Lower back pain in computer professionals Dr Hemant K. Kalyan MBBS, MS(Orth), DOrtho, FCPS, DSportsMed(Edin) Consultant in Orthopedic Surgery and Sports Medicine, Bangalore ;

Schematic cross-section of an inter-vertebral disc inter-vertebral disc Herniated disc

Causal factors for back pain…  Spinal fracture  Herniated disc  TB spine  Mechanical low back pain - Diagnosis of exclusion – 75-80% of cases. Spinal Fracture Herniated Disc TB Spine

Trigger factors   Excessive load on normal back   Long / erratic hours   Poor workplace ergonomics   Stress: Physical, mental and emotional   Travel

 Normal load on weak or unprepared back  Fatigue  Improper posture/ chronic malpositioning  Lack of exercise, poor physical conditioning  Weight control problems Poor posture Trigger factors (contd)…

Three phases of management strategy…   Treatment of acute episodes.   Amelioration of chronic condition.   Prevention of exacerbation/ reinjury.

The case against protracted rest   Deconditioning: Loss of muscle strength and endurance   C hance of micro traumatic injury   Protracts recurrent episodes   Maintains chronic disability   Decreased flexibility   Adversely modifies spinal biomechanics   Physiology of disc hydration affected “Avoid pill popping”

Exercise - for which patients? Central focus in 95% cases   “YES” in mechanical causes   “NO” in non-mechanical causes

Exercise types…   Back-specific exercises   Peri-pelvic and LL flexibility and strengthening   Aerobic conditioning Double knee to chest stretch

Pelvic tilt Some exercises for the back… Lower trunk rotation stretch

Trunk Flexion Stretch Trunk flexion stretch Prone lumbar extension Some exercises for the back…

Alternate Prone Leg Extension Alternate prone leg extension Aerobic conditioning

Abdominal Strengthening Abdominal strengthening

Lower Limb Stretches Lower limb stretches

Complementary therapy   Back hygiene and back school   Correction of biomechanical factors   Posture   Weight control

Weight training Yoga

Yoga The right chair Counter height

Working Posture Posture at work The right posture…

Sitting Posture Sitting posture Forward bending

Pulling an Object Pulling an object

Thank you