 Low back pain, the most common

musculoskeletal condition
 Which affects the bones, joints, ligaments, and
muscles of the back,
 The symptom that occurs primarily in middle-
aged adults, but it also may occur in children
and adolescents.
 Age:
 Adults: Common
 Children: Uncommon:
 Children and adolescents with scoliosis may have mild
pain.
 Severe back pain in children should alert the clinician to
look for a potentially serious problem, such as a tumor
or infection.
 Gender
males > females  higher rates of involvement
with manual labor, motor vehicle injuries, and
industrial accidents
 Obesity
 Smoking
 Manual labor
 Accidents
 Traumatic:
 Fractures/microfractures (causes severe immediate back pain)
 Dislocations
 Herniated discs
 Ligament tears
 Atraumatic:
 Degenerative disc disease
 Degenerative spinal stenosis
 Inflammatory arthritis
 Osteoporosis
 Spondylolysis and spondylolisthesis
 Neoplasms
 Primary or metastatic tumor
 Infection
 Symptoms:
 Low back discomfort/pain
 Stiffness
 Numbness
 Signs:
 Paravertebral muscle spasm
 Motor weakness
 Loss of deep tendon reflexes
 Loss of sensation
 Clonus
 Positive Babinski sign
 Physical Exam
 Begin with a general inspection of the spine.
 Note any asymmetry of the ribs, flank, or pelvis, and
inspect the natural sagittal curvatures of the patient.
 Assess ROM and determine local tenderness.
 Note flexion, extension, lateral bending, and rotation
of the lumbosacral spine.
 Sudden pain accompanying movement is suggestive
of a mechanical abnormality
 Pain with extension is common in patients with facet
joint arthritis and spinal stenosis
 Elicit paravertebral muscle spasms and percussion
tenderness
 Imaging
Conventional radiographs, CT scans, MRI, and
technetium bone scans should be used only to
confirm pathology or rule out a specific
diagnosis
 CT Scan  detecting bone abnormalities such as
fractures or osteoid osteomas.
 MRI  detecting marrow abnormalities or soft-tissue
processes such as metastatic bone disease
 Adults:
 Traumatic:
 Herniated discs
 Compression fractures
 Fracture/dislocation
 Atraumatic:
 Degenerative disc disease
 Spinal stenosis
 Inflammatory arthritis: Rheumatoid arthritis, AS
 Spondylolysis and spondylolisthesis
 Ligament strains
 Neoplasms: Metastatic bone disease, multiple myeloma
 Children:
 Traumatic:
 Herniated disc
 Fracture
 Atraumatic:
 Scoliosis
 Disc space infection
 Vertebral osteomyelitis
 Neoplasms
 Most patients with low back pain can be
treated nonoperatively with short-term bed rest
in the supine position, NSAIDs, and physical
therapy to improve muscle strength of the
lower back
 During the initial period of severe spasm and
pain (usually 2-7 days), patients may have
restricted mobility
 Medication
NSAIDs are the medications of choice for
decreasing inflammation.
 Generally, they are prescribed for an initial 4-6
weeks.
 If the pain resolves, the medication is discontinued
 Physical Therapy
Physical therapy  increasing endurance and
strength, lowers the recurrence rate and shortens
the history of back pain
 Surgery
Depends on the nature of the individual's
problem) have several principles in common:
 Decompression of any nerve root or spinal cord
compression
 Fusion to achieve a stable spine
 Consideration of realignment and fusion to correct spinal
deformities (i.e., scoliosis and spondylolisthesis)
 The prognosis is good (not always excellent) in
patients who do not have major structural
abnormalities.
 Patients with major fusions can return to most
activities, but they generally do not tolerate
heavy work or repetitive loading of the back