LOW BACK PAIN WITH

MOBILITY DEFICITS
ACUTE LOW BACK PAIN WITH MOBILITY
DEFICITS
• Mr. X exhibits symptoms of acute low back pain with mobility deficits, in
that he has had the symptoms for a period longer than 12 months, but were
aggravated by intense pressure on the lumbar segment.
• Patients with acute lower back pain resulting from injuries to the
back muscles and lumbar vertebra have difficulties with the range of motion
of their lower back muscles.
• Patients with a high BMI experience greater stress on the lumbar vertebra,
which aggravates pain and increases risk of disability.
• Mr. X exhibited limited range of motion of the lumbar area with limited
segmental mobility,
• Patients with chronic lower back pain experience an increase in the severity
of pain and disability in the event the affected muscles are provoked.
PHARMACOLOGICAL MANAGEMENT

•Analgesics to relieve pain, such as paracetamol, which act by reducing the

patient's sensitivity to pain impulses.
•Non-steroidal anti-inflammatory drugs, such as ibuprofen, which inhibit
prostaglandin synthesis, thus reducing the amount of pain impulses
transmitted to the central nervous system (Urits et al,
2019). However, NSAIDs should not be used for long periods as they may
lead to renal damage.
•Muscle relaxants such as carisoprodol are also prescribed to soothe the
aching back muscles by relieving spasms.
NON-PHARMACOLOGICAL MANAGEMENT

•Promoting activity with resumption of activities of daily living by the patient

to reduce incidence of joint stiffness, pressure ulcers, loss of mineral density
in the bones, and venous thrombo-embolism.
•Assisting the patient to develop coping strategies to manage their condition
through education is also important to maintain wellness while preventing
future injuries.
•Patient educations on provocative movements to avoid, such as twisting and
bending, also help maintain back muscle integrity and avoid aggravating the
pain.
•Chiropractic spinal manipulation helps improve motion and enhances spinal
function.
•Acupuncture is also an effective method of back pain management, as
it reduces discomfort in the patient and provides an effective method of
chronic lower back pain management (George et al, 2021).
•Therapeutic massage for management of short term back pain can also be
employed, which can greatly relieve discomfort in the patient, and improve
their quality of life.
 Core stabilization exercises can also improve the patient's musculoskeletal
function by strengthening the transverse abdominus and multifidus
muscles.
 Anterior and posterior pelvic tilt and bridges also improve the patient's
back muscles, and help promote good posture and muscle stretching.
 Patient education on the appropriate posture during lower back movement
such as bending is also important to avoid further stress in the lower back
muscles and the lumbar segment of the spine.
PHYSICAL THERAPY FOR LOWER BACK
PAIN
• The aim of physical therapy is to lower pain and improve the patient's
activity through physical exercise.
• Hip rotation therapy with lateral and medial prone hip rotation helps relieve
pain by reducing muscle tension and joint stiffness.
• Multi-directional hip stretching exercises can also be done to promote
muscle activity and improve function, and include lunges, crook-
lying, standing and sitting groin-stretch, sitting with medial hip rotation,
flexion and abdominal stretches.
•A home strengthening program can be developed for the patient to follow on
discharge, which will ensure that he maintains activity in the affected back
muscles and avoid further injury.
•The program includes exercises to be done over a certain period of time, and
involve different muscles in the back and lower limbs.
•Such exercises include; quadruped hip extension, side-lying hip
abduction, lateral hip exercise, single leg bridge and single leg squats.
• The exercises promote lower limb function and improve pain.
GLOBAL POSTURAL REEDUCATION
METHOD
•GPR refers to a stretching program aimed at improving pain and optimizing
the patient's function, and the patient's quality of life.
• The method targets the muscle chains in which muscle shortening can
occur, and can be as a result of behavioral, psychological or constitutional
factors (Cavalcanti et al, 2020).
•GPR aims to stretch the shortened muscles using the creep of the
viscoelastic tissue and to enhance the contraction of the antagonist muscles,
which helps eliminate the possibility of postural asymmetry.
•The exercises involved in the GPR method include;
•Lying on the back with the lower limbs flexed.
•Sitting with the lower limbs extended,
•Lying on the back with lower limbs extended.
•Standing at the center.
•Standing while leaning forward.
OTC VS PRESCRIPTION MEDICATION

