LOW BACK PAIN
- a complaint that often causes the individual to seek help from the medical system
- Four of five adults will experience significant LBP sometime during their lives
- After the common cold, LBP is the most frequent cause of lost workdays in adults younger than 45 years
- Most cases of LBP are not serious and respond to simple treatments such as rest or anti-inflammatory drugs
- Common Causes:
> poor conditioning
> improper use of the back
> obesity
> smoking
> age
> simple wear and tear over time
- most common causes of structural problems of LBP:
> Osteoporosis
> arthritis
> fractures of the spine
> protruding disks
-=SPINAL ANATOMY=-
VERTEBRAL COLUMN
- composition:
> vertebrae
> intervertebral disks
- parts of vertebrae
> vertebral body - weight-bearing component
> vertebral arch – composed of two pedicles (one on each side) that extend into the lamina
> laminae - join together to form the vertebral foramina
> vertebral foramina - make up the vertebral canal in which the spinal cord resides
> vertebral process - three bony projections from the pedicle and joining of laminae
= lateral process - form joints with adjacent vertebrae superiorly and inferiorly
> intervertebral foramen - Between the joint of adjacent vertebrae; where the spinal nerves enter and exit
> spinous process - where muscles attach ; back of the spinal arch
- low back region – 5 lumbar vertebrae
- intervertebral disk
> composition:
= fibrocartilage
= nucleus pulposus (central mass of pulpy tissue)
> shock absorber
> provide flexibility for movement
> supine position – relieve of pressure
- Anterior and posterior longitudinal ligaments
> extend the length of the vertebral column
> attached to the vertebral bodies and intervertebral disks
> check excessive movement of the column
- sacrum
> lower fused portion of the vertebral column
> attached to the pelvis
Muscles of the lumbar spine
- intertransversarii and interspinalis
> connect the transverse process to the spinous process of adjacent vertebrae
- lumbar muscles:
> lumbar multifidus – extensor
> lumbar longissimus – extensor, lateral flexor
> iliocostalis – extensor, lateral flexor
- muscles of the abdominal wall - stabilization of the spine
> transversus abdominis – Corseting effect
> obliquus internus abdominis - Corseting effect
-=INCIDENCE (occurrence) OF LBP=-
- 90% of clients – resolve within 6 weeks
- 5% - resolves in 12 weeks
- Less than 1% - due to ‘serious’ spinal disease (e.g., tumor, infection)
- Less than 1% - from inflammatory disease
, - less than 5% - true nerve root pain
- cause:
> poor physical fitness
> obesity
> reduced muscle strength and endurance
> use of poor body mechanics
- Problems:
> Sciatic (nerve root) pain - nerve is entrapped by a herniated disk
> Spinal stenosis - Narrowing of the intervertebral foramen decreases the space where the spinal nerve exits or enters the spine.
> Facet joint pain - Inflammation or changes in the spinal joints cause facet joint pain.
> Spondylosis - stress fracture of the dorsal to the transverse process.
> Spondylolisthesis - One vertebra slips on another.
> Herniated nucleus pulposus - Stress may tear fibers of the disk and result in an outward bulge of the enclosed nucleus pulposus. This
bulge may press on spinal nerves and cause various symptoms, including nerve entrapment.
> Compression/stress fractures - These fractures are usually a result of osteoporosis and occur in the vertebrae
-=REHABILITATION=- > Finances
- team:
> physician PHYSICAL THERAPY
> occupational therapist - address:
> physical therapist > pain
> caseworker > spasms
> Psychologist > limited flexibility
> vocational counselor > posture
> social worker - PT evaluation:
> discharge planner > mechanism of injury
> nutritionist > date of injury
> nurse > progression of symptoms
- issues that needs to be addressed > medical history
> decreased job satisfaction > recent tests and procedures
> anxiety > medications
> past treatment history
PHYSICIAN > previous level of functioning
- responsible for the initial work-up (or evaluation) of the client > client’s goal for therapy
- examination: - subjective:
> medical history > hx of ADL
> current symptoms and complaints > sleep disturbances
> functional limitations - objective: analysis of:
> posture > posture
> gait > gait
> strength > active range of motion (ROM) of the spine
> reflexes and sensation > active ROM of the extremities
> past interventions for this problem > pelvic symmetry
- additional tests: > signs of nerve tension
> nerve conduction tests > strength
> computed tomography scans > reflexes and sensation
> magnetic resonance imaging > leg length
> blood work > palpation of soft tissue
- after diagnosis: - tx plan
> prescribes medication > pain and spasm control
> determines restrictions in activity > exercises
> exercise guidelines > determination of the pelvic basis for daily activities
- re-evaluation after 1-2 weeks > symptoms not decreased = pt can > patient education
be referred to PT - PT Goals:
- areas of clients life that can be affected: (affect the outcome of > reduce symptoms
treatment) > increase strength and flexibility to achieve a functional
> personal interactions pain-free outcome for the client
> work, finances
