Lower back pain

1. THE LOWER BACK PAIN
 The lower back pain involves muscles spasms localizing on the supportive
muscles along the spine
 The back pain also relates to pain and numbness to the lower extremities and
the gluteal area(CASAZZA, 2017).
 The pain could be either chronic or acute, with multiple causes.
 Acute back pain is attributed to the most common reasons why an adult
would consult a physician.
 Patients may recover quickly with minimal treatment, but it remains
imperative that an elaborate evaluation is done to identify underlying
pathology.

2. Lower back pain continued..
 The red flags such as trauma from falls and motor vehicle crashes involving
people with osteoporosis or possible osteoporosis presents, could precipitate
back pain (D'Arcy, 2013).
 An absence of serious pathology may eliminate a need to have diagnostic
imaging and lab testing.
 Majority of people will experience acute lower back pain at sometime in their
life time, with the first episode occurring between the age 20 to 40 years.
 Many cases of lower back pain are self limiting

3. Lower back pain continued..
 However, 31% of lower back cases persist beyond six months.
 25% to 60% of people with resolved back pain will experience relapse within 1
to 2 years (CASAZZA, 2017).
 33% of the recurrent cases will present with moderate pain and approximately
15% experiencing severe pain.
 The non-specificity of the lower back pain lead to difficult in attributing the
pain to a specific cause.

4. Lower back pain continued..
 The relieve of pain, improvement of function and reduction of time away
from work are some of the treatment goals.
 Other costs include optimization of treatment associated with prevention of
chronic back pain (D'Arcy, 2013).
 A detailed history and physical examination are paramount in evaluation of
acute lower back pain.
 It is imperative to note that some red flags are more useful than others and
some may also be inaccurate in eliciting causes of back pain.

5. Lower back pain continued..
 A comprehensive clinical approach is essential rather than reliance on limited
lower back pain indicators.
 Pain directly from the spine structures could refer to the region of the thigh,
and rarely below the knee region (Davis & Richardson, 2015).
 The pain from the sacroiliac joint could radiate to both the thigh and the
below the knee.
 Pain from L1-L3 nerve roots tend to radiate to the thigs and hip whereas pain
from L4 to S1 will radiate to below the knee.

6. Causes of lower back pain
 Tear in the nucleus pulposus could precipitate discogenic lower back pain.
 The proteins with inflammatory properties are extravasated and washes the
nerve fibers, leading to irritation of the nerve fibers(Cooper, 2015).
 Lower back pain could also be caused by injury to the zygapophysial joint.
 The pain results for instance when the there is tearing of the capsule of a
joint and degeneration of the cartilage.
 Such changes lead to an inflamed joint, hence the pain.

7. Causes of the lower back pain
continued..
 Altered biomechanics could results in pain in the lower back around the
sacroiliac joint.
 The degenerative changes and inflammation at the joint majorly precipitates
the sacroiliac joint pain (McKinnis, 2013).
 Spondylolisthesis could result into chronic lower back pain.
 Spondylolisthesis includes a slipping of bones in relation to another
 The slippage leads to irritation and subsequent inflammation, amounting to
pain.

8. Causes of the lower back pain
continued..
 Muscle strain could also result into lower back pain due to overworking of the
muscles.
 The muscles of the lower back are stationed to provide mobility and strength
to undertake activities of daily living (Cooper, 2015)
 Sudden and forceful movements or prolonged stress could precipitate
ligament sprain.
 The ligaments connect the spinal vertebrae and have a role on provision of
support and stability to the lower back by way of connecting the lower back.

9. Causes of lower back pain continued..
 Poor postural alignment could be associated with lower back pain
 Muscular fatigue may result when a person sits hunched over a desk or
slouching over a television set, all constituting poor postural alignments
(Powers et al., 2012).
 The pain occurs when there is joint compression and stress to the vertebral
disks.
 Another cause is the wear and tear related to aging.
 Normal aging causes decreased bone density and reduced elasticity of
ligaments and muscles

10. Causes of the lower back pain
continued..
 Degenerative changes of the inter-vertebral discs may also result from
inherited factors
 The degenerative joint disease and the degenerative disc disease are often
inherited factors (Davis & Richardson, 2015).
 Other causes include bulging of the inter-vertebral disks or herniation causing
pressure on the nerves.
 The pressure on the nerves cause irritates the nerves and radiates pain down
the limbs.

