Low Back Pain & Sciatica, a brief epidemiological introduction and review of 2 articles with conflicting findings addressing the prognostic factors and outcome.
The document discusses lower back pain, which is the second most common cause of office visits. It provides information on the prevalence, causes, treatment options, and prevention of both acute and chronic lower back pain. Common causes include lumbar strain or sprain, degenerative changes, herniated discs, and osteoporosis fractures. For acute pain, recommendations include anti-inflammatory medications, muscle relaxants, chiropractic care, exercise and limited bed rest. For chronic pain lasting over 6 weeks, additional options discussed include antidepressants, physical therapy exercises, injections, and surgeries like diskectomy. Prevention focuses on exercise, weight loss, and proper lifting techniques.
This presentation provides an overview of the 2016 NICE guidance for low back pain and sciatica. It pays particular attention to pragmatic issues surrounding the current call for evidence based medicine and the disconnect between patients wishes and the clinicians expertise and experience. This was presented at an evening seminar for London Sports Orthopaedic Consultant group for Musculoskeletal Physiotherapists.
Differential Diagnosis of Lower Back Painwestwriters
Low back pain is pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, and is defined as chronic when it persists for 12 weeks or more.
Diagnosis and Treatment of Low Back Pain Ade Wijaya
This document summarizes guidelines for diagnosing and treating low back pain from the American College of Physicians and American Pain Society. It recommends clinicians conduct a focused history and physical to classify back pain and assess psychosocial risk factors. Imaging and testing are not routinely needed for nonspecific back pain but may be for severe or progressive neurological symptoms. Options for acute back pain treatment include medications, spinal manipulation, and staying active. Chronic back pain may be helped by interdisciplinary rehabilitation, exercise, acupuncture, massage, spinal manipulation, yoga, or cognitive-behavioral therapy.
The document discusses the Appropriateness Criteria for evaluating back pain, noting that acute low back pain is a leading cause of disability. While most cases are self-limiting, imaging may be warranted to identify red flags like trauma, weight loss, or neurological deficits. Common imaging modalities for back pain are listed along with their strengths and limitations. Plain films are inexpensive but MRI provides the best soft tissue contrast. Imaging correlates best with outcomes when combined with clinical examination, and is usually not needed for uncomplicated back pain without red flags.
This document provides information on low back pain, including its definition, prevalence, costs, causes, examination, diagnosis, and treatment options. Some key points:
- Low back pain is very common, affecting 60-80% of adults at some point. It costs the US over $90 billion annually in direct medical expenses and lost work.
- Causes can be non-spinal (e.g. hernia, infection) or spinal (e.g. arthritis, herniated disc, stenosis).
- Examination involves assessing gait, range of motion, motor strength, sensation, and reflexes. Common diagnostic tests are x-rays, MRI, CT.
- Treatment depends on cause but
This document discusses the evaluation and diagnosis of chronic low back pain through history and physical examination. It outlines common causes of low back pain such as mechanical back pain, radicular pain, and sacroiliac joint dysfunction. The physical exam focuses on inspection, palpation, range of motion testing, and special tests to identify pain generators and neurological involvement. Differential diagnoses are discussed including mechanical back pain, radiculopathy, and conditions affecting the hip.
Low back pain is a common condition affecting 60-80% of adults at some point. It is typically caused by minor trauma or injury to the back muscles or spinal disks in the lumbar region from repeated twisting or lifting of heavy objects. Common causes include degenerative disk disease and spondylosis. Risk factors include jobs involving heavy lifting/twisting and smoking. Symptoms include lower back pain that may radiate to the buttocks or legs along with tenderness, stiffness, and difficulty standing or sitting. Treatment options include allopathy, homeopathy, ayurveda, naturopathy, chiropractic manipulation, hydrotherapy, acupuncture, massage, and yoga or exercise.
The document discusses lower back pain, which is the second most common cause of office visits. It provides information on the prevalence, causes, treatment options, and prevention of both acute and chronic lower back pain. Common causes include lumbar strain or sprain, degenerative changes, herniated discs, and osteoporosis fractures. For acute pain, recommendations include anti-inflammatory medications, muscle relaxants, chiropractic care, exercise and limited bed rest. For chronic pain lasting over 6 weeks, additional options discussed include antidepressants, physical therapy exercises, injections, and surgeries like diskectomy. Prevention focuses on exercise, weight loss, and proper lifting techniques.
This presentation provides an overview of the 2016 NICE guidance for low back pain and sciatica. It pays particular attention to pragmatic issues surrounding the current call for evidence based medicine and the disconnect between patients wishes and the clinicians expertise and experience. This was presented at an evening seminar for London Sports Orthopaedic Consultant group for Musculoskeletal Physiotherapists.
Differential Diagnosis of Lower Back Painwestwriters
Low back pain is pain, muscle tension, or stiffness localized below the costal margin and above the inferior gluteal folds, with or without sciatica, and is defined as chronic when it persists for 12 weeks or more.
Diagnosis and Treatment of Low Back Pain Ade Wijaya
This document summarizes guidelines for diagnosing and treating low back pain from the American College of Physicians and American Pain Society. It recommends clinicians conduct a focused history and physical to classify back pain and assess psychosocial risk factors. Imaging and testing are not routinely needed for nonspecific back pain but may be for severe or progressive neurological symptoms. Options for acute back pain treatment include medications, spinal manipulation, and staying active. Chronic back pain may be helped by interdisciplinary rehabilitation, exercise, acupuncture, massage, spinal manipulation, yoga, or cognitive-behavioral therapy.
The document discusses the Appropriateness Criteria for evaluating back pain, noting that acute low back pain is a leading cause of disability. While most cases are self-limiting, imaging may be warranted to identify red flags like trauma, weight loss, or neurological deficits. Common imaging modalities for back pain are listed along with their strengths and limitations. Plain films are inexpensive but MRI provides the best soft tissue contrast. Imaging correlates best with outcomes when combined with clinical examination, and is usually not needed for uncomplicated back pain without red flags.
This document provides information on low back pain, including its definition, prevalence, costs, causes, examination, diagnosis, and treatment options. Some key points:
- Low back pain is very common, affecting 60-80% of adults at some point. It costs the US over $90 billion annually in direct medical expenses and lost work.
- Causes can be non-spinal (e.g. hernia, infection) or spinal (e.g. arthritis, herniated disc, stenosis).
- Examination involves assessing gait, range of motion, motor strength, sensation, and reflexes. Common diagnostic tests are x-rays, MRI, CT.
