LOW BACK PAIN

PRESENTED BY
K.KARTHICA
B.O.T 3RD YEAR
INTRODUCTION
Low back pain(LBP) can impact almost every area of functioning,
from self-care activities, to childcare and relationships, to emotional
functioning.
Low back pain is the most common type of pain in the united states
(27%) and the leading cause of disability in Americans younger than
45 years old
Nearly 1 in every 12 people experience frequent back pain of varying
degrees.
For some, this pain will resolve on its own and for others, it can be
minimized or eliminated with exercise, core strengthening, and
rehabilitation.
As for the rest, back pain can become chronic, and these people will
have to function with back pain for the rest of their lives.
DEFINITION
Low back pain or pain in the lumbosacral region is
triggered by some combination of overuse, muscle
strain, and injury to the muscles, ligaments, and discs
that support the spine.
EPIDEMIOLOGY OF LOW BACK PAIN

ACUTE
SUBACUTE
CHRONIC
CAUSES OF LOW BACK PAIN
 congenital causes
Traumatic causes
 Inflammatory causes
 Degenerative
 Neoplastic
 Metabolic causes
 Pain referred from viscera
 Miscellaneous causes
CONGENITAL CAUSES

SPINA BIFIDA SPONDYLOLYSIS

SPONDYLOLISTHESIS
TRAUMATIC CAUSES

VERTEBRAL FRACTURES PROLAPSED DISC

INFLAMMATORY CAUSES

TUBERCULOSIS ANKYLOSING SPONDYLITIS

DEGENERATIVE
METABOLIC CAUSES
OSTEOPOROSIS
NEOPLASTIC
BENIGN :
• OSTEOID OSTEOMA

MALIGNANT :
• MULTIPLE MYELOMA
 PAIN REFERRED FROM VISCERA
 Genitourinary diseases
 Gynaecological diseases
 MISCELLANEOUS CAUSES
 Functional back pain
 postural back pain
occupational bad posture
habitual bad posture
HISTORY
Age
 sex
Occupation
Past history
Features of pain :
 Location
 Onset
 Localisation of pain
 Progress of the pain
 Relieving and aggravating factors
 Associated symptoms:
 stiffness
 pain
 Swelling
 Numbness
 weakness
CLASSIFICATION:
ACUTE : less than 4 weeks
SUBACUTE : 4-12 weeks
CHRONIC : greater than 3 months
PHYSICAL EXAMINATION
 General : posture, pain behaviour
 General inspection of lower back
deformities, symmetry, redness, swelling.
 General palpation of lower back
tenderness, deformities, warmth tone
 Gait :
(ROM)testing
 Neurologic examination:
Evaluate sensation, strength & reflexes.
Provocative test:
straight- leg- raise- test(SLR).
STRETCHING:
 straight leg raising test
 contralateral straight leg raising test
 femoral stretch test
 faber test
MYELOPATHIC SIGNS(gait abnormalities):
 clonus sign & babinski’s sign
Five cathegories of tests included in waddell’s sign
 Simulation test
 Tenderness test
 Flip test
 Non anatomic weakness & sensory finding
CLINICAL FEATURES
GENERAL FEATURES:
1. Localized back pain
2. Muscular spasms
3. Difficulty in walking
4. Difficulty in getting up
5. History of trauma
6. Radiculitis
CAUDA EQUINA SYNDROME – RED FLAGS
 Severe low back pain with bilateral or unilateral
sciatica.
 Bladder or bowel dysfunction.
 Anaesthesia or paresthesia in perineal region or
buttocks.
 Significant lower limb weakness.
 Sexual dysfunction.
“RED FLAG” SYMPTOMS IN BACK PAIN =
TUNA FISH

T = Trauma
U = Unexplained weight loss
N = Neurologic symptoms
A = Age >50
F = Fever
I = IVDU(intravenous drug users)
S = Steroid use
H = History of cancer(breast, lung, renal, prostate)
RISK FACTORS
Aging
Genetics
 Occupational hazards
 Sendentary lifestyle
 Excess weight
 Poor posture
 Pregnancy
 Smoking
Alcohol and drug abuse
 Sports
Previous back injury
INVESTIGATION
X – rays
 CT SCAN
MRI
ESR
Liver function test
Renal function test
Urine examination
TREATMENT
Mainly conservative
 Bed rest/ pelvic traction
 Physiotherapy
 Back exercise
 Modification of daily activities
 Ultrasound
 NSAIDs/COX-2 inhibitor
Pelvic traction
surgery
OCCUPATIONAL THERAPY
ROLE:
OCCUPATIONAL THERAPY ROLE:
PROMBLEMS RELAVENT TO OT:
1. ADL
2. Limited range of motion
3. Muscle power
4. Postural abnormalities
5. Gait
6. Vocational
7. Sensations
GOALS:
To maximize their independent level (ADL)
To improve active ROM
To improve muscle power
To regain their sensation
To resettlement their vocation
APPROACH:
Biomechanical Frame of Reference
Rehabilitative frame of reference
Model of human occupation
Canadian occupation performance measure
Neuro developmental treatment
Psychoanalytical frame of reference
Sensory integration treatment
problem goal intervention Expected Home program
progression

Pain that limits Re- engagement Patient Understanding Incorporation

participation in in social education in of tools followed of pain
social activities activities pain by patients management
management using them tools into
tools independently ADLs/IADLs
and proactively