11. Treatment of the lower back pain
 The main goals of managing lower back pain include prevision of enough pain
relief, prevention of further injuries and maintenance of ability to function.
 The non surgical options in lower back pain management could include the
NSAIDs (Samraj & Kuritzky, 2012).
 NSAIDS inhibits COX.1 and COX-2 activity and,therefore, exerting their
analgesia effects.
 NSAIDS could also reduce the prostaglandin biosynthesis amounting to reduced
inflammation and pain relief.

12. Treatment of LBP continued..
 Oral corticosteroids such as prednisone have been found effective against
acute sciatica as a result of disc herniation (Chou et al., 2016).
 However, little information exist towards the support of corticosteroids
towards management of acute back pain.
 Nevertheless, corticosteroids present as options utilizable in management of
pain
 The epidural steroids injections are particularly useful in managing lower
back pain

13. Treatment continued..epidural pain
injections
 Through the epidural space, the drug is delivered to the spinal nerves.
 a steroid injection is composed of a corticosteroid and an aesthetic numbing
agent (Benoist, Boulu & Hayem, 2012).
 Such would include a triamcinolone and lidocaine
 The delivery of the drugs at the epidural space induces analgesia and
inflammation.
 The injection does not reduce the herniated disks but can act on the spinal
nerves through flushing of proteins that cause swelling.

14. Platelet-rich plasma therapy in LBP
management
 Involves injection of autologous blood back into the donors body at the cite of
concern
 The portion of the blood concentrated with the platelets is the autologous
portion of the blood (Monfett et al., 2016).
 20-60cc of blood is drawn from a patient’s blood and centrifuged.
 The blood is separated into distinct layers
 The platelet section is extracted and is made ready for use.

15. PRPT management continued..
 The plasma section is mixed with anticoagulants and injected into tissues that
require healing e.g. sacroiliac joints.
 Administration of local anesthetic is imperative; to minimize pain from PRPT
procedure(Monfett et al., 2016).
 The anesthetic is administered separately from PRPT solution to avoid dilution
of the solution.
 The severity of the injury and the healing process dictate the number of
injections to be made on the affected lower back area.

16. Cold therapy in management of LBP.
 The first 24 to 72 following the onset of lower back pain are essential for
effective cold therapy.
 Cold therapies minimizes inflammation and swelling (Davis & Richardson,
2015).
 Cold therapy may also numb the tissues and minimize the tissues damage
 The cold therapy options could include frozen bags of vegetables, frozen gel
packs or even frozen towel

17. Cold therapy continued..
 In cold therapy avoid ice burn by putting clothe between skin and source of
cold
 Application of cold therapy should not exceed 20 minutes at a time (Benzon
et al., 2014).
 The healing could also be facilitated by application of heat therapy.
 Heat therapy stimulates blood flow to the area, hence restoration of oxygen
and nutrients

18. Manual manipulation in managing LBP..
 This kind treatment is done by a chiropractor or an osteopathic doctor.
 When performed by a qualified professional, it can reduce lower back
(painMcKinnis, 2013).
 The mode of action is through reduction of pressure on structures such as
nerves
 The procedure also reduces muscle tension , increases flexibility and reduces
stiffness of the muscles.