- Treatment depends on cause but
This document discusses the evaluation and diagnosis of chronic low back pain through history and physical examination. It outlines common causes of low back pain such as mechanical back pain, radicular pain, and sacroiliac joint dysfunction. The physical exam focuses on inspection, palpation, range of motion testing, and special tests to identify pain generators and neurological involvement. Differential diagnoses are discussed including mechanical back pain, radiculopathy, and conditions affecting the hip.
Low back pain is a common condition affecting 60-80% of adults at some point. It is typically caused by minor trauma or injury to the back muscles or spinal disks in the lumbar region from repeated twisting or lifting of heavy objects. Common causes include degenerative disk disease and spondylosis. Risk factors include jobs involving heavy lifting/twisting and smoking. Symptoms include lower back pain that may radiate to the buttocks or legs along with tenderness, stiffness, and difficulty standing or sitting. Treatment options include allopathy, homeopathy, ayurveda, naturopathy, chiropractic manipulation, hydrotherapy, acupuncture, massage, and yoga or exercise.
Lower Back Pain Symptoms, Diagnosis, and TreatmentRajesh singh
Lower back pain may be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons within the spine.
Exercise and Low Back Pain: How to Get a Strong Core and a Healthier BackPamela Brown
1) Low back pain can be caused by poor movement patterns, lack of postural control, tight hip and ankle muscles, muscle imbalances, and lack of core endurance.
2) Exercises should focus on improving postural control, increasing flexibility of tight muscles like hip flexors, activating weak muscles like glutes, and using the core in functional movements.
3) Core exercises that emphasize a neutral spine in isolation and with movement are recommended, while avoiding exercises that involve spine flexion or twisting until stability improves. Maintaining proper form is important to prevent aggravating back pain.
Low back pain is a common condition that affects 60-80% of people at some point in their lives. It is caused by injuries or strains to the muscles, ligaments or discs in the lower spine. Common symptoms include pain in the lower back that may radiate to the buttocks or thighs. Prolonged sitting, obesity, poor posture, heavy lifting and repetitive bending or twisting can contribute to back pain. Diagnosis is typically based on symptoms and physical exam rather than tests. Treatment involves medications, physical therapy, injections or surgery in severe cases. Maintaining a healthy lifestyle and proper lifting technique can help prevent back pain.
Gingerich back pain presentation (sept. 2012)sepaincare
This document discusses common causes and treatments for chronic low back pain. It provides an overview of pain management as a specialty focused on finding and treating the source of pain. Common causes of chronic low back pain include herniated discs, spinal stenosis, and facet joint arthritis. Treatment approaches include conservative options like physical therapy and medications, as well as more advanced interventional techniques such as epidural steroid injections, radiofrequency ablation, and spinal cord stimulation. The goal of treatment is to control pain, improve function, and enhance quality of life.
This document provides information on the assessment and management of various low back pain conditions. It discusses acute and chronic back pain, sciatica, radiculopathy, spondylolisthesis, and spinal stenosis. Treatment approaches include education, exercises, analgesics, physical therapy, injections, and surgery if conservative options fail. Referral is recommended for urgent cases involving neurological deficits or when pain persists for over 3 months without an identified cause.
Back pain is a common problem that affects up to 90% of the population. It can be classified as acute (less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks). Red flags on history and exam can indicate more serious underlying causes like cancer, infection, or fracture that require further evaluation. For nonspecific back pain without red flags, treatment focuses on analgesics, activity modification, and physical modalities. Referral is considered if red flags are present, pain persists after 4-6 weeks, or neurological deficits develop.
Chronic back pain is defined as pain that recurs and lasts for more than 3-4 months. The document discusses various ways to deal with chronic back pain, including proper sleeping positions, anti-inflammatory medicines, magnetic therapy pads, and exercises to strengthen back muscles while avoiding prolonged bed rest. Magnetic therapy is highlighted as an effective treatment that can help rebalance ion concentrations and reduce inflammation, pain, and muscle spasms for chronic back pain conditions.
1) This document provides guidance on evaluating and differentiating the causes of low back pain through patient history, physical examination, and imaging.
2) The differential diagnosis depends on characteristics of the pain such as duration, location, radiation, and aggravating/relieving factors. Common etiologies include inflammatory, mechanical, and radicular causes.
3) The physical examination focuses on the spine, hips, and tests to reproduce pain including range of motion and provocative maneuvers. Red flags are identified.
4) Imaging like MRI can identify abnormalities in the discs, vertebrae, nerves and surrounding tissues that provide diagnostic clues. Both regular sequences and enhanced images after contrast are useful.
Here are some key references that could be used to support the evaluation, examination, interventions, and outcomes discussed in this case:
- Goniometry measurement techniques
- Manual muscle testing procedures
- Fundamentals of orthopedic management for musculoskeletal conditions
- Principles of therapeutic exercise and rehabilitation
- Modalities like interferential current, aquatic therapy, etc.
- Studies on the effectiveness of different treatment approaches
- Resources on specific techniques like myofascial release, dry needling, lumbar stabilization exercises
- Articles on back safety, ergonomics, body mechanics
Let me know if you need any of the full references included. I selected sources that would be relevant to further examining and treating this particular low back
Low back pain is very common, affecting 80% of adults at some point. The back is made up of vertebrae, discs, and nerves. Low back pain originates in the lumbar region and can range from dull to sharp. Common causes include muscle strains, disc issues, age-related degeneration, and injuries. Risk factors include age, lack of exercise, excess weight, pregnancy, and psychological conditions. Symptoms may include pain that worsens with activity and improves with rest, pain radiating to the legs, and muscle aches. Treatment involves medications, physical therapy, nerve blocks, injections, and sometimes surgery. Prevention focuses on proper lifting, exercise, maintaining a healthy weight, and ergonomic seating and
Low back pain is a common neurological problem with a variety of underlying causes. Pain results from complex interactions between sensory input and neural networks in the spine and brain. Central sensitization can cause disproportionate pain responses and chronic pain even after the original injury has healed. Tramadol is well-suited for treating back pain involving central sensitization due to its effects on opioid, serotonin, and norepinephrine systems in the brain. Proper treatment requires targeting medications to individual symptoms and regularly evaluating patients.
The document discusses lower back pain, including common causes such as disc injuries, degeneration, muscle strains, and nerve root compression. It explains that discs can degenerate naturally over time and have poor blood supply, making them prone to injury and slow to heal. While muscles heal quickly, they can weaken or tighten, contributing to back pain. The document outlines how acute lower back pain lasts up to 6 weeks as tissues heal, while chronic pain lasts over 3 months even though tissues may have healed. It describes how pain pathways become sensitized, causing pain to be felt more often and without real tissue threat. Management strategies discussed include exercise, posture, lifting correctly, and pacing activities to avoid reinforcing pain behaviors.
