Definition Low back pain originating from the disc, vertebralbody, or posterior elements or might be unrelated tothe spine. A common musculoskeletal symptom that may beeither acute or chronic.
Pathogenesis/ Pathophysiology Many causes of mechanical low back pain exist. Musculoskeletal causes:1) Nerve root syndromes2) Musculoskeletal pain syndromes3) Skeletal causes
Nerve Root Syndromes Classic nerve root syndrome ischaracterized by radicular painarising from nerve rootimpingement due to herniateddiscs. Impingement pain tends to besharp, well localized, and canbe associated withparesthesia, associated with apositive straight leg raisingsign
Nerve Root Syndromes Impingement syndrome is most commonly herniateddiscs, but it may also be caused by spinalstenosis, spinal degeneration, or cauda equinasyndrome.
Musculoskeletal Pain Syndromes Musculoskeletal pain syndromes that produce lowback pain include: Myofascial pain syndromes characterized by pain and tenderness over localized areas(trigger points), loss of range of motion in the involved musclegroups, and pain radiating in a characteristic distribution butrestricted to a peripheral nerve.
Musculoskeletal Pain Syndromes Fibromyalgia Pain and tenderness on palpation of 11 of 18 triggerpoints, one of which is the low back area, Generalizedstiffness, fatigue, and muscle ache are reported.
Skeletal Causes Osteomyelitis Infectious processes involving thebones of the spine. Sacroiliitis Inflammatory changes in the sacroiliacjoints. Malignancy Primary or metastatic
Acute Mechanical Low Back Pain Most commonly caused by a sprain or muscle tear. The pain is usually localized, and there may bemuscle spasms or soreness. The patient usually feels better when resting.
Chronic Mechanical Low Back Pain Caused by chronic strain on the muscles of the lowerback may be caused by obesity; pregnancy; or job-related stooping, bending, or other stressfulpostures.
Bed Rest & Exercise• One or two days of bed rest if necessary• Advice to stay active:– ‘There is no evidence that advice to stay active isharmful for either acute low back pain or sciatica.’– Hurt does not equal harm• Light activity, avoiding heavy lifting, bendingor twisting (ie. walking)• No data on any particular exercises
Medications• Anti-inflammatory medications (NSAID’s):– Beneficial (relief pain) , watch side-effects• Narcotic Pain Relievers:– More effective than NSAID’s– Many side effects• Muscle Relaxants (ie. Flexeril®):– Can decrease pain and improve mobility– 70% with drowsiness/dizziness
Chiropractic/Osteopathic• Spinal manipulation• Conflicting evidence on the effects of spinalmanipulation– ~75-90% improvement anyway within 4 weeks• Greater patient satisfaction
Massage & Physical Therapy1. Might be beneficial2. Physical therapy modalities:TENS, ultrasound, hot packs, massage