19. Physical therapy in management of LBP..
 The technique involves a qualified physical therapist.
 A combination of exercises involving the back aid in reduction of pressure
exerted on structures such as nerves (Chevan & Clapis, 2012).
 The stretching and strengthening exercises could include yoga and tai chi
exercises.
 A program will be essential, well formulated and controlled by a physical
therapist

20. Stem cell therapy in managing LBP..
 The procedure is useful in LBP resulting from degeneration of discs in the
vertebrae.
 The chronic LBP can be managed by this process through introduction of stem
cells (Moore, 2013).
 Adult stem cells are extracted form the patient, purified and injected into
the damaged tissue.
 The procedure is non surgical and the recovery time is little.

21. Stem cell therapy continued..
 Patients may only report some soreness around the area of injection.
 No reported side effects from stem cell therapy can be termed as
serious.
 The research now is focusing on generating cells that can replace
damaged tissues or better still generation of transplantable organs
(Moore, 2013).
 Engineered tissues that require greater vascularization and could
potentially teat diseases and conditions such as LBP.

22. Preventive measures towards LBP
 Patients should look after their posture, through
reduction of the daily stresses on the lower back.
 Relax and stretch for some minutes if the job is
demanding a sitting posture for long periods of time
(Hoeger & Hoeger, 2015).
 Proper footwear is also advocated while walking.
 Poor footwear can precipitate back pain or even
knee pain

23. Preventive measures towards LBP
continued..
 Correct postures maintains normal orientation of the
spine.
 The body weight is equally transmitted through the body’s
center of gravity (Hoeger & Hoeger, 2015).
 Footwear should be comfortable and fit the feet well,
should give support when making sudden turns.
 Some shoes that increase the curvature of the body’s
lower spine should be avoided. E.g. high-heel shoes.

24. Preventive measures towards LBP
continued..
 An individual should be flexible
 Simple back stretching on a daily basis lasting at least 5
minutes protects against sudden back injuries and pain
(Ebnezar et al., 2012).
 Maintaining a flexible spine reduces chances of recurrent
back pain.
 Stiffness of joint that could affect facet joints and spine
ligaments could also be avoided through maintenance of
flexibility.

25. Preventive measures towards LPB
continued..
 Maintenance of a comfortable sleeping position.
 The most comfortable position is the best position.
 Change of position once pain sets in is advocated (Davis &
Richardson, 2015).
 To protect the low back section of the spine , it is
imperative that one maintains the natural curve of the
lower spine while sleeping.
 A supine position on a flat , cushioned level should be
accompanied by a pillow under the knees.

26. Preventive measures towards LBP
continued..
 The external pressure on the nerves should be minimized.
 A wallet on the back pocket will cause bad alignment of
the spine (Chevan & Clapis, 2012).
 The compression of the sciatic nerve by such objects as
wallets will also culminate into discomfort in body
alignment.
 Specifically, objects causing pressure on the nerves can
constitute piriformis syndrome type of pain.

27. Preventive measures towards LBP
continued..
 Avoid tilting spine while carrying loads during the
every day activities.
 Bags and loads should be carried on the back not
on one side (cooper, 2015).
 Use of rolling bags can also immensely work.
 Hand bags ought to be light when carrying them
on one side

28. Preventive measures towards LBP
continued..
 Maintaining a balanced diet can go a long way in
prevention of back pain.
 Experience of back pain could be associated with of
health issues.
 The health of the tissues around the lower back and the
whole body as a whole can be prevented by a balanced
diet (Moore, 2013)
 Vitamins and supplements can aid in healing of possibly
damaged tissues.

29. Preventive measures towards LBP
continued..
 For body builders and weight lifters, vitamins aid in
muscle building
 Simple and inexpensive multivitamin supplementation is
also essential if a balanced diet is evidently unachievable
(Chevan & Clapis, 2012).
 Disappearance of pain may not mean healing of the
tissues around the spine.
 Tissues may take up to nine months before complete
healing.

30. Preventive measures towards LBP
continued..
 Avoidance of stressful situations.
 Corticoid hormones are produced in large amount
in stressful situations .
 What results is soft tissues inflammation and
increased muscle tension (MOORE, 2013).
 Such would result into back pain in some patients
and hence avoidance measures are advocated.