Low back pain is one of the most common reasons for seeking medical attention. The majority of episodes are self-limited, but some suffer from chronic or recurrent courses. Almost any structure in the back can cause pain, most commonly the intervertebral discs and facet joints. A thorough history and physical exam are important to determine the likely cause and guide appropriate treatment. Imaging such as X-rays, CT, and MRI may help identify structural abnormalities but often are not needed for typical mechanical low back pain.
This document discusses low back pain, including its causes, risk factors, and treatments. It notes that 80% of people will experience low back pain in their lifetime. Common causes include mechanical issues like spinal degeneration or disc herniations that put pressure on nerves. Chiropractic care can help by improving spinal balance and mobility to reduce pain and prevent further issues. Maintaining good posture and exercising are also recommended for prevention and treatment.
The document discusses low back pain from multiple perspectives. It covers epidemiology, costs, causes, mechanics, common injuries, and treatment approaches. The causes of low back pain are multi-factorial, involving both mechanical and central nervous system factors. A common story of low back pain progression is described. Treatment focuses on thorough education, addressing impairments, and modifying activities to reduce mechanical stresses on the spine.
The document discusses several cases of patients presenting with low back pain and how to approach them. It provides guidance on red flags to watch out for that could indicate a serious underlying cause. Conservative treatment is generally recommended as the first approach unless red flags are present. This includes medications, physical therapy, exercise and counseling. Further investigation may be needed if red flags are present or the patient does not improve with initial treatment.
Acute back pain is common and usually non-specific. It is important to thoroughly examine patients to rule out red flags indicating serious underlying causes. Non-specific back pain typically improves within two weeks with medications and staying active. Yellow flags like depression and fear of movement can slow recovery, so it is important to address psychosocial factors as well.
Mr. B is a 37-year-old male who experienced acute lower back pain while working in his yard. He reports dull, burning pain localized to his lower back radiating into his left buttock. Physical examination reveals tenderness over the paraspinous muscles but normal range of motion, strength, and sensation in the lower extremities. Non-surgical management including medications, exercise, and lifestyle modifications is recommended. Further investigations are not needed unless symptoms fail to improve within 4-6 weeks.
Low back ache is a common condition that can have many causes, including mechanical strains, herniated discs, and spinal stenosis. A thorough history, physical exam, and imaging tests are used to diagnose the underlying problem, with treatment depending on the specific cause but often involving rest, physical therapy, medications, or surgery. Radiculopathy and plexopathy can cause low back pain radiating into the legs.
The document discusses low back pain, its prevalence, causes, types of pain, and natural treatment approaches. It notes that low back pain is very common, costly, and can be caused by strains, sprains, herniated discs, and more. Treatment approaches discussed include trigger point therapy, spinal traction, exercise, posture correction, and chiropractic care, which studies have shown to be effective and safe alternatives to medication and surgery.
Understanding the Causes, Symptoms, and Treatments for Sciaticalspineinstitute
Sciatica is caused by compression of the sciatic nerve, which originates in the lower back and extends down the leg. Common causes include degenerative disc disease, facet disease, osteophytes, and spinal stenosis. Symptoms include pain in one or both legs as well as numbness and tingling. Treatment begins with diagnosing the underlying cause through imaging and physical exams. Initial treatment focuses on non-invasive options like medication, exercise, and alternative therapies. Surgery may be considered if more serious conditions are causing nerve compression.
Lower Back Pain Symptoms, Diagnosis, and TreatmentRajesh singh
Lower back pain may be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons within the spine.
Exercise and Low Back Pain: How to Get a Strong Core and a Healthier BackPamela Brown
1) Low back pain can be caused by poor movement patterns, lack of postural control, tight hip and ankle muscles, muscle imbalances, and lack of core endurance.
2) Exercises should focus on improving postural control, increasing flexibility of tight muscles like hip flexors, activating weak muscles like glutes, and using the core in functional movements.
3) Core exercises that emphasize a neutral spine in isolation and with movement are recommended, while avoiding exercises that involve spine flexion or twisting until stability improves. Maintaining proper form is important to prevent aggravating back pain.
Low back pain is a common condition that affects 60-80% of people at some point in their lives. It is caused by injuries or strains to the muscles, ligaments or discs in the lower spine. Common symptoms include pain in the lower back that may radiate to the buttocks or thighs. Prolonged sitting, obesity, poor posture, heavy lifting and repetitive bending or twisting can contribute to back pain. Diagnosis is typically based on symptoms and physical exam rather than tests. Treatment involves medications, physical therapy, injections or surgery in severe cases. Maintaining a healthy lifestyle and proper lifting technique can help prevent back pain.
Gingerich back pain presentation (sept. 2012)sepaincare
This document discusses common causes and treatments for chronic low back pain. It provides an overview of pain management as a specialty focused on finding and treating the source of pain. Common causes of chronic low back pain include herniated discs, spinal stenosis, and facet joint arthritis. Treatment approaches include conservative options like physical therapy and medications, as well as more advanced interventional techniques such as epidural steroid injections, radiofrequency ablation, and spinal cord stimulation. The goal of treatment is to control pain, improve function, and enhance quality of life.
This document provides information on the assessment and management of various low back pain conditions. It discusses acute and chronic back pain, sciatica, radiculopathy, spondylolisthesis, and spinal stenosis. Treatment approaches include education, exercises, analgesics, physical therapy, injections, and surgery if conservative options fail. Referral is recommended for urgent cases involving neurological deficits or when pain persists for over 3 months without an identified cause.
Back pain is a common problem that affects up to 90% of the population. It can be classified as acute (less than 6 weeks), subacute (6-12 weeks), or chronic (more than 12 weeks). Red flags on history and exam can indicate more serious underlying causes like cancer, infection, or fracture that require further evaluation. For nonspecific back pain without red flags, treatment focuses on analgesics, activity modification, and physical modalities. Referral is considered if red flags are present, pain persists after 4-6 weeks, or neurological deficits develop.
Chronic back pain is defined as pain that recurs and lasts for more than 3-4 months. The document discusses various ways to deal with chronic back pain, including proper sleeping positions, anti-inflammatory medicines, magnetic therapy pads, and exercises to strengthen back muscles while avoiding prolonged bed rest. Magnetic therapy is highlighted as an effective treatment that can help rebalance ion concentrations and reduce inflammation, pain, and muscle spasms for chronic back pain conditions.