- a complaint that often causes the individual to seek help from the medical system
- Four of five adults will experience significant LBP sometime during their lives
- After the common cold, LBP is the most frequent cause of lost workdays in adults younger than 45 years
- Most cases of LBP are not serious and respond to simple treatments such as rest or anti-inflammatory drugs
- Common Causes:
> poor conditioning
> improper use of the back
> obesity
> smoking
> age
> simple wear and tear over time
- most common causes of structural problems of LBP:
> Osteoporosis
> arthritis
> fractures of the spine
> protruding disks
-=SPINAL ANATOMY=-
VERTEBRAL COLUMN
- composition:
> vertebrae
> intervertebral disks
- parts of vertebrae
> vertebral body - weight-bearing component
> vertebral arch – composed of two pedicles (one on each side) that extend into the lamina
> laminae - join together to form the vertebral foramina
> vertebral foramina - make up the vertebral canal in which the spinal cord resides
> vertebral process - three bony projections from the pedicle and joining of laminae
= lateral process - form joints with adjacent vertebrae superiorly and inferiorly
> intervertebral foramen - Between the joint of adjacent vertebrae; where the spinal nerves enter and exit
> spinous process - where muscles attach ; back of the spinal arch
- low back region – 5 lumbar vertebrae
- intervertebral disk
> composition:
= fibrocartilage
= nucleus pulposus (central mass of pulpy tissue)
> shock absorber
> provide flexibility for movement
> supine position – relieve of pressure
- Anterior and posterior longitudinal ligaments
> extend the length of the vertebral column
> attached to the vertebral bodies and intervertebral disks
> check excessive movement of the column
- sacrum
> lower fused portion of the vertebral column
> attached to the pelvis
Muscles of the lumbar spine
- intertransversarii and interspinalis
> connect the transverse process to the spinous process of adjacent vertebrae
- lumbar muscles:
> lumbar multifidus – extensor
> lumbar longissimus – extensor, lateral flexor
> iliocostalis – extensor, lateral flexor
- muscles of the abdominal wall - stabilization of the spine
> transversus abdominis – Corseting effect
> obliquus internus abdominis - Corseting effect
-=INCIDENCE (occurrence) OF LBP=-
- 90% of clients – resolve within 6 weeks
- 5% - resolves in 12 weeks
- Less than 1% - due to ‘serious’ spinal disease (e.g., tumor, infection)
- Less than 1% - from inflammatory disease
, - less than 5% - true nerve root pain
- cause:
> poor physical fitness
> obesity
> reduced muscle strength and endurance
> use of poor body mechanics
- Problems:
> Sciatic (nerve root) pain - nerve is entrapped by a herniated disk
> Spinal stenosis - Narrowing of the intervertebral foramen decreases the space where the spinal nerve exits or enters the spine.
> Facet joint pain - Inflammation or changes in the spinal joints cause facet joint pain.
> Spondylosis - stress fracture of the dorsal to the transverse process.
> Spondylolisthesis - One vertebra slips on another.
> Herniated nucleus pulposus - Stress may tear fibers of the disk and result in an outward bulge of the enclosed nucleus pulposus. This
bulge may press on spinal nerves and cause various symptoms, including nerve entrapment.
> Compression/stress fractures - These fractures are usually a result of osteoporosis and occur in the vertebrae
-=REHABILITATION=- > Finances
- team:
> physician PHYSICAL THERAPY
> occupational therapist - address:
> physical therapist > pain
> caseworker > spasms
> Psychologist > limited flexibility
> vocational counselor > posture
> social worker - PT evaluation:
> discharge planner > mechanism of injury
> nutritionist > date of injury
> nurse > progression of symptoms
- issues that needs to be addressed > medical history
> decreased job satisfaction > recent tests and procedures
> anxiety > medications
> past treatment history
PHYSICIAN > previous level of functioning
- responsible for the initial work-up (or evaluation) of the client > client’s goal for therapy
- examination: - subjective:
> medical history > hx of ADL
> current symptoms and complaints > sleep disturbances
> functional limitations - objective: analysis of:
> posture > posture
> gait > gait
> strength > active range of motion (ROM) of the spine
> reflexes and sensation > active ROM of the extremities
> past interventions for this problem > pelvic symmetry
- additional tests: > signs of nerve tension
> nerve conduction tests > strength
> computed tomography scans > reflexes and sensation
> magnetic resonance imaging > leg length
> blood work > palpation of soft tissue
- after diagnosis: - tx plan
> prescribes medication > pain and spasm control
> determines restrictions in activity > exercises
> exercise guidelines > determination of the pelvic basis for daily activities
- re-evaluation after 1-2 weeks > symptoms not decreased = pt can > patient education
be referred to PT - PT Goals:
- areas of clients life that can be affected: (affect the outcome of > reduce symptoms
treatment) > increase strength and flexibility to achieve a functional
> personal interactions pain-free outcome for the client
> work, finances
