Low Back Pain By: Brandon Hodes EXS 486

What is Low Back Pain? Low Back Pain (Nonspecific low back pain) is defined as pain in the lumbosacral area caused by a variety of somatic (musculoskeletal) dysfunctions No major identifiable pathology Better definition: Pain experienced in the lumbosacral region in the absence of major identifiable pathology. Pain is typically diffuse and located in a region that includes the areas of the back below the ribs and above the distal fold of the buttocks.

SCOPE Most people will experience nonspecific low back pain (NSLBP) at least once in their lifetime Annual rates between 14 and 93% in individuals have a history of NSLBP Considered the most expensive musculoskeletal affliction and the most common cause for disability among Americans under the age of 45 Incidence of NSLBP of 49.1 % in working aged adults

SCOPE cont. Age related NSLBP could be related to the spine losing its elasticity and increasing stiffness Younger people are more likely to experience brief episodes of pain, while adults experience more frequent and prolonged pain Need to avoid acute pain becoming chronic Chronic back pain cost estimates in U.S. range from $12.2 to $90.6 billion a year The big question is, at what point do we start prevention treatments? And how?

Pathophysiology No true identifiable source for NSLBP However, many structures with pain receptors could be a cause Ex: intervertebral joint capsules, vertebral fascia, paravertebral muscles, etc. Microsurgery has been used as a test for these structures. Pain was always present with nerve root compression

Pathophysiology cont. Intervertebral discs the most frequently implicated structure in NSLBP Others believe that it’s the combination of several anatomic structures to be a cause

Known causes of low back pain Herniated discs- intervertebral discs get compressed together and bulge outward Sprains and strains- caused by overstretching, ligament tears, muscle or tendon tears. Occurs from heavy lifting, turning, twisting, etc. Intervertebral disc degeneration- loss of elasticity and flexibility in vertebral column. Age related Spinal Stenosis- narrowing of the spinal column putting pressure on spinal cord and nerves. Leads to pain, and leg weakness David Wright MLB player who suffers from spinal stenosis

History/Physical Exam Accurate history and physical exam are important for low back pain Keep track of first time pain or reoccurring pain Physicians should use clinical approach to help examine patient Pain in different areas of body can help identify where pain comes from Ex: pain from L1-L3 will radiate to hip/thigh region, where pain from L4-S1 will radiate below the knee Physicians should also be aware of “Red Flags” to help distinguish causes Ex: infections, cancers, cauda equina syndrome, and fractures

Diagnostics X-rays MRI’s CAT scans Myelogram

Exercise testing However useful for EXS prescription, testing is not necessary unless patient indicates some form of coronary artery disease or other medical conditions that would require exercise testing Subject also should be in minimal discomfort for testing to be done; may have to wait a week or two before testing could be done

Exercise Prescription Post initial treatment by physician or physical therapist Patient must experience no pain or mild discomfort before exercise can proceed (no radiating pain)

Exercise Prescription cont. Cardiovascular: 40-60% max VO2. Can go up to >60% 3-5 x per week, preferably everyday during lighter intensities Modes: treadmill, stationary bike, ergometers Resistance: submaximal, higher repitition 2-3 x per week on non-consecutive days Modes: free weights, machines, resistance bands Flexibility: static stretching, PNF. Feel stretch not strain 2-7 x per week

Case Study 42 year old male Experiencing some pain in lower extremities BP: 130/70 Cholesterol: 175 mg/dl Family History: none Risk: Low Goals: Increase strength, relieve pain in lower extremities Possible diagnosis: spinal stenosis Treatment: increase lower back strength, stent between vertebrae’s where compression occurs

Conclusion Low back pain or NSLBP is very common and most people will experience it in their lifetime Mild and severe cases Need to be careful when lifting/exercising Treatable, not curable

Sources pain.htm#3102_3 pain.htm#3102_3 tests tests Ehrman,Jonathon K. “24/Nonspecific Low Back Pain” Clinical Exercise Physiology. 3 rd ed. Champaign, IL: Human Kinetics, Print.