Low back pain causes treatment and prevention in physiotherapy practice

1. LOW BACK PAIN

2. PHYSIOTHERAPY
• Physiotherapy is a science-based
profession that takes into account a
whole person approach to health and
wellbeing, which include the client’s
general lifestyle.
• At core is the patient getting
involved in their own care through
education, awareness, empowerment
and participation in treatment

3. LOWER BACK MUSCLE

4. Superficial / Spinotransversales
*associated with movements of the shoulder.
Intermediate / Erector spinae
*associated with movements of the thoracic cage.
Deep / Transversospinales
*associated with movements of the vertebral
column.

5. Splenius Capitis -Rotate head to the same side
Splenius Cervicis -Rotate head to the same side
The two splenius muscles can also act together to
extend the head and neck.
Iliocostalis -unilaterally to laterally flex the
vertebral column.
-bilaterally to extend the vertebral
column and head
Longissimus -same
Spinalis. -same
Semispinalis -Extends and contralaterally rotates the head
and vertebral column.
Multifidus -Stabilizes the vertebral column.
Rotatores -Stabilizes the vertebral column, and has a
proprioceptive function
Interspinales - Spans between adjacent spinous processes.
Acts to stabilize the vertebral column.
Intertranversari – Spans between adjacent transverse
processes.
Acts to stabilize the vertebral column.
Levatores costarum – Originates from the transverse
processes of C7-T11, and attaches
to the rib immediately below.
Acts to elevate the ribs.

6. LBP CLASSIFICATION
 Mobility Impairment
 Radiating/ Referring Pain Lower Extremity
 Movement Coordination Impairment
 Generalized Weakness
 Cognitive/ Affective / Noxious Stimuli
CLINICAL CLASSIFICATION
 Acute
 Subacute
 Recurrent
 Chronic
Medical Diagnosis
 Lumber Radiculopathy Spondylolysis
 Spondylolithesis Ankylosing Spondylitis
 Disc Prolapse/Herniation

8. MRI lumbar image:
L5/S1 disc has suffered a 9mm disc extrusion
(red arrow) that is not contained by the PLL
L4/5 disc has suffered a smaller 4mm disc
protrusion (green arrow) that is contained by
the PLL
L3/4 (blue arrow) is completely normal and
has no disc material projecting posteriorly
into the epidural space Note: L3/4 disc is
white in color, which indicates it is non-
degenerated (i.e., full of water and healthy
proteoglycan)
Herniated discs (L4/5 & L5/S1) are "black"
which indicates disc desiccation (lack of
water and proteoglycan)

9. Acute Low Back Pain
• (Low back strain or sprain, “pulled
muscle”, mechanical LBP)
• Risk factors include: repetitive bending,
twisting and lifting; heavy lifting; whole-
body vibration; sustained awkward
posture; smoking; poor fitness.
• May occur without any history of injury
or overuse.
• 85% resolve within 4 weeks regardless of
treatment
Acute lumbar disc herniation
• Risk factors include extreme
lifting, age >50 years
• 10-25% have persistent sciatica
at 6 weeks,
• 80-90% resolve without
surgery

10. Degenerative disease
• Osteoarthritis (DJD)
• Degenerative disc disease
• Spinal stenosis
• Ankylosing spondylitis
• All more likely after age 50
• Chronic pain
Medical
• Infection (paraspinous abscess,
pyelonephritis, gyn infections)
• Nephrolithiasis
• Metastatic disease
Traumatic
• Compression fracture (increased risk
with osteoporosis, age >70)
• Spondylolysis/spondylolisthesis

11. MUSCLE STRAIN
History of heavy/repetitive lifting
 Pain increases with passive, active flexion and
resisted extension.
 Neurological Evaluation indicates negative
results
RX
 Stay active
 Education on lifting and appropriate
ergonomics
 Modalities to reduce pain
 Gentle stretching
 Stabilization exercises
 Mobilization and manipulation
 Graded return to tasks

12. Surgery or Conservative Treatment?
Ø Lumbar disc herniation (Spine, 26:1179-87; 2001; Weber H, Spine,
1983)
Ø Surgery vs non-surgery; 1-10 yr outcomes
Ø 1 yr f/u: surgical outcomes were better for reduction of primary c/o
Ø 1-2 yrs: little to no difference btw treatments
Ø 4-10 yr f/u: no difference

13. TREATMENT BASED CLASSIFICATION
• Level 1 Triage: Determination for Rehabilitation
Appropriateness, Self-care Management
• Level 2 Triage: Determination of Rehab
Approach
• Symptom Modulation Approach
• Movement Control Approach
• Function Optimization Approach

15. THERAPEUTIC CONCIDERATION
 Core Strengthening Exercise
 Neurodynamic Stretching
 Fascia Distortion Modulation
 Dynamic Stabilization Exercise
 Mobilization
 Muscle Stretching Protocols
EXERCISE CHALLENGES
 The program prescribed does not include active
exercise
 Patients do exercise incorrectly
 Patients do not stick to prescribed program
 Patients do not keep with exercise long-term

16. BACK ERGONOMICS
ERGONOMICAL WORK RISKS
• Force
• Repetition
• Awkward & Prolonged Posture
• Contact stress
• Vibration
• Cold temperature with above
risks
• Static loading
ERGONOMIC INJURY
• Cumulative Trauma Disorders
(Exposure driven)
• Strain/Sprain Instantaneous
(Event driven)

17. BACK ERGONOMIC
• The greater the understanding of how the
body moves and the capacity of joints,
bones and ligaments to perform certain
actions, the easier it is to improve the
execution of the movements required for
each activity.
• Individuals who incorporate proper
biomechanics are able to pursue their
potential to their highest level and help
minimize the potential for injury