4. Haldemann (1977) 26 causes Whyke (1976) 20 categories Introduction

5. BACK ACHE DR.BHARAT PATEL M.S.(Ortho) SAMVED HOSPITAL DR.BHARAT PATEL M.S.(Ortho) SAMVED HOSPITAL

6. Introduction Hazleman and Bulgar (1979) Disc prolapse over diagnosed

7. Introduction Moorey and Robertson Benign lumbar pain syndromes

8. Classification of low back pain Spondylogenic back pain Neurogenic back pain Viserogenic back pain Vascular back pain Psychogenic back pain

9. CAUSES OF BACK PAIN

15. Causes of back pain Poor Posture  Disturbed normal “natural S” shape of spine leads to back pain.

16. Causes of back pain Out of Shape Your overall physical condition can affect your back.

17. Causes of back pain Tension and Stress

18. Causes of back pain Aging and Disease  Loss of muscle strength with aging.  “slip disc”  Osteoarthritis, a form of aging arthritis, can cause back pain.

19. Causes of back pain Impact Trauma

20. Causes of back pain  Obesity

21. Causes of back pain

22. Adolescent acute back 12 to 14 yrs in girls 14 to 16 in boys Disc space infection Herniated lumbar disc Spondylolysis or lysthesis

23. Lumbar Instability The tall young man House wife Post surgical patient The keep-fit enthusiast Young man in his 20’s with undetected lumbar osteochondrosis. Mature woman between 40-50 with degenerative spondylolisthesis.

24. The man fearful of his back Over 40 and in past years suffered probably a minor episode of back pain. Because of this temperament, combined at the time with a strongly worded caution from his doctor to take care, the patient has lost all confidence in the health and durability of the low back.

25. Time dependent back ache Particular movement aggravates the pain. Particular time aggravates pain – rising in the morning.

26. Over stressed labourers back Strong solidly built man Farmer No sciatica Insidious onset

27. The Equinox Syndrome Severe leg pain limb cold Feel of numbness Unless the neurological involvement is multiradicular, normal muscle power regained in 10 wks.

28. Spinal stenosis Congenital stenosis. Acquired stenosis – facet joint arthrosis, ligamentum flavum thickening, disc trespass, posterior vertebral lipping, spondylolisthesis, venous congestion, isolated disc resorption, degenerative stenosis, disc prolapse.

29. Chair bound back ache 40 year old physically active in the past, but risen professionally to assume responsibility which entail much administrative work. Obese. Lumbar stiffness on rising in the morning.

30. Low back pain in pregnant women 50% of the pregnant women. Sweden is the highest 70% (9 wks of sick leave). Common with multiparus women. Mechanism : Increased lumbar lordosis. Hormone relaxing.

31. How to prevent by exercise programme Before pregnancy & during 1 st trimester. Can be continued in 2 nd and 3 rd trimester.

32. Low back pain in children Rare complaint. Often illusive – Delayed diagnosis because of rarity. Must be investigated. Causes : Mechanical Developmental Inflammatory Neoplastic Tethered cord Psychogenic

33. Sports related low back ache

34. Collapsed back with kissing spine Women in late middle age Lumbar ache on standing Degenerated all joints

35. DISORDERS OF IV DISC

37. Backache Leads To…… Pain Disability to pursue activities of daily leaving Absenteeism Sexual dysfunction Financial and psychological set back

38. Diagnosis of back pain Physical Examination & Investigations

39. Diagnosis of back pain Physical Examination

40. Diagnosis of back pain Investigation : Blood Ix Radiological Ix - Plain X-ray - Myelography - CT scan - MRI

41. Management of back pain Conservative Treatment Operative Treatment Preventive Treatment

42. Conservative treatment Medicines  Pain killers  Muscle relaxants  Vitamins

43. Conservative treatment Bed rest

44. Conservative treatment Physiotherapy Activity modification

45. Conservative treatment Manipulation of back

46. Conservative treatment – Orthosis- (belts)

47. Conservative treatment Weight reduction

48. Conservative treatment Injection therapy ( epidural steroids)

49. Operative treatment

50. WHY WHEN ?? WHERE ?

51. Preventive Treatment DO’S & DON’TS

52. Preventive treatment While working in standing position, use a small stool under one foot to avoid back strain.

53. Preventive treatment While carrying weights, divide the load into two equal halves

54. Preventive treatment Always climb up to bring heavy object from height. Avoid stretching your back.

55. Preventive treatment Sit with back straight & well supported while doing work. Avoid stooping.

56. Preventive treatment Reduce weight keep slim & active

57. Preventive treatment Always carry weight near the body.

58. Preventive treatment After a heavy day at work A good way to rest your back Correct sleeping posture A firm mattress, A small pillow under head & neck A small bolster under the knees

59. Preventive treatment Simple exercises to keep the back fit

60. Preventive treatment Follow this posture & avoid back, neck & shoulder pain Reduce brightness to avoid strain Elbow support Back support Low back support Correct distance between table and chair Foot support Correct table height

61. THANK YOU