1) This document provides guidance on evaluating and differentiating the causes of low back pain through patient history, physical examination, and imaging.
2) The differential diagnosis depends on characteristics of the pain such as duration, location, radiation, and aggravating/relieving factors. Common etiologies include inflammatory, mechanical, and radicular causes.
3) The physical examination focuses on the spine, hips, and tests to reproduce pain including range of motion and provocative maneuvers. Red flags are identified.
4) Imaging like MRI can identify abnormalities in the discs, vertebrae, nerves and surrounding tissues that provide diagnostic clues. Both regular sequences and enhanced images after contrast are useful.
Here are some key references that could be used to support the evaluation, examination, interventions, and outcomes discussed in this case:
- Goniometry measurement techniques
- Manual muscle testing procedures
- Fundamentals of orthopedic management for musculoskeletal conditions
- Principles of therapeutic exercise and rehabilitation
- Modalities like interferential current, aquatic therapy, etc.
- Studies on the effectiveness of different treatment approaches
- Resources on specific techniques like myofascial release, dry needling, lumbar stabilization exercises
- Articles on back safety, ergonomics, body mechanics
Let me know if you need any of the full references included. I selected sources that would be relevant to further examining and treating this particular low back
Low back pain is very common, affecting 80% of adults at some point. The back is made up of vertebrae, discs, and nerves. Low back pain originates in the lumbar region and can range from dull to sharp. Common causes include muscle strains, disc issues, age-related degeneration, and injuries. Risk factors include age, lack of exercise, excess weight, pregnancy, and psychological conditions. Symptoms may include pain that worsens with activity and improves with rest, pain radiating to the legs, and muscle aches. Treatment involves medications, physical therapy, nerve blocks, injections, and sometimes surgery. Prevention focuses on proper lifting, exercise, maintaining a healthy weight, and ergonomic seating and
Low back pain is a common neurological problem with a variety of underlying causes. Pain results from complex interactions between sensory input and neural networks in the spine and brain. Central sensitization can cause disproportionate pain responses and chronic pain even after the original injury has healed. Tramadol is well-suited for treating back pain involving central sensitization due to its effects on opioid, serotonin, and norepinephrine systems in the brain. Proper treatment requires targeting medications to individual symptoms and regularly evaluating patients.
The document discusses lower back pain, including common causes such as disc injuries, degeneration, muscle strains, and nerve root compression. It explains that discs can degenerate naturally over time and have poor blood supply, making them prone to injury and slow to heal. While muscles heal quickly, they can weaken or tighten, contributing to back pain. The document outlines how acute lower back pain lasts up to 6 weeks as tissues heal, while chronic pain lasts over 3 months even though tissues may have healed. It describes how pain pathways become sensitized, causing pain to be felt more often and without real tissue threat. Management strategies discussed include exercise, posture, lifting correctly, and pacing activities to avoid reinforcing pain behaviors.
Low back pain is one of the most common reasons for seeking medical attention. The majority of episodes are self-limited, but some suffer from chronic or recurrent courses. Almost any structure in the back can cause pain, most commonly the intervertebral discs and facet joints. A thorough history and physical exam are important to determine the likely cause and guide appropriate treatment. Imaging such as X-rays, CT, and MRI may help identify structural abnormalities but often are not needed for typical mechanical low back pain.
This document discusses low back pain, including its causes, risk factors, and treatments. It notes that 80% of people will experience low back pain in their lifetime. Common causes include mechanical issues like spinal degeneration or disc herniations that put pressure on nerves. Chiropractic care can help by improving spinal balance and mobility to reduce pain and prevent further issues. Maintaining good posture and exercising are also recommended for prevention and treatment.
The document discusses low back pain from multiple perspectives. It covers epidemiology, costs, causes, mechanics, common injuries, and treatment approaches. The causes of low back pain are multi-factorial, involving both mechanical and central nervous system factors. A common story of low back pain progression is described. Treatment focuses on thorough education, addressing impairments, and modifying activities to reduce mechanical stresses on the spine.
The document discusses several cases of patients presenting with low back pain and how to approach them. It provides guidance on red flags to watch out for that could indicate a serious underlying cause. Conservative treatment is generally recommended as the first approach unless red flags are present. This includes medications, physical therapy, exercise and counseling. Further investigation may be needed if red flags are present or the patient does not improve with initial treatment.
Acute back pain is common and usually non-specific. It is important to thoroughly examine patients to rule out red flags indicating serious underlying causes. Non-specific back pain typically improves within two weeks with medications and staying active. Yellow flags like depression and fear of movement can slow recovery, so it is important to address psychosocial factors as well.
Mr. B is a 37-year-old male who experienced acute lower back pain while working in his yard. He reports dull, burning pain localized to his lower back radiating into his left buttock. Physical examination reveals tenderness over the paraspinous muscles but normal range of motion, strength, and sensation in the lower extremities. Non-surgical management including medications, exercise, and lifestyle modifications is recommended. Further investigations are not needed unless symptoms fail to improve within 4-6 weeks.
Low back ache is a common condition that can have many causes, including mechanical strains, herniated discs, and spinal stenosis. A thorough history, physical exam, and imaging tests are used to diagnose the underlying problem, with treatment depending on the specific cause but often involving rest, physical therapy, medications, or surgery. Radiculopathy and plexopathy can cause low back pain radiating into the legs.
The document discusses low back pain, its prevalence, causes, types of pain, and natural treatment approaches. It notes that low back pain is very common, costly, and can be caused by strains, sprains, herniated discs, and more. Treatment approaches discussed include trigger point therapy, spinal traction, exercise, posture correction, and chiropractic care, which studies have shown to be effective and safe alternatives to medication and surgery.
Understanding the Causes, Symptoms, and Treatments for Sciaticalspineinstitute
Sciatica is caused by compression of the sciatic nerve, which originates in the lower back and extends down the leg. Common causes include degenerative disc disease, facet disease, osteophytes, and spinal stenosis. Symptoms include pain in one or both legs as well as numbness and tingling. Treatment begins with diagnosing the underlying cause through imaging and physical exams. Initial treatment focuses on non-invasive options like medication, exercise, and alternative therapies. Surgery may be considered if more serious conditions are causing nerve compression.
Sciatica is pain that radiates from the lower back down the back of the thigh and leg. It is caused by irritation or compression of the sciatic nerve, which can occur due to herniated discs, spinal stenosis, spondylolisthesis, or other causes like tumors or infections. Symptoms include pain that is worsened by certain movements and activities, numbness, and difficulty walking. Diagnosis involves physical examination including straight leg raise testing and neurological evaluation, as well as imaging like MRI or CT scan. Treatment options include medications, physiotherapy, surgery such as laminectomy or removal of bone compressing the nerve.
