Mechanical back pain is caused by abnormal stress or strain on the back muscles. It is diagnosed after ruling out trauma, inflammation, or other causes. Common symptoms include dull pain that is aggravated by physical activity like lifting, stooping, or coughing. Treatment focuses on rest, analgesics, physiotherapy, and patient education.

1. Mechanical Back pain
Bipin Poudel

2. Defined as pain and discomfort
between the costal margin and
inferior gluteal folds with or without
leg pain

3. Mechanical pain is the general
term that refers to any type of
back pain caused by placing
abnormal stress and strain on
muscles of the vertebral column.

4. Introduction
• No clearly defined pathology
• No significant clinical or radiological findings
• Diagnosis of exclusion

5. • Aggravated with movement and relieved by rest
• Patients may complain of symptoms on standing
up from supine or seated positions, and pain on
turning over in bed.

6. Clinical features
• Dull Pain
• Aggravated by
• physical activity
• Stooping
• Lifting
• turning and coughing
• No neurological signs and symptoms

9. Mechanical Back Pain
Improves with rest,
Worse after exertion
Inflammatory Back Pain
Worse early morning
Improves with activity

10. • Patient history is relevant
• Spine examination
• Pain on flexion may indicate disc pathology and
with extension facet joint pain and spinal
stenosis may predominate.
• Hip Examination
• Neurological assessment

11. Approach to a patient with back pain

14. “Diagnosed when trauma,
inflammatory and other causes have
been ruled out”

15. Treatment
• Rest
• Analgesics
• Physiotherapy
• Education

16. Mechanical Back Pain
Disc Origin Facet Origin Spinal Stenosis Root
Compression
Pain Dominance Back Back Leg Leg
Aggravation Flexion Extension,
standing, walking
Exercise,
extension,
walking, standing
Flexion
Onset Gradual More sudden Congenital or
acquired
Acute leg+-back
pain
Duration Long (weeks,
months)
Shorter (days,
weeks)
Acute or chronic
on history (weeks
to months)
Short episodes
attacks (minutes)
Treatment Relief of strain,
exercise
Relief of strain,
exercise
Relief of strain,
exercise
Relief of strain,
exercise +
surgical
decompression if
progressive or
Summary- Types of Back Pain

17. References
• Essential Orthopaedics, 6th Edition
• Apley’s and Solomon System of Orthopaedics and
Trauma, 10th Edition
• Toronto Notes, 12th Edition