Back Pain

What do we PREVENT for Low Back Pain?

-Pain: acute pain or chronic pain -Fatigue -Injury -Surgical intervention -Decline in participation -Social isolation

What do we MAINTAIN for Low Back Pain?

-Post-op precautions in activity -Body mechanics in activity

What do we MODIFY for Low Back Pain?

-Posture -Ergonomics -Environemtn -Activities: work simplification -Perfromance patterns -Pacing -Energy conservation -Standing: with leg on stool -Adaptive equipment -Sitting on therapy ball

What is localized low back pain?

-The patient will feel soreness or discomfort when the doctor palpates on a specific surface area of the lower back

What are the body mechanics of pushing/pulling?

-Use the lower body, one foot in front of the other, keep the elbow next to the body (KEY!!!) Pushing is better than pulling. Vacumming is difficult and causes a lot of back pain, need to keep the arm next to the side

What are faulty body mechanics?

-Worse: twist and bend, causes low back pain or initial injury. In work do they work in a place that causes twisting and bending -Body mechanics of lifting: not the bending down movement, but the lifting up and recovery of motion. When stretching use arms to walk up legs to help alleviate the strain on the lower back.

What is a bulging disc?

-disc extends beyond vertebra

What is spondylitis?

-inflammation of spinal column (Vertebral)

What is mechanical low pack pain?

-muscle spasm -relieved by abdominal bracing. Elastic bracing: adds external support to lower back and abdominal muscles. Virtual abdominal bracing: stronger ab muscles -treated with trigger point release: release of know when muscle spasms, must get certified for this -Modalities: heat or cold

What is mechanical back pain?

-muscle spasm, trigger point or referred pain -can be relieved by abdominal bracing, trigger point release, use of modalities -PT: dynamic spinal stabilization, neutral spine

What is low back pain?

-musculoskeletal -acute -sub acute -chronic -"an illness in search of a disease"

What is diffuse low back pain?

-pain is spread over a larger area and comes from deep tissue layers

What are the common causes of back pain?

-poor conditioning -faulty body mechanics: twist & bend -overuse, wear -obesity -smoking: constricts blood flow -Age: wear & tear, gravity -pregnancy -heavy backpacks & purses: shifts COG -Structural: osteoporosis, arthritis, spinal fractures, & protruding/ruptured discs, intervertebral disc degeneration, muscle spasms

What are the Standing postures?

Observation -Look at front and side to observe the clients posture -Sway back -Lumbar lordosis -Thoracic kyphosis -Cervical lordosis

What is radicular low back pain?

-Pain is caused by irritation of a nerve root. Sciatica is an example of a radicular pain

What are the occupations that are affected by low back pain?

-ADL: Bathing, dressing, functional mobility, personal hygiene, toileting, sexual activity, sleep -IADL: childcare, driving, home management, shopping, work, leisure

What is the analysis of occupations for low back pain?

-Activity/pain diary: what is pain level after the activity -Analyze the activity: which activity causes more pain, or the performance pattern (have they done 3 activities prior) -Provoking movements: they may already notice which movement is more provoking -Preventative strategies -Adapting the environment -Ergonomics (posture): how the environment is set up -Energy conservation: pacing -Increase strength and endurance for standing and sitting activity: progressive, 10 minutes of standing activity, then gradually increase -Stress reduction -Coping with chronic low back pain: other psychosocial issues, stress related, sitting on therapy ball is the best for sitting posture

What are sitting postures?

-Anterior pelvic tilt:

What do we CREATE/PROMOTE for Low Back Pain?

-Body mechanics -Core strength -Nutrition -Hydration (intercartilage requires fluid to keep spongy) -Proper standing/sitting posture

What is a herniated disc?

-Cartilage has a break/crack and inside fluid is leaking out

What is Radiculopathy?

-Caused by spinal stenosis -Nerve is being compressed and there is irritation, this will lead to sensory and motor problems along the nerve

What is the anatomy of the vertebral column?

-Cervical, thoracic, lumbar, and sacral. -Cervical = lordosis -Thoracic = kyphosis -Lumbar = lordosis -All moves together so if there is a defect or problem in one area the spine will usually be seen throughout the rest of the spine, change one area and the other areas will change -General Rule of Thumb: we work at the lowest region, ir work on kyphosis then that will effect the lordosis

How do we assess for scoliosis?

-Check by putting fingers on the ASIS of the pelvic bone -Weakness on one side from CVA will impress the scapula and need to align the scapula

What do we ESTABLISH/RESTORE for Low Back Pain?

-Core strength -Body mechanics -Proper standing/sitting posture -Pain management strategies -BLT/Log rolling (for Post-op)

What are the surgical interventions?

-Decompression, Fusion, and Laminectomy: all three for spinal stenosis -Post-op SPINAL precautions: bending, lifting no more than 5 lbs and twisting -Adaptive equipment: LB dressing requires dress stick, sock aid, lift leg up. How do we educate not to twist: teach to step instead of twist and arm next to the body, don't cross midline with arms. These precautions usually lst 6 months, but depends on the surgeon. Log rolling for no bending or twisting, shoulder and hip stay together, very common in use to get in and out of bed without straining the back.

What is spondylolysis?

-Defect in spinal column

What is spondylosis?

-Degeneration of spinal column -Stress fracture of the dorsal to the transverse process

What is Sciatica?

-Form of radiculopathy -Nerve roots L 4/5 - S 1/2/3 -The nerve is entrapped by disc herniation -For example: at s3 then there will be pain at the bottom of the foot

What is Myelopathy?

-Functional or pathological change in the spinal cord -Considered a mild SCI

What is Spondylolisthesis?

-Interior/posterior displacement of the vertebral -There is a slippage of one vertebra on another

What are the body mechanics of Golfer's lift?

-Lift one leg, good for THR (need good cognition = problem solving, firm surface to put hand on), EX: feeding the cat or dog

What are the types of low back pain?

-Localized: more acute -Diffuse -Radicular: more long term -Referred -Spondy: spinal column -Bulging disc -Herniated disc -Spinal stenosis: narrowing of the spinal canal and is touching or pinching the spina nerve, this will cause rediculopathy

What is spinal stenosis?

-Narrowing of the intervetebral foramen decreases the space where the spinal nerve exits or enters the spine

What are good body mechanics of squats?

-Neutral spine when lifting, and keeping things close while carrying

What are the body mechanics of standing?

-One foot up on small stool, keeping one leg on stool takes pressure off of the lower back. Cooking, washing dishes, brushing teeth, open counters and can put foot on the bottom of the cabinet