Fear of pain Increased level Cognitive Decreased fear Incorporate

resulting in of activity to behavioral avoidance cognitive
decreased allow therapy to behaviors behavioral
engagement in completion of address fear exhibited by strategies into
home tasks avoidance patients. daily living.
management issues.
tasks
Activity Increased Increases
simulation and activity activity level.
modification to tolerance and
facilitate task participation
completion
without pain
Outcome measures...
Decreased back pain
VAS
Wong-baker FACES pain rating scale
Brief pain inventory
Improved engagement in ADLs/IADLs, work and social activities
Improved self efficacy and coping
Improve quality of life
Improved functional mobility
FIM
COPM
Roland-morris disability questionnaire
Oswestry disability questionnaire
OCCUPATIONAL THERAPY
INTERVENTION:
Based on the occupational therapy evaluation, the
therapist may implement any of the following
intervention areas, depending on the needs and
personal goals of the client.
Factors to consider when implementing interventions
include the client’s willingness to change old
behaviors, educational level, financial abilities,
social support, cognition and self awareness.
Client education
Body mechanics:
It is important that clients thoroughly understand
how to use body mechanics to stabilize their backs.
This includes maintaining a straight back, bending
from the hip, avoiding twisting, maintaining good
posture, carrying objects close to the body, lifting with
the legs to promote safe performance, and using a
wide base of support.
Ergonomics at work:
 Many LBP injuries are caused or exacerbated by
working. Whether the person sits at a computer all day
or works on an assembly line, the spine is involved
with every movement. For labor-intensive jobs,
principles of body mechanics are applied to encourage
posture and limit strain on the back. For desk jobs,
ergonomic principles are applied to ensure a neutrally
positioned spine and to minimize muscle strain during
periods of extended sitting
 Equipment that allows employees to work while both
sitting & standing.
Energy conservation
Activity pacing
Self regulation training and coping skills
Stress and anxiety
Depression
Behavioral health interventions
ADAPTIVE DEVICES....
BEHAVIORAL HEALTH STATUS AND THE
RELATION TO PAIN

PAIN STRESS

DEPRESSIO
ANXIETY
N
LIFESTYLE MODIFICATION
Eating
Sleep
Exercise
Medication modification and cognition
Adaptive equipment
INTERVENTION STRATEGIES FOR
FREQUENTLY IMPACTED OCCUPATIONS
 Showering
Dressing
Functional mobility
Personal hygiene
Sleep
Toileting
Child care
Computer use
Driving
Home modification
Organization
Laundry
Dishes
Cleaning
Shopping
DRESSING
BED POSITIONING
STAND TO SIT AND SIT TO
SHAVING
STAND
 CHILD CARE

A. Incorrect way to
reach into a
refrigerator
B. squat with the
knees apart to
reach the lower
shelves and
drawers
LAUNDRY
OTHER MULTIDISCIPLINARY PAIN TEAM
MEMBERS
MULTIDISCIPLINARY:
 Physician
 Occupatioal therapist
 Physical therapist
 Pain psychologist
 Psychiatrist
 Case worker
 Nurse
OTHER PAIN TEAM MEMBERS:
 Surgeon (if needed)
 Pharmacist
 Nutritionist
 Vocational counseior
 Discharge planner
 Social worker
COMPLEMENNTARY AND ALTERNATIVE
THERAPIES:
 Yoga
 Massage
 acupuncture
CASE STUDY
Lets see how Mr. X got his active life back after
OCCUPATIONAL THERAPY treatment.
Mr. X 28 yrs old mechanical engineer, was very active from
his childhood participated in various sports, scout and
guides etc.
First time Mr. X got back pain when he was doing monkey
ladder, his continuous physical ad mental stress related to
his job, aggravated his back pain to the extent which made
him to rethink about his future and carrier. But as an
occupational therapist we took challenge with him to
continue the same job without back pain, but how!!
But it is a big question, what exactly
occupational therapy is!?
In simple term, occupational therapy is a form of
treatment where we help people to understand and
learn how you should do your job whatever it
is(occupation, household task, sports, driving,....) in a
way that it follow normal body biomechanics, which
should no hurt your back
Occupational therapy practitioners are uniquely
qualified with ergonomics, to provide services in
independent living settings, as they have an
understanding of dynamics interplay between the
individual and the environment.
Let’s begin:
occupational therapists initiate with analyzing
activity/ job and the context in which the activity is
performed, as well as the consumers ability to perform
the task . The therapist would then identify barriers to
performance and make recommendation accordingly.
As prevention is better than cure
Top 10 point to prevent lower back pain:
 Good posture
 Make the right moves
 Level of height
 Sleep right
 Practice relaxation technique
 Identify feeling of exertion and pain
 Drop the load
 Strengthen your abdominal muscles
 Take a break
 Perform back strengthening activities
 We need to reflect back to Mr. X who developed his back pain through
repetitive physical strain on his back which got double from mental stress
from his job, OT started intervention from Mr. X office where he spends 8-
10 hrs every day, by analyzing all the factors associated with back pain, we
recommended:
 First – regular break in your job
 Second – few small modification to his workstation, frequent use material
within his arm reach.
 Third – as he is mechanical engineer, analysis of frequent use instruments,
at worksite and modification in some instruments as per requirement.
 Fourth – detailed explanation and demonstration for maintaining proper
posture during working on instruments.
 Fifth – suggestion for doing regular therapeutic activity to improve strength
of his back and abdomen muscles.
REDUCING INJURY RISK FACTORS
Targeted stretch – spine, shoulder, hips
Consult an occupational therapist or health care
professionals to begin a targeted spine work
conditi0ning program
Improve general physical condition and
Cardiovascular fitness.