Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA
LOWER BACK PAIN
ETIOLOGY:
There is no definite etiology in 85% of cases. It is one of the most common cause of occupational absenteeism.
SITES OF PAIN:
1. Facet joints
2. Intervertebral discs
3. Spinal canal
4. Sacroiliac joint
5. Muscles
6. Ligaments
7. Nerves
8. Hip joint/ piriformis syndrome
PHYSICAL FACTORS CAUSING LOWER BACK PAIN:
1. Lack of fitness
2. Heavy lifting objects
3. Prolonged sitting
4. Operating motor vehicles, vibrating tools
5. Smoking
6. Sports like golf, horse back riding
RED FLAG SIGNS FOR CANCER:
1. Age more than 50 years
2. Pain at rest and night.
3. Unexplained weight loss
4. History of cancer
5. Bone destruction involving the pedicle
RED FLAG SIGNS FOR INFECTION:
1. Diabetes mellitus
2. Fever
3. Urinary tract infection
4. Previous surgery
5. Intravenous drug abuse
6. Previous surgery
WORK UP FOR BACK PAIN:
1. Look for red flag signs
2. Imaging studies. In the absence of red flag signs, intensive work up or imaging studies may not be helpful in the initial 4-6 weeks.
TREATMENT:
1. Bed rest not more than 2-3 days.
2. Exercise, physiotherapy.
3. Soft brace- may restrict 50- 65% of the normal gross body motion.
4. Epidural injection- often short lived improvement.
5. Continue daily activities within the limits permitted by pain.
PROGNOSIS:
Most patients return to work or normal routine activities with physical rehabilitation.
Leave a Reply