1. د. مــازن باشـيـخ

2. 1-Lower back pain (less than 12 weeks)  Etiology.  Diagnosis.  management. 2-Chronic lower back pain (more than 12 weeks) 3-cervical pain.

4. 1-Disc herniation (Spondylosis)

6. 2-Spondylolisthesis

8. 3-Musculo-ligamintous pain

9. 4-Spinal stenosis

11. 5-Degenrative Changes in the vertebrae, joints or intervertebral discs (osteoarthritis).

12. 6-Systimic diseases:  Infection.  Rheumatological diseases.

13. 8-Visceral diseases. e.g.:  Kidney diseases.  Aortic aneurism.

14. 9-Trauma. 10-Psychogenic.

17. History Physical examination Investigation

18. History Personal data : - Age : serious condition are found most frequently > 50 years.

19. Pain -O-Onset : suddenly  trauma or disk lesions gradually  other D.D. -D-Duration : acute < 12 weeks chronic >12 weeks -N-Nature and severity : how it affect functional life of the patient -S-Site : low or high unilateral low back pain with buttock pain which get worse with standing  SI joint derangement

20. Radiation : below knee with paresthesias and weakness of lower limbs  disk herniation Progression of pain Aggravating and precipitating factors: lifting heavy objects or walking Reliving factors : bed rest, NSAID, or leaning forward Previous episode

21. History of trauma,weight loss,loss of appetite, fever, saddle anesthesia,loss of sphincter control, lower limbs weakness, history of immune suppression, arthalgia. Systemic review to detect systemic causes Past history: especially of cancers (bronchus, breast, thyroid,prostate, or kidney ) Social history Family history Psychological history is important

22. Physical examination Inspection : posture, deformity, and walking Palpation : of spinal processes,iliac crest,iliolumbar ligament,and sacroiliac joint Rang of motion : asymmetrical or limitation Flip test  disc lesion Neurological examination : for lower limbs especially L4,L5,S1

23. Investigation NB : this list of most of investigation to most common cause of back pain but you don’t have to do all of it. Laboratory Radiological

24. Laboratory Alkaline phosphatase  paget’s disease,osteomalcia, secondary deposit in bones Serum calcium  high in cancers, myloma CBC U&E

25. Radiological Spine X-ray : fracture, erosion,destruction of bones and intervertebral discs,osteolytic or osteosclerotic lesions CT scan and MRI : location of disc lesion, spinal tumor,spinal compression

28. 8/7/2015copyright (your organization) 200328 Management of back pain divided into : Management of AcuteManagement of Acute back pain back pain Management of ChronicManagement of Chronic back pain back pain Management of Cervical painManagement of Cervical pain

29. 8/7/2015copyright (your organization) 200329 What is a management of acute back pain ? - A management involve : Patient educationPatient education Exercise and physical treatmentExercise and physical treatment Medication & injectionMedication & injection SurgerySurgery Psychosocial factorsPsychosocial factors

30. 8/7/2015copyright (your organization) 200330 1- Patient education : It's an important aspect of a successful outcome as a 90 % of patients recover within 4 weeks despite method of treatment. The education should be about : It's an important aspect of a successful outcome as a 90 % of patients recover within 4 weeks despite method of treatment. The education should be about : A - Activity level : bed rest should be avoided except in the most severe cases ( for 1-2 days only )bed rest should be avoided except in the most severe cases ( for 1-2 days only ) and usual activity should be initiated as soon as possible (except for bending & lifting should be avoided ).and usual activity should be initiated as soon as possible (except for bending & lifting should be avoided ). exercise classes ( physical treatmentexercise classes ( physical treatment )

31. 8/7/2015copyright (your organization) 200331 b- Prevention of recurrence : Back Pain can be prevented by: practicing safe bending and lifting techniques, strengthening and stretching exercises for the muscles support the back, good posture, and weight controlBack Pain can be prevented by: practicing safe bending and lifting techniques, strengthening and stretching exercises for the muscles support the back, good posture, and weight control

32. 8/7/2015copyright (your organization) 200332 2-exercise & physical therapy 2-exercise & physical therapy : should be started during the first month of symptom with physical therapists. the aim : the aim : strengthening the back and relieving pain what kind of exercises should the patient do ? what kind of exercises should the patient do ? two kinds of exercises : first,first, the patient should start by stretching of the back ( increase circulation and increase a process of healing )

33. 8/7/2015copyright (your organization) 200333 second,second, then he continue with strengthen type of exercises to make the muscles of his back, stomach, hips and thighs strong and flexible and this can be done by Low Back Exercise Guide for 10 -30 minutes / day and it's divided into 3 levels : initial exercisesinitial exercises IntermediateIntermediate advancedadvanced also involve aerobic conditioning such as ( also involve aerobic conditioning such as walking, swimming, or jogging walking, swimming, or jogging ) http://www.back.com/articles-exercises.html

34. 8/7/2015copyright (your organization) 200334 3- Medication & Injection : NSAIDs ( commonly use ) Muscle relaxant (not effective as NSAIDS ) Injection Injection :e.g. : Epidural injection ( after surgery, spinal stenosis to relieve the pain )

35. 8/7/2015copyright (your organization) 200335 4- Surgery : Only 5 -10% of a symptomatic disc hernia require surgery. Types of surgery : decompression and stabilization. Decompression may be used on a patient with a disc pressing on a nerve or a nerve being impinged by bone, both of which can have neurological effects( Usually these types of problems are caused by a bulging disc or a herniation of the disc which is pressing on a nerve). Stabilization is performed to eliminate spinal weakness.

36. 8/7/2015copyright (your organization) 200336 5- Psychosocial factors : Social factor Social factor is very important as a poor situation can alter a patient's reaction to pain. Psychologist Psychologist – addresses symptoms of depression, anxiety and stress, supporting patient and family with education

37. 8/7/2015copyright (your organization) 200337