1. Presented by : Chathura Karunarathna DPHY 01/09/001

2. Content Introduction Anatomy Causes Symptoms Red and Yellow Flags Investigation Treatments Prevention

3. Introduction Low back pain affects over 80% of persons at some point in their life. 90% of the time low back pain is recurrent. The peak age of incidence of low back pain is 30 to 50 years old. The most common cause of disability of a persons in more than 45 years. Second most common reason for physician visit.

4. Anatomy 5 lumbar vertebra Sacrum Coccyx

5. Anatomy Lumbar Intervertebral Disc

6. Anatomy Lumbosacral Joint

7. Anatomy Lumbar ligaments 1.Anterior longitudinal ligament 2.Posterior longitudinal ligament 3.Ligamentum flavum 4.Facet capsulary ligaments 5.Interspinous ligaments 6.Supraspinous ligaments

8. Anatomy

9. Nerve supply

10. Low Back Pain Back pain is described by the length of time symptoms persist: Acute LBP lasts less than 6 weeks Sub acute LBP lasts between 6 and 12 weeks Chronic LBP persists for more than 12 weeks

11. Causes of Low Back Pain Mechanical Causes

12. Muscle or soft tissues sprain or strain Back pain most often occurs from strained muscles and ligaments. From improper or heavy lifting. After a sudden awkward movement.

13. Lumber Disc Herniation The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. 95% of disc herniations occur at the level between the fourth and fifth lumber vertebrae in the low back.

14. Other Mechanical Causes Kyphosis Fractures Leg length difference Restricted hip motion Lumbar spinal stenosis Osteoporosis

15. Causes of Low Back Pain Inflammatory Causes

16. Ankylosing spondylitis Ankylosing spondylitis is a form of chronic inflammation of the spine and the sacroiliac joints. Characterized by pain and progressive stiffness in and around the spine. Over time, chronic inflammation of the spine (spondylitis) can lead to a complete cementing together (fusion) of the lumbar vertebrae.

17. Lumbar Spine Arthritis Lumbar spine arthritis is most commonly seen in older patients, but can be seen in all age groups. Patients with degenerative changes resulting in spinal stenosis (narrowing of the spinal column) may experience numbness, tingling, or weakness in the legs due to irritation of the lumbar nerve roots.

18. Symptoms Symptoms are depend on the affected cause of lower back. Back sprain or strain Muscle spasms, cramping, and stiffness. Pain in the back and buttocks. Nerve-root pressure Leg pain Tingling, Numbness, or Weakness along the leg. Loss of bladder and/or bowel control.

19. Symptoms Arthritis of the spine Usually causes pain that is worse in the back and hip region. Starts gradually, gets worse over time. Other conditions Fever weight loss Progressive weakness in the legs (cauda equina syndrome)

20. Red Flags of Lower Back Pain Weight loss, fever, night sweats Infection (current/recent) History of cancer Prolonged use of corticosteroids Older age Major Trauma Osteoporosis Back pain at rest Bowel or bladder dysfunction

21. Yellow Flags of Lower Back Pain Environmental factors Societal factors Stressors in relationships Mental health The belief that pain is harmful or severely disabling Job dissatisfaction

22. Yellow Flags of Lower Back Pain

23. Investigations MethodMainly use for identify X-raysOsteoporotic fractures, Dislocations. Bone scanInfection, Paget disease. CTBone tumours, Fractures, Spinal stenosis. MRISpinal cord, Nerve roots, Discs, Haemorrhage problems. Dexa ScanBone density

24. Treatments Although for many years there was no agreement among health professionals on how to best treat back pain. The treatment are very specific to the cause of the low back pain.

25. Treatments Surgical Microdiscectomy Discectomy Laminectomy Spinal fusion Disc replacement Manual Physical Therapy Back Brace TENS Ultrasound Hot or Cold packs Traction Massage

26. Physical Therapy Treatments Back Brace braces for the lower back are built to support abdominal muscles by restricting motion, they can take pressure off the lower back, relieving back pain and in many cases improving posture.

27. Physical Therapy Treatments Transcutaneous Electrical Nerve Stimulation TENS is a therapy that uses low-voltage electrical current for pain relief. The electrodes are often placed on the area of pain and creating a circuit of electrical impulses that travels along nerve fibers.

28. Physical Therapy Treatments Ultrasound sound waves Micro massaging effect Brings more blood to the area Improve Healing Reduce Pain

29. Physical Therapy Treatments Ice Packs Apply ice packs in every one or two hours to reduce inflammation and pain in acute stage. Hot Packs Heat therapy dilates the blood vessels of the muscles surrounding the lumbar spine. This process increases the flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue.

30. Physical Therapy Treatments Traction Increase joint space and Stretch soft tissues Increase Circulation Reduce pressure on spinal cord Decrease Inflammation Provide relaxation

31. Treatments Other Treatments Acupuncture NSAIDs for pain relief Thrust Manipulation Yoga

32. Outcome of Treatments Aim: To relieve symptoms and mobilise early. Pain Control. Manage tissue injury. Motion in Pain-free range. Restore Full pain free range of motion. Restore Muscle endurance. Restore Functional movements. Improve propriocetion.

33. Exercises For Lower Back Pain The goals of performing these exercises were to reduce pain and provide lower trunk stability by actively developing the "abdominal, gluteus maximus, and hamstring muscles as well as passively stretching the hip flexors and lower back muscles.

34. Low Back Extension Exercises Prone, or lying on your stomach on the floor or bed, is the best position in which to do extension exercises.

35. Low Back Flexion Exercises Pelvic tilt exercise increases the strength of the lower back muscles and help to improve full range of motion in both the pelvis and lower back vertebrae. This move loosens up any stiffness and can improve posture.

36. More Exercises For Lower Back

37. Prevention Lose any excess weight Wear flat shoes Avoid sudden movements Stop smoking Maintain healthy diet Avoid lifting heavy objects

38. Maintain Correct Posture Standing Sitting

39. Maintain Correct Posture SleepingLifting

40. Maintain Correct Posture Driving

41. Use Correct Body Mechanics