•It is important to advise patients on the possible interactions between OTC

and prescription medications, especially those recommended by people with
no medical expertise.
•In patients with a history of clotting disorders, coQ10 is likely to increase
the risk of clotting in patients who take warfarin, and Mr. X having a
warfarin-containing prescription medication is at risk of developing DVT.
•OTC medications usually have side effects that may affect a patient's general
wellbeing. Kava kava, for example, exhibits diarrhea, depression, fatigue,
dizziness and headache as side effects.
•Kava kava also poses a risk of liver damage, which can lead to liver cirrhosis
and liver failure.
•The patient should be advised to consult with his health practitioner on the
OTC medications he decides to buy to avoid any negative impact on his
acute and chronic conditions, and organ damage including the kidneys and
liver.
MR. X'S EDUCATION PLAN

•Provide extensive education about the patient's condition, medical and non-
pharmacological management and possible outcomes.
•Encourage the patient to express his concern about his condition, including
backpain and the pre-existing chronic conditions, and voice his preferences
on how his condition is to be managed (Lim et al, 2019).
•Reassure the patient that his condition is manageable and eliminate any fears
concerning how the condition can affect his pre-existing chronic
conditions i.e. Diabetes Mellitus and DVT.
•Encourage the patient to stay active and stick to the exercise
routine provided, to ensure that the back muscles are stretched,
and that joints do not become stiff.
•Self-management is also important in ensuring the patient's wellbeing is
maintained, and the patient should strive to be good at solving
problems, making decisions, planning action and monitoring their behavior
and actions.
•Obesity increases the risk of disability, and the patient should strive to
maintain a healthy diet, and exercise to ensure his BMI falls within the
healthy range.
•The patient should be offered a self-management tool to ensure that he sticks
to the exercise plan provided, such as a mobile app to track his diet and
activity.
•The patient should also be advised to avoid self-medication, as OTC
medications can lead to adverse drug interactions that may worsen
symptoms and increase the risk of DVT.
•Include the patient's family in decision-making to ensure the patient receives
the best care possible on discharge.
•Advise on quitting smoking as it may lead to osteoporosis and reduced bone
density, which may lead to a greater risk of reduced musculoskeletal
function and disability.
•Reassure the patient that the condition is not life-threatening, and that it can
be managed and improved by regular exercise and pharmacological
management.
•The patient should also be provided with evidence based options for
management of back pain at home, which the patient can employ to improve
his overall wellbeing and quality of life.
REFERENCES

•Cavalcanti, I. F., Antonino, G. B., Monte-Silva, K. K. D., Guerino, M. R., Ferreira,

A. P. D. L., & das Graças Rodrigues de Araújo, M. (2020). Global Postural Re-
education in non-specific neck and low back pain treatment: A pilot study. Journal
of Back and Musculoskeletal Rehabilitation, 33(5), 823-828.

•George, S. Z., Fritz, J. M., Silfies, S. P., Schneider, M. J., Beneciuk, J. M., Lentz, T.
A., ... & Vining, R. (2021). Interventions for the management of acute and chronic
low back pain: revision 2021: clinical practice guidelines linked to the international
classification of functioning, disability and health from the academy of orthopaedic
physical therapy of the American Physical Therapy Association. Journal of
Orthopaedic & Sports Physical Therapy, 51(11), CPG1-CPG60.
Lim, Y. Z., Chou, L., Au, R. T., Seneviwickrama, K. M. D., Cicuttini, F. M.,
Briggs, A. M., ... & Wluka, A. E. (2019). People with low back pain want
clear, consistent and personalised information on prognosis, treatment
options and self-management strategies: a systematic review. Journal of
physiotherapy, 65(3), 124-135.
Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., ... &
Kaye, A. D. (2019). Low back pain, a comprehensive review:
pathophysiology, diagnosis, and treatment. Current pain and headache
reports, 23, 1-10.