LOW BACK PAIN causes and treatment Everything You Need To Know Dr Nabil Ebraheim



Published
Dr. Ebraheim’s educational animated video about low back pain and the causes and treatment.
Important facts of low back pain:
No definite etiology in 85% of the cases.
90% of the patients with a single episode of low back pain return to work within 6 weeks.
Most patients get better with time.
2nd most common cause of work absenteeism.
History of low back pain is the single most important factor predicting future occupational low back pain.
Persistent back pain more than 6 months constitutes 40% of the cases.
Disability is closely linked to compensation and litigation.
The least amount of pressure is measured with the patient lying supine.
Highest disc pressure measured while sitting and 20 degrees forward leaning with 20 kg load in arms.
By keeping the weight of the load close to the body, this reduces the compressive forces placed on the lumbar spine.
Yoga activities and exercises performed during sitting probably have less pressure being placed on the discs.
Physical factors which lead to low back pain:
•Lack of fitness
•Heavy lifting of objects: holding loads close to the body is important to reduce compression forces on the lumbar spine.
•Operating motor vehicles
•Prolonged sitting.
•Operating vibrating tools.
•History of cigarette smoking. Nicotine causes disc degeneration.
Examples of sports-related activities related to low back pain:
Golf:
•Pain as a result of twisting, bad forward bending and overarching the spine during the swing.
•After the age of 40, you lose 50% of your rotational movement of the spine.
•It is important to perform stretching and warmups before starting the game.
Horseback riding
•Vibration caused by horseback riding increases the load on the discs.
•The back muscles work constantly to keep your posture straight.
•Caring for horses could be bad for the back due to the bending and lifting associated with their care.
Etiology
Virtually any structure in the spine can hurt:
•Facet Joints
•Intervertebral discs
•Spinal canal
•Sacroiliac joint.
•Muscles
•Ligaments
•Nerves
•Hip joint/piriformis syndrome
•Trochanteric bursitis
Red flags for cancer:
•Over 50 years of age
•Pain at rest and night
•Unexplained weight loss
•History of cancer
•Bone destruction involving the pedicle is pathognomonic.
Red flags for infection
•Diabetes mellitus
•Fever
•Intravenous drug abuse
•Urinary tract infection
•Previous surgery.
Physical examination
Initial assessment
Focus on red flags ( fractures, tumor, infection or cauda equina)
Signs and symptoms of cauda equina
•Back pain
•Bowel or bladder disturbances
•Bilateral leg pain and weakness
•Saddle anesthesia (rectal and genital area sensory changes).
In the absence of red flags, imaging studies are usually not helpful in the first 4-6 weeks.
Intensive workup may not be necessary for early stages of routine low back pain.
Treatment of low back pain
Conservative treatment
•Maximum 2-3 days of bed rest.
•Pain control: NSAIDS, Medrol dose pack. Watch for NSAIDS toxicity: gastritis, visceral bleeding, platelet dysfunction, renal dysfunction)
•Physical therapy as soon as pain control is achieved.
•Soft brace or a corset. The most effective braces that have high extension restrict 50-65% of the normal gross body motion.
•Epidural injection: up to 50% success rate, often short-lived improvement.
•Return to work: patients sustaining chronic disabling occupational low back pain without any intensive rehabilitation.
•If out of work for 6 months, 50% return to work.
•If out of work for 1 year, 20% return to work.
•If out of work for more than 2 years, almost none return to work.
•The best treatment for acute low back pain is to continue with ordinary daily activities within the limits permitted by the pain.
•The best treatment for low back pain patients is to go to work.
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Health
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