Low Back Pain (LBP) basic management

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