Low back pain (LBP) is a common disorder involving the muscles, nerves, and bones of the lower back. It can range from a dull ache to a sharp pain. LBP is more common in older adults and those who are overweight, smoke, or lack exercise. The most common causes are mechanical issues like muscle strains from lifting or injuries to discs. Symptoms include back pain that may radiate down the legs and is worse with prolonged sitting. Treatment involves rest, heat/ice, over-the-counter medications, physical therapy, and sometimes injections or surgery. Prevention emphasizes exercise, posture, and lifting properly.

1. LOW BACK PAIN
Presented By,
Dr.Sajid Hasan
MBBS
Army Medical College Chattogram

2. What is it?
 LBP: Low back pain (LBP) or lumbago is a common
disorder involving the muscles, nerves, and bones of the
back, in between the lower edge of the ribs and the
lower fold of the buttocks. Pain can vary from a dull
constant ache to a sudden sharp feeling.

3. Risk factors
Anyone can develop back pain, even children and teens. These factors might
put at greater risk of developing back pain:
 Age: Back pain is more common in older pt (40-50 yr)
 Lack of exercise: Weak, unused muscles in back and abdomen might
lead to back pain.
 Excess weight: Excess body weight puts extra stress on back.
 Diseases: Some types of arthritis and cancer can contribute to back pain.
 Improper lifting: Using back instead of legs can lead to back pain.
 Psychological conditions: People prone to depression and anxiety
appear to have a greater risk of back pain.
 Smoking: Smokers have increased rates of back pain.

4. Etiology
 Most commonly mechanical issues and soft-tissue injuries are the
cause of low back pain. These injuries can include damage to the
intervertebral discs, compression of nerve roots, and improper movement
of the spinal joints.
 The single most common cause of lower back pain is a torn or pulled
muscle and/or ligament. Common causes of sprain and strain include:
a) Lifting a heavy object, or twisting the spine while lifting
b) Sudden movements that place too much stress on the low back, such as a
fall
c) Poor posture over time
d) Sports injuries, especially in sports that involve twisting or large forces of
impact.

5.  There are may be some other causes in chronic case.
Such as –
 Lumbar herniated disc.
 Degenerative disc disease.
 Facet joint dysfunction.
 Sacroiliac joint dysfunction.
 Spinal stenosis.
 Spondylolisthesis.
 Osteoarthritis.
 Deformity like scoliosis or kyphosis
 Compression fracture.
 Trauma
Etiology cont...

6. Symptoms of LBP
Low back pain is typically characterized by a combination of the
following symptoms:
 Dull, aching pain at back.
 Pain that radiates to the buttocks, legs, and feet.
 Pain that is worse after prolonged sitting.
 Pain that feels better when changing positions.
 Pain that is worse after waking up and better after moving around.

7. Red Flags of LBP
History:
 Malignancy
 Unexplained wt loss or loss
of appetite
 Recent fever & chill or
infection.
 Immunosuppression
 Pain at rest or during the
night
 Trauma
 Recent onset of bowel or
bladder dysfunction.
Physical Exam:
 Progressive neurological
deficit in the lower extremity.
 Saddle anesthesia
 Anal Sphincter weakness
 Fever

8.  When to see a doctor: The pain often goes away without treatment, but if
it occurs with any of the following symptoms, then pt is needed
consultation from a physician:
 Pain that does not improve with rest
 Pain after an injury or fall
 Pain with numbness in the legs
 Pain with weakness
 Pain with fever
 Pain with unexplained weight loss

9. Diagnosis of LBP
 Patient History: Before starting a physical exam, the patient will be asked
to provide information regarding symptoms and medical history. Inquiries
typically include:
a) Information about current symptoms
b) Life style
c) Sleep habits
d) Posture
e) Injuries

10. Diagnosis Cont...
 Physical Examination: The goal of a physical exam is to further narrow
down possible causes of pain. A typical physical for low back pain includes
some combination of the following steps:
a) Palpation
b) Neurologic exam
c) Range of motion test
d) Reflex test
e) Leg raise test

11. Diagnosis Cont...
 Diagnostic Imaging Tests: It is indicated if the patient’s pain is severe,
not relieved within two or three months, and does not get better with
nonsurgical treatments. These includes:
a) Spine X-ray – Which uses radiation to produce images of bones.
b) MRI – Which uses a magnet and radio waves to create pictures of bones,
muscles, tendons and other soft tissues.
c) CT scan – Which uses X-rays and a computer to create 3D images of
bones and soft tissues.
d) Electromyography (EMG) to test nerves and muscles and check
for neuropathy (nerve damage)

12. Management & Treatment
Home treatments:
 Applying a hot compression or an ice pack to the painful area may also
reduce pain.
 Resting from strenuous activity can help, but moving around will ease
stiffness, reduce pain, and prevent muscles from weakening.
 Using of back braces – Some patients find that a back brace can be used
to provide comfort and possibly reduce pain

13. Treatment cont.…
Medical treatment:
If home treatments do not relieve back pain, a doctor may recommend the
following medication, physical therapy or both
 Over-the-counter pain medications: The most common (OTC) medications
are Aspirin, Ibuprofen, Naproxen, and Acetaminophen.(Commonly used in
acute case)
 Muscle relaxants
 Narcotic pain medications.
 Anti-seizure drugs such as: Pregabalin, Gabapentin (Commonly used in
Chronic case)
 Injections: Epidural steroid injections.

14. Treatment cont.…
Physical therapy:
 Applying Heat, Ice etc.
 Ultrasound and electrical stimulation.
 Muscle-release techniques to the back muscles and soft tissues
 Flexibility and strength exercises for the back and abdominal muscles.

15. Treatment cont.…
Surgical Treatment:
a) Decompression Surgeries: Microdiscectomy & Laminectomy
b) Spinal Fusion surgery.
c) Vertebroplasty and kyphoplasty.
d) Foraminotomy.
e) Nucleoplasty/Plasma disk decompression
f) Artificial disk replacement.

16. Prevention
To prevent LBP, following things are needed to be practiced.
 Exercise. Regular low-impact aerobic activities.
 Build muscle strength and flexibility. Abdominal and back muscle exercises
 Maintain a healthy weight.
 Quit smoking.

17. Prevention cont...
 Avoid movements that twist or strain the body
 Stand smart. Maintain a neutral pelvic position.
 Sit smart. Choose a seat with good lower back support, armrests and a
swivel base.
 Lift smart. Avoid heavy lifting.

18. Take Home Messages
 LBP is a growing problem.
 Low back pain mostly diagnosed clinically.
 Degenerative back pain is common.
 Neutral spine is the key.
 Usually self limiting.
 Medication is not everything.
 Stop smoking
 Reduce body weight.
 Grow the healthy habit of sitting, bending, lifting, driving.

20. Reference:
 https://www.spine-health.com/conditions/lower-back-pain/causes-lower-back-
pain#:~:text=Most%20commonly%2C%20mechanical%20issues%20and,moveme
nt%20of%20the%20spinal%20joints.&text=The%20single%20most%20common%
20cause,pulled%20muscle%20and%2For%20ligament.
 https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-
20369906
 https://www.medicalnewstoday.com/articles/172943#risk-factors
 https://www.medicalnewstoday.com/articles/172943#prevention
 https://my.clevelandclinic.org/health/diseases/7936-lower-back-pain
 https://fpnotebook.com/ortho/sx/lwbckpnrdflg.htm