Sciatica is a common radiating pain syndrome caused by irritation of the sciatic nerve root, usually from a herniated disc at L4-L5 or L5-S1. It presents as low back pain radiating down the back of the leg and can affect the foot. Sciatica is a symptom rather than a diagnosis. Examination may reveal a positive straight leg raise test. Differential diagnoses include spondyloarthropathies. Imaging like MRI can identify disc herniations while conservative treatments include rest, analgesics, and epidural injections. Surgery is considered if conservative options fail or neurological deficits are present.
Sciatica Self Care discusses the causes of sciatica and provides simple exercises and home treatment methods to ease sciatica symptoms and keep them from returning.
Most internists found more similarities than differences in caring for young adults with intellectual and developmental disabilities (I/DD) and elderly adults with dementia. Both populations require longer office visits and more staffing resources due to complex health histories. Obtaining records and coordinating care can be difficult for both. Reliance on advocates, community services for transportation and supervision, and vulnerability to insurance changes are also similarities. While specific diseases differ, models for geriatric care could potentially address supervision and caretaking needs for adults with I/DD. Strengthening safety net services would help low-income families and elderly patients with dementia or I/DD.
This document discusses young-onset dementia (YOD), which is defined as cognitive and functional impairment in individuals under 65 years of age. It provides epidemiological data on YOD, noting that the most common causes are Alzheimer's disease, frontotemporal lobar degeneration, and Creutzfeldt-Jakob disease. Unique challenges of YOD include difficulties with diagnosis due to atypical presentations, as well as social, family, financial and caregiver challenges. Five case studies are presented to illustrate different causes and presentations of YOD.
Young onset dementia, which affects those under 65 years old, can create special issues for those who are still working, including misdiagnosis, loss of income and benefits, and emotional challenges. This document discusses approaching an employee who may be experiencing early-onset dementia to discuss concerns, determine appropriate accommodations through adapting their work environment or responsibilities, and connecting them to support services that could allow them to continue working successfully.
The document discusses various cognitive disorders including delirium, dementia, amnesia, Alzheimer's disease, and Parkinson's disease. It describes the symptoms and causes of these disorders and notes that differentiating physical disorders from psychological ones can be difficult. Treatment options discussed include behavioral management techniques and medications that aim to slow neuronal breakdown for conditions like Alzheimer's.
Epilepsy is characterized by recurrent seizures caused by abnormal neuronal activity in the brain. Seizures can have various presentations depending on the affected brain region. Epilepsy has genetic and acquired causes such as brain injuries, tumors, or infections. Diagnosis involves tests like EEG, MRI, and bloodwork to identify structural or metabolic abnormalities. Treatment focuses on medications, dietary changes, surgery, or devices like vagus nerve stimulators to reduce or eliminate seizures. Identifying a patient's epilepsy syndrome provides guidance on determining causes and appropriate treatments.
Research on Young-Onset Dementia and Its Implications for Criminal and Civil ...guest7053e1d
This document summarizes a presentation on young-onset dementias and their forensic implications. It discusses the differential diagnosis of young-onset dementias, common neuropsychiatric complications, and management challenges. Specific conditions covered include Alzheimer's disease, frontotemporal lobar degeneration, traumatic brain injury, Creutzfeldt-Jakob disease, and Huntington's disease. Case examples are also provided to illustrate real-world management issues.
Kristie Rauter, Community Health Improvement Planner from the Wood County Health Department, presented on Get Active Wood County, an initiative aimed at obesity prevention at the Wisconsin Women's Health Foundation's Annual Gathering event. She spoke about the collaboration between the Health Department, local businesses, schools and non-profit organizations to create a healthier Wood County.
The document provides information about epilepsy including:
1. It defines epilepsy as a condition with recurrent seizures due to an underlying chronic process, and classifies seizures as either partial or generalized depending on where they originate in the brain.
2. Common epilepsy syndromes are described such as temporal lobe epilepsy, Lennox-Gastaut syndrome, and West syndrome. Causes of epilepsy include genetic factors, injuries, infections, and tumors.
3. The diagnosis involves evaluating the patient's medical history and performing tests like an EEG to determine the seizure type and localization. Differential diagnoses include syncope, migraines, and psychogenic seizures.
Work related musculoskeletal disorders in physical therapistsTuğçehan Kara
This study examined work-related musculoskeletal disorders (WMSDs) in physical therapists through a prospective cohort study with 1-year follow up. The study found that 57.5% of physical therapists reported a WMSD in the follow up year, with a 1-year prevalence rate of 28% and incidence rate of 20.7%. Risk factors for low back WMSDs included patient transfers, repositioning, bent/twisted postures, and job strain. Risk factors for wrist/hand WMSDs included soft tissue work, joint mobilization, and manual therapy techniques. The study recommends safer patient handling policies and further research to examine the link between physical therapy exposures and WMSDs.
Diagnosis of inflammatory arthritis - Dr Louise Warburtonpcsciences
Co-host of the 2017 Musculoskeletal Education Day, Dr Louise Warburton helps healthcare professionals understand the difficulties in diagnosing inflammatory arthritis
This document discusses strategies to prevent and manage delirium in critically ill patients. It outlines the ABCDEF bundle which includes assessing, preventing, and managing pain, both spontaneous awakening and breathing trials, minimizing sedation, assessing and preventing delirium, early mobility and exercise, and engaging family members. Screening for delirium using the CAM-ICU tool and implementing non-pharmacological interventions can reduce length of hospital stay, duration of mechanical ventilation, and mortality. Widespread use of protocols and bundles that incorporate these strategies may help address the high cost and poor outcomes associated with delirium.
The document discusses shoulder pain, specifically subacromial pain/non-specific shoulder pain. It notes that shoulder pain is prevalent, can impact daily activities, and for 40% of patients the pain is ongoing or recurrent after 12 months. Imaging and physical exams are not always reliable in diagnosing the source of pain. Exercise appears to be the most promising intervention for shoulder pain, though what type or amount of exercise is unclear. A proposed intervention focuses on teaching patients self-management skills and a home exercise program with 1-5 sessions from a physiotherapist and proactive follow-up.
Pilot Study of Massage in Veterans with Knee OsteoarthritisMichael Juberg
This pilot study assessed the feasibility and preliminary efficacy of Swedish massage therapy for 25 veterans with knee osteoarthritis. The study found high retention and adherence rates, suggesting massage was feasible and acceptable for veterans. Veterans receiving 8 weekly one-hour massage sessions experienced statistically significant improvements in self-reported knee pain, stiffness, function, and quality of life, as well as trends toward improved range of motion. The results support further study of massage as a treatment approach for knee osteoarthritis in veterans.
