Schematic cross-section of an inter-vertebral disc Herniated disc

Causal factors for back pain… Spinal fracture Herniated disc TB spine Mechanical low back pain - Diagnosis of exclusion – 75-80% of cases. Spinal Fracture Herniated Disc TB Spine

Spinal fracture

Herniated disc

TB spine

Mechanical low back pain - Diagnosis of exclusion – 75-80% of cases.

Trigger factors Excessive load on normal back Long / erratic hours Poor workplace ergonomics Stress: Physical, mental and emotional Travel

Excessive load on normal back

Long / erratic hours

Poor workplace ergonomics

Stress: Physical, mental and emotional

Travel

Trigger factors (contd)… Normal load on weak or unprepared back Fatigue Improper posture/ chronic malpositioning Lack of exercise, poor physical conditioning Weight control problems Poor posture

Normal load on weak or unprepared back

Fatigue

Improper posture/ chronic malpositioning

Lack of exercise, poor physical conditioning

Weight control problems

Three phases of management strategy… Treatment of acute episodes. Amelioration of chronic condition. Prevention of exacerbation/ reinjury.

Treatment of acute episodes.

Amelioration of chronic condition.

Prevention of exacerbation/ reinjury.

The case against protracted rest Deconditioning: Loss of muscle strength and endurance C hance of micro traumatic injury Protracts recurrent episodes Maintains chronic disability Decreased flexibility Adversely modifies spinal biomechanics Physiology of disc hydration affected “ Avoid pill popping”

Deconditioning: Loss of muscle strength and endurance

C hance of micro traumatic injury

Protracts recurrent episodes

Maintains chronic disability

Decreased flexibility

Adversely modifies spinal biomechanics

Physiology of disc hydration affected

Exercise - for which patients? Central focus in 95% cases “ YES” in mechanical causes “ NO” in non-mechanical causes

Central focus in 95% cases

“ YES” in mechanical causes

“ NO” in non-mechanical causes

Exercise types… Back-specific exercises Peri-pelvic and LL flexibility and strengthening Aerobic conditioning Double knee to chest stretch

Back-specific exercises

Peri-pelvic and LL flexibility and strengthening

Aerobic conditioning

Pelvic tilt Some exercises for the back… Lower trunk rotation stretch

Trunk Flexion Stretch Trunk flexion stretch Prone lumbar extension Some exercises for the back…

Alternate Prone Leg Extension Alternate prone leg extension Aerobic conditioning

Abdominal Strengthening Abdominal strengthening

Lower Limb Stretches Lower limb stretches

Complementary therapy Back hygiene and back school Correction of biomechanical factors Posture Weight control

Back hygiene and back school

Correction of biomechanical factors

Posture

Weight control

Weight training Yoga

Yoga The right chair Counter height

Working Posture Posture at work The right posture…

Sitting Posture Sitting posture Forward bending

Pulling an Object Pulling an object

Thank you