Back pain.pdf

Back pain Dr Dean Everett Wright 2019 epidemiology 50 to 80% all people LBP types what it is Pain T spine to pelvis either Mechanical vs nonMechanical causes Muscle strain most common degenerative disorders lumbar spinal stenosis lumbar disc herniation discogenic back pain Risk factors Obesity/ fema...

Back pain Dr Dean Everett Wright 2019 epidemiology 50 to 80% all people LBP types what it is Pain T spine to pelvis either Mechanical vs nonMechanical causes Muscle strain most common degenerative disorders lumbar spinal stenosis lumbar disc herniation discogenic back pain Risk factors Obesity/ female/ smoking lifting/ vibration/ prolonged sitting job dissatisfaction RED FLAGS symptoms/ signs Caption RED FLAG fall/ injury loss bowel/bladder control groin numbness limb weakness RED FLAG fever pain coughing/ urinating pain worse at rest RED FLAG history of cancer unintentional weight loss, long-term steroid use, weak immune system, history of IV drug use pain coughing/ urinating pain worse at rest red flags infection fever/ chills/ IV drug user tumour h/o cancer trauma MVA/ fall cauda equina bowel/ bladder issues symptoms axial pain spondylogenic/ musculogenic discogenic pain mechanical pain sacroiliac symptoms Neurogenic pain radicular pain referred pain neurogenic claudication myelopathy symptoms Neurogenic pain conus medullaris syndrome cauda equina Spinal cord injury symptoms ? psychogenic pain malingerer Wadell signs Waddell signs NON organic back pain superficial / non anatomic tenderness negative SLR/ distract patient regional symptoms / signs that are NOT dermatomal overreaction Xray IF Pain > 1 month NON responsive to NON op Mx RED FLAGS MRI RED FLAGS MRI ABN findings abound in N asymptomatic people disc prolapse ⇧⇧ age/ 20% to 40% age 20 to 70 disc bulge ⇧⇧ age/ 50% to 80% age 20 to 70 disc degeneration ⇧⇧ age 30% to 90% age 20 to 70 DDx Neck/ arm cervical spondylosis cervical radiculopathy cervical myelopathy cancer (primary/ metastatic) Infection ankylosing spondylitis DDx Thorax/ Upper back; Rib osteoporotic compression fracture cancer (primary/ metastatic) Infection thoracic disc herniation Muscle strains sports/ golf/ tennis carrying heavy load reach high Muscle strains pain swelling ± nerve compression (shooting pain) Muscle strains/ REHAB Begin when pain starts to recede gentle stretch avoid lifting weights IF pain persists?? MYOFASCIAL PAIN MYOFASCIAL PAIN Muscle pain sensory/ motor/ autonomic symptoms myofascial trigger points Myofascial trigger point hyperirritable spot within taut band of skeletal muscle painful on compression causes REFERRED PAIN/ motor/ sensory/ autonomic issues Myofascial trigger point active trigger spontaneous pain/ triggers local/ referred pain latent trigger sensitive spot/ pain on pressure Myofascial trigger point tightness twitching painful knot causes Spine injury/ Trauma Poor posture mental/ emotional myofacial pain fibromyalgia regional widespread triggers ➨ referred pain triggers NOT cause referred pain triggers asymmetric triggers symmetric Rx Myofascial pain Multidisciplinary myofascial release MF release Massage muscles move up/ down Release firm pressure MF pain Rx Medications Physiotherapy PhysioRx MASSAGE HEAT Electrical Stimulation (TENS) Ultrasound Education/stretches Other Rx Dry needling Trigger point injections acupuncture LBP Acute sudden x days to weeks Chronic > 3 months LBP Muscle strain: A sports injury, fall, or strenuous activity can strain muscles and ligaments. Lack of exercise increases the risk. Bulging or herniated disc: The gel-like center of a spinal disc can bulge or rupture through a weak area in the disc wall and compress nerves. Stenosis: Narrowing of the bony canals in the spine can compress the spinal cord and nerves. Osteoarthritis (degenerative disc disease): As discs naturally age they dry out and shrink. Small tears in the disc wall can be painful. Bone spurs can form. The facet joints enlarge and ligaments thicken. prevention Proper lifting techniques Good posture during sitting, standing, moving, and sleeping Regular exercise with stretching and strengthening An ergonomic work area Good nutrition, healthy weight, lean body mass Stress management and relaxation techniques No smoking SCIATICA gluteal stretch planks planks Rx rest, ice or heat, massage, pain relievers, and gentle stretches. Medications panadol NSAIDs muscle relaxant steroids PhysioRx prevention Prevention is key to avoiding recurrence: Proper lifting techniques Good posture during sitting, standing, moving, and sleeping Regular exercise with stretching and strengthening An ergonomic work area Good nutrition, healthy weight, lean body mass Stress management and relaxation techniques No smoking results 90% are symptom-free within 1 to 2 weeks and 10% recover within 3 months. regular job duties cannot be performed initially, modified (light or restricted) duty may be prescribed for a limited time. Sciatica Back pain problem with sciatic nerve/ its roots radiating to below knee radiates below knee “Type a quote here.” –Johnny Appleseed herniated disk cause lumbar spinal stenosis spinal tumours piriformis syndrome sacroiliitis trauma Rx stretches steroid injection discectomy Preventing Sciatica Exercise regularly. Maintain good posture. Bend at the knees to lift heavy objects. DDx Low back pain disc herniation/ discogenic degenerative spondylolisthesis spinal stenosis Abdominal Aortic Aneurysm DDx Sacroiliac/ sacral Coccygodynia fracture ankylosing spondylitis infection TREAT CAUSE