This study examined the effects of manual therapy techniques on 5 former professional football players with histories of concussion. The players underwent cognitive, pain, and mobility tests before and after a 5-day intensive manual therapy program. The therapies aimed to address post-concussion imbalances and included craniosacral, visceral, and neuromeningeal techniques. Results showed improvements in quality of life, depression symptoms, sleep, pain levels, and range of motion. However, the small sample size and lack of controls were limitations; further research with more participants is needed to validate the findings.
Clinical prediction rules (CPRs) are tools that use clinical findings to predict outcomes. This document summarizes several CPRs for orthopedic conditions seen in outpatient settings. It describes the Ottawa Ankle Rules and Ottawa Knee Rules, which use symptoms and physical exam findings to determine if imaging is needed for ankle or knee injuries. It also summarizes CPRs related to patellofemoral pain, hip osteoarthritis, benefit from manual therapy or exercise, and carpal tunnel syndrome. The document provides details on the clinical findings and validation levels for each CPR.
Clinical prediction rules use combinations of clinical findings to predict the probability of a specific condition or outcome. This document summarizes several clinical prediction rules for orthopedic conditions seen in outpatient settings, including rules for ankle injuries, knee injuries, patellofemoral pain, hip osteoarthritis, and low back pain. It provides details on the clinical findings and validation levels for each rule. The document concludes by describing where to find more information on clinical prediction rules and validation studies.
Healthy aging is a multidimensional process influenced by genetics, lifestyle, environment and healthcare factors. It involves maintaining physical and cognitive function to allow well-being in older age. Key aspects of healthy aging include regular health assessments, nutrition, exercise, managing chronic conditions, mental health, vaccination, sleep, and injury prevention. Geriatric assessments evaluate multiple health domains. Nutrition, exercise, stress management and preventing smoking and excessive drinking promote healthy aging. Public health policies also play a role by supporting factors like financial security, housing, mobility and social connections in older adults.
This document discusses primary care for people with spinal cord injuries. It provides information on demographics of spinal cord injuries, health care utilization and barriers faced by people with SCIs, complications and secondary effects of SCIs, and approaches to managing issues like pain, bowel and bladder dysfunction, and autonomic dysreflexia. The goals are to review basics of SCIs, discuss major health issues and their management, and call for improved accessibility and advocacy to address unmet health care needs of people living with SCIs.
Matt Anstey is an intensivist from Sir Charles Gardiner hospital in Perth, Australia.
He gave this talk on outcomes after intensive care at an ICN WA meeting in Perth last year.
QUALITY OF LIFE AS A PREDICTOR OF POST OPERATIVE OUTCOME FOLLOWING REVASCULAR...Shantonu Kumar Ghosh
World Health Organization (WHO) defines quality of life as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.8
QOL encompasses the concept of health-related quality of life (HRQOL) and other domains such as environment, family and work. HRQOL is the extent to which one’s usual or expected physical, emotional and social well-being is affected by a medical condition or its treatment.9
For patients suffering from peripheral arterial disease (PAD), quality of life (QoL) has become as important as medical outcome end points, such as mortality and morbidity, to evaluate the effect of disease and treatment.10
1) Geriatric assessment is important for elderly cancer patients to evaluate multiple health domains beyond just cancer and avoid under or overtreatment.
2) Assessments can identify issues like frailty, nutrition, mood, functionality that require management to optimize outcomes and quality of life during cancer treatment.
3) A multidisciplinary approach including nutrition support, exercise interventions, and comprehensive management of geriatric conditions can improve survival and reduce complications in elderly cancer patients.
This document summarizes research on and statistics related to spinal decompression therapy. It notes that spinal decompression offers a non-surgical option for treating back and neck pain caused by disc issues like herniations and degeneration. Studies have found decompression reduces herniation size, increases disc height, provides significant pain relief for 88.9% of patients, and improves function without adverse effects. The document positions spinal decompression as a promising alternative to drugs, physical therapy, chiropractic care, and surgery, which can be ineffective or lead to complications.
Daniel Lee, M.D., of UC San Diego Owen Clinic, presents "Update from the 15th International Workshop on Co-Morbidities and Adverse Drug Reactions in HIV"
Hospice care and palliative care: Is there a difference between the two, and if so, what?
Many people still think that palliative care means hospice care. But today, hospice is only a small part of palliative care.
The goal of palliative care is to prevent or treat the symptoms and side effects of a disease; and it should be part of the picture from the first day a serious illness is diagnosed.
Dr. Jim Meadows, Director of Hospice and Palliative Care at Tennessee Oncology, will discuss this important topic. How does a family and a health care team best work together to guide a patient through a terminal illness? How does everyone continue to support quality, patient-centered, end-of-life care?
I didn't know this option of Palliative care existed prior to my mother's passing earlier this year of colorectal cancer. However, I do now know about it and want to share it with all of you
Deborah Stein SMACC Chicago talk Trauma is Risky Business - delves into the risk patients and physicians undergo when treating or being treated for Trauma.
Stein’s speaks of the Risk Benefit Determination that physicians make daily and how this is used to best answer on going questions such as; can a patient have?, how do we care for this patient? and how do we best make all the these decisions?. Stein’s suggests a thorough Risk Benefit Determination will include:
Analysis of best available data
Use of best available judgement
Gathering of different opinions
An understanding that you won’t always make the right decision
To document the 'crap' out of it!
And to remember you’ll never know what you prevented from not occurring.
Stein’s also focuses on the risk to patients due to missed injuries and the processes physicians can take to help ensure that a patient injuries are not missed. Stating that 1.3-39% of injuries in trauma are missed (a majority of which present as orthopaedic cases).
Touching on the processes designed to prevent missed injuries such as;
Territory Trauma Survey
Roles of clinical decision rules
To scan the living ‘crap’ out of them - whole body CT scans (can decrease mortality but comes attached with its own risks).
Stein’s then delves into the risks trauma providers (physicians) face on a daily bases. Stating that in the USA trauma providers are one of the highest categories of physicians to be sued, have higher indemnity payment awarded against them and achieve a higher risk score in studies for being sued. While, lawsuits are more likely to increase the chance of physician burnout, career burnout, depression and are emotionally and physically exhausting. Steins sights recent studies that suggest the more open, honest and forthright a physician is with their error with their peers and their hospital the likelihood of being sued reduces.
