Low Back Pain

Disease Process

Low Back Pain (LBP) can be divided into two categories:

1. Acute:
   • Lasts a few days to a few weeks.
   • Is usually mechanical in nature (a result of trauma to the low back or arthritis).
2. Chronic:
   • LBP that has been present for more than 3 months.
   • Can often be progressive (getting worse over time).

Causes

Common causes of LBP include:

• Muscle strain:
  Injury to the back can strain the back muscles.
• Bulging Disc(protruding, herniated, ruptured):
  As the disc degenerates and weakens (with age or trauma), part of the disc can be bulge or be pushed into the space containing the spinal cord or nerve root.
• Sciatica:
  a herniated disc puts pressure on the sciatic nerve (the large nerve that extends out of the pelvis and down into the leg).
• Spinal Stenosis:
  The narrowing of the bony canal (which puts pressure on the nerve roots).
• Spinal Degeneration:
  Wear and tear over times leads to narrowing of the spinal canal (which puts pressure on the spinal cord).
• Osteoporosis:
  A decrease in bone density creates a loss of bone strength. This can lead to fracture or collapse (compression fracture) of the vertebrae in the low back.
• Skeletal Irregularities:
  These place strain on the vertebrae and supporting structures (muscles and ligaments). An example of this is scoliosis.
• Spondylitis:
  Chronis back pain and stiffness is caused by infection or inflammation of the spinal joints.

Symptoms

1. Acute:
   • Muscle Aches
   • Shooting or stabbing pain
   • Decreased flexibility
   • Decreased range of motion (ROM)
   • Difficulty sitting, standing or walking
   • Difficulty doing functional activities
2. Chronic: all of the above for more than 3 months.
3. Sciatica:
   • LBP with pain through the buttocks and down one leg.
   • Numbness of the leg is possible.
   • Loss of motor control can occur.

Diagnosis

A diagnosis of LBP will be made through medical history, physical examination and special tests such as X-rays, MRI’s, CT scans, discograms, reflex testing and nerve conduction tests. Often these tests are done to rule out other causes of the pain such as tumors, cysts or metastatic disease.

Current Treatment

The treatment for LBP will vary depending on what the actual cause of the symptoms is determined to be, but it will probably include at least some of the following:

• Rest
• Ice or Heat
• Exercise
• Medication (NSAIDS, anticonvulsants, antidepressants or opiods).
• Physical Therapy
• Surgery

How Can Physical Therapy Help

Specific physical therapy treatment will depend on the actual diagnosis (cause of the pain), but the goals remain the same: decrease pain, increase motion and strength, increase function and work on prevention. Treatment may include:

• Posture and Body Mechanics, Ergonomics
• Modalities such as electrical stimulation, ultrasound and traction.
• Exercise (strengthening muscles, increasing flexibility, increasing endurance, helping with weight loss)
• Joint and Soft Tissue Mobilization
• Education about disease process and prevention.

Patient Resources

About.com
National Institute of Neurological Disorders and Stroke
American Academy of Orthopedic Surgeons
Spine-Health

Disease Process
Causes
Symptoms
Diagnosis
Treatment
Physical Therapy
Patient Resources

Facts

The US spends about $50 billion a year on Low Back Pain.

LBP is most common between the ages pf 20 and 50.

LBP is the most common cause of job related disability.

LBP is the 2nd most common neurological ailment (Headache is the 1st).