• If you don’t have it, it will come sometimes

• If you are lucky it wont visit you for long

• When it leaves you hopefully it wont take away too much

• Even when it goes away there is always a chance it will come back

KNOW YOUR BACK

Anatomy : Complex structure of bones & cartilge supported by muscles

• Bones: 33 vertebra• Ligaments• Muscles• Nerves & Spinal

Cord

CAUSES OF LOW BACK PAIN• Non Specific• Nerve root entrapment- Sciatica• Spondylolysis• Spine fracture• Infection eg. TB• Cancer• Arthritis eg Ankylosing Spondylitis• Traumatic• Metabolic- Osteoporosis/ Osteomalacia• Referred pain from abdomen

RISK FACTORS

• Overweight

• Sedentary lifestyle

• Heavy manual workers

• Prolonged standing in an awkward posture

• Physical factors such as heavy physical work, frequent bending, twisting, lifting, pulling and pushing, repetitive work, static postures and vibrations.

CLASSIFICATION

• MECHANICAL

• NEUROLOGICAL

MECHANICAL BACK PAIN• By far the commonest type, possibly related to

posture/ activities cannot identify any disease process

• Dysfunction of ligamentous or musculoskeletal structures)

Ligament strain Facet joint strain Muscle strain Disc degeneration• Types

– Acute– Chronic

MECHANICAL BACK PAIN cont ...

• Acute Low back pain

Less than 6 weeks old

Overall good prognosis

Postural cause very common

May be related to over activity ,lifting weights/ twisting

• Chronic back pain

Over 6 weeks duration

Needs evaluation

DIAGNOSIS• History• Examination• Blood test

Hb, TLC, DLCESRCalcium/ PhosphateAlkaline Phosphatase

• Radiological investigations X rays CT Scan MRI Bone Scan Bone Density

RED FLAGS Worry

• Very young and very old with first onset of pain (below 20 yrs & above 55yrs)

• History of Cancer• History of fever & weight loss• Night pain• Ill health or other medical problems• Bladder & Bowel problems• Mid back pain • Significant & progressive weakness

PREVENTIONOF LOW BACK PAIN

WHAT SHOULD WE KNOW

• RISK FACTORS

• IDEAL POSTURES

• EXERCISES

EDUCATION IS THE EDUCATION IS THE KEY TO PREVENTIONKEY TO PREVENTION

POSTURE : THE RULE OF THUMB

STATIC POSTURE• SITTING• DRIVING• LYING• STANDING

DYNAMIC POSTURES

• WALKING• LIFTING• GETTING UP FROM

BED• GETTING UP FROM

CHAIR

IDEAL POSTURES

SITTING STANDING

STANDING

IDEAL POSTURES

DRIVING

LYING

PICKING UP

OFFICE OF HORRORS !

WHAT TO CHECK

• WORKSTATION AND YOUR POSTURE

IDEAL SITTING POSTURE AT DESKTOP

CORRECTING POSTURE

CORRECTING POSTURE

FEW MORE CULPRITS

MATTRESS FOOTWEAR

WALLET OVERLOADED BAG

EXERCISES

DEPENDS UPON THE CAUSE OF PAIN

INCLUDES

• SPINAL MOBILIZATION EXERCISES

• STRECHING EXERCISES

• STRENGTHENING EXERCISES

• GENERAL CONDITIONING EXERCISES

GOALS OF TREATMENT

• To recognize red flags • To recognize disability from simple low back

pain • To relieve pain • To improve ability to function and alleviate

disability • To prevent recurrence and the development of

chronicity

TREATMENT

• REST

• MEDICINES

• PHYSIOTHERAPY

Electrotherapy

Exercises

Postural care

• SURGERY

QUESTIONS

THANK YOU