31. Preventive measures …continued
 Seeking of spiritual peace could reduce the stress.
 Hobbies have also been proven effective in stress
management (Benzon et al., 2014).
 If stress aggravates backache, medications under
prescription of a qualified professional is
advocated
 SSRIs are stress relieving medications and have
relatively fewer side effects.

32. Preventive measures towards LBP
continued..
 Getting into a habit of bending knees when lifting heavy
objects.
 Incorrect lifting of objects could result into back pain
(McKinnis, 2013).
 Avoid picking objects from the bac sit while driving a car.
 A habit of using hips and knees while lifting heavy loads
from the ground.

33. References.
 Benoist, M., Boulu, P., & Hayem, G. (2012). Epidural steroid injections in the
management of low-back pain with radiculopathy: an update of their efficacy and
safety. European Spine Journal, 21(2), 204-213.
http://dx.doi.org/10.1007/s00586-011-2007-z
 Benzon, H., Rathmell, J., Wu, C., Turk, D., Argoff, C., & Hurley, R.
(2014). Practical management of pain.
 CASAZZA, B. (2017). Diagnosis and Treatment of Acute Low Back Pain (4th ed., pp.
343-348). North Carolina: American Family Physician. Retrieved from
http://www.aafp.org/afp/2012/0215/p343.pdf
 Chevan, J., & Clapis, P. (2012). Physical Therapy Management of Low Back Pain.
Jones & Bartlett Publishers
 Chou, R., Pinto, R., Fu, R., Lowe, R., Henschke, N., & Dana, T. (2016). Systemic
corticosteroids for radicular and non-radicular low back pain. Cochrane Database
Of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd012450

34. References
 Cooper, G. (2015). Lower Back Pain: An Overview of the Most Common
Causes. Non-Operative Treatment Of The Lumbar Spine, 11-13.
http://dx.doi.org/10.1007/978-3-319-21443-6_2
 Cooper, G. (2015). Non-operative treatment of the lumbar spine. princeton:
Springer.
 D'Arcy, Y. M. (2013). Compact Clinical Guide to Critical Care, Trauma, and
Emergency Pain Management: An Evidence-Based Approach for Nurses. Springer
Publishing Company.
 Davis, L. E., & Richardson, S. P. (2015). Fundamentals of Neurologic Disease.
Springer.
 Ebnezar, J., Nagarathna, R., Yogitha, B., & Nagendra, H. R. (2012). Effects of an
integrated approach of hatha yoga therapy on functional disability, pain, and
flexibility in osteoarthritis of the knee joint: a randomized controlled study. The
Journal of Alternative and Complementary Medicine, 18(5), 463-472.

35. References
 Hoeger, W. W., & Hoeger, S. A. (2015). Principles and labs for fitness and wellness. Cengage
Learning.
 McKinnis, L. N. (2013). Fundamentals of musculoskeletal imaging. FA Davis.
 Monfett, M., Harrison, J., Boachie-Adjei, K., & Lutz, G. (2016). Intradiscal platelet-rich
plasma (PRP) injections for discogenic low back pain: an update. International
Orthopaedics, 40(6), 1321-1328. http://dx.doi.org/10.1007/s00264-016-3178-3
 Moore, R. J. (Ed.). (2013). Handbook of pain and palliative care: Biobehavioral approaches
for the life course. Springer Science & Business Media.
 Powers, C., Bolgla, L., Callaghan, M., Collins, N., & Sheehan, F. (2012). Patellofemoral Pain:
Proximal, Distal, and Local Factors—2nd International Research Retreat, August 31–September
2, 2011, Ghent, Belgium. Journal Of Orthopaedic & Sports Physical Therapy, 42(6), A1-A54.
http://dx.doi.org/10.2519/jospt.2012.0301
 Samraj, & Kuritzky, L. (2012). Nonsteroidal anti-inflammatory drugs in the treatment of low
back pain. Journal Of Pain Research, 579. http://dx.doi.org/10.2147/jpr.s6775

36. THE END
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