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LOW BACK
PAIN

PRESETED BY:
JENNIFER ARGEL
BS OT-4

• a complaint that often causes the
individual to seek help from the medical
system
• 4:5 adults will experience significant LBP
sometime during their lives
• LBP is the most frequent cause of lost
workdays in adults younger than 45 years
(after common colds)
• Most cases of LBP are not serious and
respond to simple treatments such as rest
or anti-inflammatory drugs

• Common Causes:
– poor conditioning
– improper use of the
back
– Obesity
– Smoking
– age

• most common causes
of structural problems
of LBP:
–
–
–
–

Osteoporosis
Arthritis
fractures of the spine
protruding disks

SPINE ANATOMY

VERTEBRAL COLUMN
• Composition:
– Vertebrae
– Intervertebral Disk

PARTS OF VERTEBRAE

INTERVERTEBRAL DISK
• composition:
– fibrocartilage
– nucleus pulposus
(central mass of pulpy
tissue)

• shock absorber
• provide flexibility for
movement
• supine position –
relieve of pressure

• Anterior and posterior
longitudinal ligaments
– extend the length of
the vertebral column
– attached to the
vertebral bodies and
intervertebral disks
– check excessive
movement of the
column

• sacrum
– lower fused portion of
the vertebral column
– attached to the pelvis

MUSCLES OF THE LUMBAR SPINE
• intertransversarii and
interspinalis
– connect the transverse
process to the spinous
process of adjacent
vertebrae

• lumbar muscles:
– lumbar multifidus
• extensor

– lumbar longissimus
• extensor, lateral flexor

– iliocostalis
• extensor, lateral flexor

• muscles of the
abdominal wall
– transversus abdominis
– obliquus internus
abdominis

INCIDENCE OF LBP
• 90% of clients – resolve within 6 weeks
• 5% - resolves in 12 weeks
• Less than 1% - due to ‘serious’ spinal
disease (e
...
, tumor, infection)
• Less than 1% - from inflammatory disease
• less than 5% - true nerve root pain

INCIDENCE OF LBP
• Problems:
– Sciatic (nerve root) pain
– Spinal stenosis
– Facet joint pain
– Spondylosis
– Spondylolisthesis
– Herniated nucleus pulposus
– Compression/stress fractures

REHABILITATION

REHAB TEAM
• physician
• occupational
therapist
• physical therapist
• caseworker
• Psychologist
• vocational
counselor

•
•
•
•

social worker
discharge planner
nutritionist
nurse

PHYSICIAN
• responsible for the
initial work-up (or
evaluation) of the
client

• examination:
– medical history
– current symptoms and
complaints
– functional limitations
– posture
– gait
– strength
– reflexes and sensation
– past interventions for this
problem

PHYSICIAN
• additional tests:
– nerve conduction tests
– computed tomography
scans
– magnetic resonance
imaging
– blood work

• after diagnosis:
– prescribes medication
– determines restrictions
in activity
– exercise guidelines

• re-evaluation after 1-2
weeks
– Referred to PT if
symptoms did not
decrease

PHYSICAL THERAPY
• Address
–
–
–
–

Pain
Spasms
Limited flexibility
Posture

• Goals
– reduce symptoms
– increase strength and
flexibility to achieve a
functional pain-free
outcome for the client

• Approach
– McKenzie extension
exercises
– Williams flexion
exercises
– Dynamic Lumbar
Stabilization (DLS)

PHYSICAL THERAPY
• dynamic lumbar stabilization (DLS)
– integration of the muscle groups that control
movement of the spine and the abdominal
muscles that support the back
– Flexion, extension, body mechanics of the
lower part of the back
– Abdominal Muscles
– Control of Lordosis
– Neutral Spine

NEUTRAL SPINE
• most comfortable spinal position for the
individual to complete movement patterns

OCCUPATIONAL THERAPY
• Intervention:
– Education regarding normal back anatomy and the physiology of
back movement as they relate to performance of occupations
– Use of neutral-spine back stabilization in occupational performance to
reduce pain
– Education in basic body mechanics
– Training in the use of adaptive equipment to modify tasks
– Task analysis and use of ergonomic design to modify the
environment
– Training in the use of energy conservation to maintain participation in
occupation
– Use of occupations to increase strength and endurance
– Education in strategies for pain management, stress reduction, and
coping

OCCUPATIONAL THERAPY
• Outcomes
– reduction of pain
– use of back stabilization techniques
– use of adaptive equipment
– incorporation of body mechanics and
ergonomics into client-specific areas of
occupation
– adapt this learning to new occupations to
prevent future problems
...


• What separate movements occur during this
activity?
– Bending, reaching, pulling, and pushing are
involved
...

– We know, however, based on normal anatomy that
bending at the waist increases pressure at the anterior
portion of the vertebral body and disk, along with
increased stretch at the back of the disk
...

– Next, she should pull the drawer open, remove the
carrots, and hold them close to her body
...

Pilar might also consider purchasing one of
the newer refrigerator models that have the
least used portion—the freezer—positioned
on the bottom, thus reducing the frequency of
the need to bend
...
With practice, the new
movement patterns will become a habit and
replace the old painful movements

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