Stein’s also notes that needle stick injuries in most departments have decreased in recent years due to universal precautions, yet have increased in trauma care due to the nature of the ER environment and proper precautions not being taken. Violence is of risk to attending ER nurses, physicians and paramedics, sighting an Australian study that 79% of triage nurses have experienced physical violence from patients. And, the emotional harm the trauma environment can have on trauma providers.
Steins suggests that trauma providers must be aware and learn how to manage risk better to ensure patient and provider safety.
This document discusses sickle cell disease (SCD) pain management in the emergency department. It notes that SCD pain is the main reason for healthcare interactions in patients with SCD. There are two main types of SCD pain: vaso-occlusive crisis (VOC) and chronic pain. The patient's self-report of pain is the most reliable indicator of a VOC, as there are no objective diagnostic indicators. Guidelines recommend rapid assessment and aggressive opioid management for severe acute SCD pain. ED triage of SCD pain should be a high priority level if pain is over 7/10.
The document discusses challenges in survivorship care and improving support for cancer patients after initial treatment. It notes the growing population of cancer survivors and issues around long-term health, quality of life, and unmet needs. Additionally, it examines evidence for interventions like physical activity programs, smoking cessation, and cognitive behavioral therapy in managing late and long-term effects of cancer treatment.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
3. • Low back pain is one of the most common health problems and creates a
substantial personal, community, and financial burden globally.
• LBP is a major cause of disability - affecting performance at work and
general well-being.
• LBP affects people of all ages, from children to the elderly, and is a very
frequent reason for medical consultations.
• The 2010 Global Burden of Disease Study estimated that LBP is among the
top 10 diseases and injuries that account for the highest number of DALYs
worldwide.
4. Disability-Adjusted Life Year (DALY)??
• One DALY one lost year of "healthy" life measurement of
the gap between current health status and an ideal health situation.
DALYs for a disease or health condition are sum of the Years of Life Lost
(YLL) due to premature mortality and the Years Lost due to Disability
(YLD) for people living with the health condition in a population.
6. Prevalence:
• The lifetime prevalence of non-specific LBP is estimated at 60% to 70% in
industrialized countries (one-year prevalence 15% to 45%, adult incidence 5%
per year).
(Over 70% of people in resource-rich countries develop LBP at some time)
• The prevalence rate for children and adolescents is lower than that seen in
adults but is rising.
• Prevalence peaks between the ages of 35 and 55
7. • In the United Kingdom, low back pain was identified as the most
common cause of disability in young adults, with more than 100
million workdays lost per year
• In Sweden, a survey suggested that low back pain accounted for a
quadrupling of the number of work days lost from 7 million in 1980 to
28 million by 1987.
8. LBP in USA
• Episodes of LBP, that are frequent or persistent have been reported in
15% of the US population.
• Lifetime prevalence of 65% to 80%.
• 28% of the US industrial population will experience disabling LBP at some
time & 8% of the entire working population will be disabled in any given
year, contributing to 40% of all lost work days.
• Morbidity & mortality of occupational injury or illnesses in the US
showed that the total direct costs ($65 billion) plus indirect costs ($106
billion) were estimated to be $171 billion, with injuries costing $145
billion and illnesses $26 Billion.
9. Low back pain ranks No. 1 in musculoskeletal disorders.
Modified and adapted from Lawrence and colleagues
10. Risk Factors
• age
• Genetic
• Gender ???
• obesity, body height
• occupational posture
• frequent bending, twisting
• heavy physical work
• Whole body vibration
• depressive moods
11. II – Topic Articles Review:
Haugen, A. J., Brox, J. I., Grøvle, L., Keller, A., Natvig, B., Soldal, D., &
Grotle, M. (January 01, 2012). Prognostic factors for non-success in
patients with sciatica and disc herniation. Bmc Musculoskeletal Disorders,
13.
Peul, W. C., Brand, R., Thomeer, R. T., & Koes, B. W. (January 01, 2008).
Influence of gender and other prognostic factors on outcome of sciatica.
Pain, 138, 1, 180-91.
12. Haugen et al., Prognostic factors for non-success in
patients with sciatica and disc herniation – Study (1)
• Study Design: Prospective multicenter Cohort study.
• Main Variables measured:
1- socio-demographic characteristics
2- back pain history
3- kinesiophobia
4- emotional distress
5- pain
6- comorbidity
7- clinical examination findings.
13. • Cohort Selection and Recruitment:
1- Patients were recruited from specialty back clinics at 4 public
hospitals in Southeast Norway.
2- inclusion period was 2 years, throughout 2005 and 2006.
• Inclusion criteria:
i. age ≥18 years
ii. radiating pain and/or paresis below knee level
iii. disc herniation at the corresponding level and side that had been
verified by (MRI) or (CT).
14. • Exclusion criteria:
i. Prior surgery at the same disc level.
ii. Fracture
iii. Infection
iv. Malignancy
v. Pregnancy
vi. Lack of fluency in Norwegian.
15. • Procedure:
At the day of inclusion patients completed a comprehensive
questionnaire. Baseline data were collected at the first visit to the
department. Clinical examination was conducted by a physician or
physiotherapist. A follow-up questionnaire and a prepaid envelope
were sent to the patients after 3, 6,12 and 24 months. A reminder
was sent after 2 weeks if no reply was obtained.
In each questionnaire, the participants were asked whether they had
undergone surgery for disc herniation in the period since the last
follow-up period, and if so, the patient reported the date of surgery.
16. Outcome measure and definition of non-success
1- Maine–Seattle Back Questionnaire (MSBQ) was the main outcome
measure.
• The scale is composed of 12 items
• each with the answer yes (1) or no (0).
• The MSBQ assesses disability and functional limits due to sciatic and
back pain, and higher scores indicate worse limitations on activity.
• Non-success was defined as a MSBQ score ≥ 5
17. 2- Siatica Bothersomeness Index (SBI) is the secondary outcome
measure was the Sciatica.
• SBI is a composite of the scores for four symptoms: leg pain (sciatica);
numbness or tingling in the leg, foot or groin; weakness in the leg or
foot; and back or leg pain while sitting.
• Nonsuccess was defined as a SBI score of ≥ 7
18. Outcomes:
466 patients were included.
409 (88%) responded to the 1-year follow-up questionnaire.
380 (82%) responded to the 2-year follow-up questionnaire.
Among the responders at 1 year, 120 (29%) had received surgical
treatment.
At 2 years, 120 (32%) of the responders were recorded as surgically
treated.
For patients who were operated, surgery was performed within 3
months of follow-up for 81% of the patients.
