Low Back Pain Definition etc

• What is low back pain?

  • Low back pain is a symptom not a disease, and can result from several different known or unknown abnormalities or diseases
  • It is defined by the location of pain, typically between the lower rib margins and the buttock creases.
  • It is commonly accompanied by pain in one or both legs and some people with low back pain have associated neurological symptoms in the lower limbs
• Context:

  • LBP affects over 80% of the population
  • 80% chance of reoccurrence in next year
  • 45% acute LBP will develop chronic LBP
  • 85% of LBP is non-specific and not due to a specific pathology

  
• What do we know about back pain?

  • Very common symptom
  • Occurs across all socioeconomic status and ages
  • Low back pain is now the leading cause of disability worldwide
  • Only a small proportion of people have a pathological cause
  • Influenced by local culture and social systems
• What do we know about back pain? - We know certain groups are more likely to complain of LBP:

  • Physically demanding jobs
  • Physical and mental comorbidities
  • Smokers
  • Obesity
  • Lower socioeconomic status
• What do we know about back pain? - Most people with new episodes of low back pain recover, but:

  • recurrence is common
  • For some low back pain becomes persistent and disabling
  • Known risk factors for persistent disabling low back pain
• An Overview – the patient in a clinical setting:

  • Referral / handover - sometimes have been sent by GP, post op or after screening through virtual clinic or on the phone, so amount of information on patient varies
  • Informal assessment - how are they walking/sitting, do they have mobility aids, how did they sound on the phone
  • Subjective examination - when did the start, how long, where it is
  • Red flags - previous lectures!!
  • What do I need to assess?
• An Overview – the objective assessment:

  • Observation
  • ROM
  • Palpation
  • Neural Integrity Testing (?)
  • Neural / Nerve Provocation Tests (?)
  • Special tests
  • Muscle strength or length tests
• Problem List:

  • Problem List
  • Management Plan
  • Short, Medium versus Long Term Plan
  • Advice and Education
  • Pain Relief / Pain Advice
  • Do I have a diagnosis?
  • What should I do next?
• Common Pathologies:

  • A good by to deal with lower back pain is by trying to rule out common pathologies:
  • Spondylosis / OA
  • Disc pathologies
  • Referred Pain
  • Stenosis
  • Facet joint sprains
  • Spondylolisthesis
• Ask red flag / CES questions to every patient that comes in with spinal problems
• Key skills to managing LBP:

  • Clearing for red flags
  • Assessing for common pathologies
  • Managing LBP positively to reduce the likelihood of recurrence!