Transcript Low Back Pain - Weber State University

Jenn Littrell
http://www.nebraskamed.com/health-library/3d-medical-atlas/165/low-back-pain
Overview
Definition
Epidemiology
Clinical
Aspects
Treatment
Effects of exercise
Exercise Testing
Exercise Prescription
Summary & Conclusions
References
Definition: pain and discomfort, localized below the
costal margin and above inferior gluteal folds, with or
without leg pain.
Non-specific LBP: pain not attributed to known
specific pathology/injury (i.e. tumor, fracture,
osteoporosis, etc.)
may
occur suddenly and unclear in onset (acute)
may result from major trauma (acute)
may result from multiple episodes of micro trauma
(chronic)
LBP is one of the most widely experienced healthrelated problems in the world.
Lifetime: 58-70%
Yearly: 15-37%
Most people will have at least 1 LBP episode in
their lives. (specifically, 4 out of 5 people)
5th most common reason for doctor visits in the
United States.
Symptoms
Pain
 localized (axial or mechanical LBP)
 referred (sciatica)
Pain is characterized by type (sharp or dull) and
where it is felt (groin, buttocks, upper thigh)
Pain is also classified by what antagonizes it
 positions, activities, etc.
Chronic LBP: focused and detailed patient history and physical examination.
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Initial evaluation flow sheet
Evaluation of gait, assessment of lower extremities
Acute LBP: diagnostic imaging (MRI)
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Severe or progressive neurologic deficits
Known etiology
CT evaluation for possible surgical candidates
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Recurrence
Disability
Loss of work
Increased use of health care system
Reduced quality of life
Inactivity
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Sciatica
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Acute:
 Rest
(return to activity asap)
 Ice
 Heat
 Support
 Physical Therapy
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NSAIDs
Muscle relaxants
Opiates
The United States has the highest rate of spinal
surgery, 5 x that of Great Britain.
Immediate surgery indicated for LBP cases with
sensorimotor changes in legs or urinary retention
 Also patients with worsening neurologic deficits or
intractable pain that is unresponsive to conservative
treatment.
2 types of possible surgeries:
 Discectomy
 Spinal fusion
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Standing alone, has no effect on ability to exercise
Use caution with position: i.e.. standing or sitting
Use a variety of exercise modalities
Limiting Factors
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Pain
Fatigue
Psychological
Sociological
NSAIDs:
 No effect (caution for GI distress)
Muscle relaxants & Opiates:
 Drowsiness
 Vertigo
 Weakness
 Loss of balance and muscle control
 Constipation (long term)
 Overuse & addiction
In asymptomatic patient:
 Improve ROM, particularly in the trunk, hips
and spine
 Increase exercise tolerance
 Decrease occurrence of future episodes of LBP
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Can trigger an episode of LBP
 Inactivity
 Unwillingness to exercise
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Significantly more effective than rest
Increase incentive, willingness to exercise
Increased strength, flexibility, ROM
Pain-free exercise
Weight loss
Decrease frequency and intensity of LBP
episodes
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**Can “cure” LBP within 3-4 months
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Similar to that for a healthy individual, follow
ACSM guidelines
Max or sub-max testing not necessary, focus on
strength and flexibility
Any testing may be symptom-limiting
Allow client to choose time of day and, if
applicable, modality for sub-max or max.
Allow for a longer warm up
Goal: improve health and well being, limit
exacerbations of LBP, increase in activity,
facilitate exercise in life
Similar to exercise prescription for healthy
individuals, especially for clients with
intermittent acute LBP episodes.
During acute episode, make adjustments to
intensity (low), avoid hip and back muscle
work for approx. 2 weeks
Focus on rehabilitative exercises first.
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Core strength, flexibility and coordination
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Hip flexibility
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Leg strength
Gradually build strength in trunk, back, gluteus and legs starting with
body weight, slowly adding light resistance (bands) and adding
weight as allowed.
Build abdominal strength and low back strength simultaneously
Teach proper body mechanics, i.e.. Neutral spine, lower back pressed
into floor, stacking shoulders, knees, bracing the core, etc.
Clients with LBP may have a fear of exercise, and may be
unwilling to try exercise they feel will exacerbate an
episode.
Allow client as much control as possible in choosing
modalities, position and especially weight selection.
Small victories will allow for increases in intensity.
Client teaching is paramount!
Warm up
ROM
Alignment
Posture
***Knowing when to stop***
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LBP is characterized primarily by pain
Exercise will be symptom-limiting
Generally, testing is similar to that for healthy
individuals
Prescription is also similar to healthy individuals,
make adjustments as needed on a daily basis
Be sensitive to psychological factors
**The best treatment for low back pain is exercise**
American Academy of Orthopaedic Surgeons, Low Back Exercise Guide.
Atul T. Patel, MD, Abna A. Ogle, MD. Diagnosis and Management of Acute Low Back Pain.
American Family Physician, March 15, 2000.
Chicagotribune.com, How to Take the Strain off Back Pain.
Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American
College of Physicians and th eAmerican Pain Society. Annals of Internal Medicine,
2007;147:478-491.
Light, Kristen J. The Lowdown on low back pain. Biomechanics Vol. XVI, Number 2, February 2009.
McGill, Stuart. Low Back Disorders. 2002. Human Kinetics, Champaign, IL.
Simmonds, Maureen J. PhD, Derghazarian, PT. Lower Back Pain Syndrome. ACSM’s Exercise
Management for Persons with Chronic Diseases and Disabilities. Human Kinetics, 2009.
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