Patients with non-success (MSBQ ≥ 5) numbered 178 patients (44%)
at 1 year and 145 (39%) at 2 years.
19. Outcomes (Cont’d):
the surgically treated patients, 42 (35%) had non-success at the 1-
year follow-up, and 47 (39%) had non-success at the 2-year follow-up.
the non-surgical group, 136 (47%) and 98 (39%) patients had non-success
at 1 and 2 years respectively.
20. Results:
1) 44%–47% of the patients with sciatica who were referred for
secondary care had a non-successful outcome at 1 year and 39%–
42% at 2 years.
2) Approximately 1/3 of the patients were treated surgically.
3) For the main outcome variable, non-success at 1 year was
significantly associated with being male (OR 1.70 [95% CI; [1.06 −
2.73]), smoker (2.06 [1.31 − 3.25]), more back pain (1.0 [1.01 −
1.02]), more comorbid subjective health complaints (1.09 [1.03 −
1.15]), reduced tendon reflex (1.62 [1.03 − 2.56]), and not treated
surgically (2.97 [1.75 − 5.04]).
21. 4) factors significantly associated with non-success at 2 years were
duration of back problems > 1 year (1.92 [1.11 − 3.32]), duration of
sciatica > 3 months (2.30 [1.40 − 3.80]), more comorbid subjective health
complaints (1.10 [1.03 − 1.17]) and kinesiophobia (1.04 [1.00 − 1.08]).
5) For the secondary outcome variable, more comorbid subjective health
complaints, more back pain, muscular weakness at clinical examination,
and not treated surgically, were independent prognostic factors for non-success
at both 1 and 2 years.
22. Peul et al., Influence of gender and other prognostic
factors on outcome of sciatica Study (2):
• Research Question:
• Female gender has been found to be associated with chronic pain in
other musculoskeletal disorders.
• The study aim is to quantify the relationship between gender and
(1) rate of recovery
(2) outcome at one year
23. Design:
• Randomized Multicenter Trial
• Patients were allocated randomly to either a prolonged conservative care,
possibly with late surgery, or early surgery preferably within two weeks.
Inclusion Criteria:
• 283 patients who suffered sever sciatica were enrolled
• age 18 – 65 years old
• had a radiologically confirmed disk herniation
• incapacitating lumbosacral radicular syndrome lasting between 6 and 12
weeks
24. Exclusion Criteria:
1. cauda equina syndrome
2. muscle paralysis or insufficient strength to move against gravity
3. Patients had had identical complaints in the past twelve months
4. history of spinal surgery
5. bony stenosis
6. Pregnancy
7. severe comorbidity
25. Outcomes:
• Follow-up of patients at 2, 4, 8, 12, 26, 38 weeks and at one year was
recorded.
• A 7-point Likert global perceived recovery scale, patient experienced
recovery compared to baseline, with answers ranging from
completely recovered to much worse.
• Roland Disability Questionnaire (RDQ) for Sciatica
• Horizontal Visual Analogue Scale (VAS-leg) recording the individually
experienced intensity of pain
26. Results:
• Allocation of an early surgical strategy resulted in 125 of 141 (89%)
patients who actually underwent lumbar discectomy after a median
period of 1.9 weeks.
• while of the 142 conservatively managed patients surgery could not
be avoided in 55 (39%) after a median time of 14.6 weeks.
• At different follow-up moments during the first year 269 of 283 (95%)
patients registered complete recovery.
• At exactly 12 months, however, 83% of patients reported complete
recovery
• (34%) of 283 patients were female.
27. Results (Cont’d):
• Results at 12 months showed a significantly different outcome
between genders with 28% of females exhibiting an unsatisfactory
perceived outcome versus 11% of males??
• Women had a slower rate of recovery: HR 0.76 (95% CI 0.59–0.99)
with an unsatisfactory outcome represented by an unadjusted odds
ratio of 3.3 (95% CI 1.7–6.3) compared to males. Besides a slower
recovery rate, female gender was a strong predictor of unsatisfactory
outcome at one year for patients with sciatica
28. Conflicting Findings
Haugen et al.,
• Non-Success 44%–47% at One
Year, 39%–42% at 2 years.
• Non-success at 1 year was
significantly associated with
being male (OR 1.70) .
Peul et al.,
• (95%) patients registered
complete recovery, at 12 months
(83%) of patients reported
complete recovery.
• Women had unsatisfactory
outcome represented by an
unadjusted (OR 3.3)compared
to males.
29. Discussion & possible explanation of
conflicting findings:
• The 2 studies had different Designs, Haugen et al Prospective Cohort,
Peul et al Randomized Trial, randomization procedure wasn’t stated
in the article.
• Haugen et al enrolled 466 participants, Peul et al enrolled 283
participants (Bigger sample size in Haugen et al more precision in
results?)
• Haugen et al Followed patients for 2 years, Peul et al followed
patients for 1 year (Longer time of follow up, better assessment of
association between predictor variables & outcome variables).
30. • Exclusion Criteria in Peul et al were duration of sciatica symptoms of more
than 12 weeks, similar complaints during the previous year, or severe
comorbidity, therefore Haugen et al was probably more representative of
the majority of patients with sciatica and disc herniation.
• Haugen et al used the most precise outcome measures, which in a previous
study showed the highest sensitivity and specificity to discriminate
between successful outcome or not for sciatica patients.
• Haugen et al had a broader range of prognostic variables including several
clinical findings, psychological variables and comorbid subjective health
complaints.
• The success rates and prognoses for sciatica vary between studies,
depending on the inclusion criteria and outcome measures used.
31. Refrences:
1. Haugen, A. J., Brox, J. I., Grøvle, L., Keller, A., Natvig, B., Soldal, D., & Grotle, M.
(January 01, 2012). Prognostic factors for non-success in patients with sciatica
and disc herniation. Bmc Musculoskeletal Disorders, 13.
2. Peul, W. C., Brand, R., Thomeer, R. T., & Koes, B. W. (January 01, 2008).
Influence of gender and other prognostic factors on outcome of sciatica. Pain,
138, 1, 180-91.
3. Hall, Hamilton, & McIntosh, Greg. (n.d.). Low back pain (chronic). BMJ
Publishing Group.
4. Manchikanti, Laxmaiah, et, al. “Epidemiology of Low Back Pain”. Pain Physician
Vol. 3, No. 2, 2000.
5. Duthey, Béatrice. “Background Paper 6.24 - Low back pain”. Priority Medicines
for Europe and the World "A Public Health Approach to Innovation“ Update on
2004 Background Paper (15 March 2013). WHO.