INDUSTRIAL TRAINING

ASSESSMENT 2017:
LOW BACK PAIN

BY SITI NUR QAMARIAH IBRAHIM

113114016209
ANATOMY – LOW BACK
 The Lumbar spine consists of the vertebral body, posterior
elements, intervertebral disks, and ligaments. The lumbar spine
is made up of the five lumbar vertebrae located between the
thoracic spine and the sacrum. This area is commonly called
the “lower back”. The lumbar vertebrae are the largest of the
vertebrae because of their weight-bearing function supporting
the torso and head.
 The function of the structures of the lumbar spine are to protect and
support the spinal cord and spinal nerves. The spinal nerves pass through a
large hole (foramen) in the center of each vertebrae, which when lined
up is called the spinal canal. The lumbar spinal nerves branch off the spinal
cord at each level between the vertebrae. The joints—a joint is where two
or more bones meet—between the vertebrae contain a disk
(intervertebral disk) that acts as a shock absorber.

 The vertebrae of the back are “linked” together by pedicles (lamina,

transverse process, and spinous process) to form facet joints.
 Important muscles of the lumbar spine include:

 Multifidus: This long muscle travels nearly the entire length of the back. It
stabilizes and rotates the lumbar spine.
 Longissimus: Another long muscle, this one begins in the middle of the
lumbar spine and continues up to the transverse process.
 Spinalis: This superficial muscle begins as a thick tendon from the sacrum
and travels up into the neck, inserting at the spinous processes of the
cervical vertebrae.
 Ligaments of the Back
 The function of ligaments is to attach bones to bones and give strength
and stability to the back. Ligaments are strong, tough bands that are not
very flexible. The vertebral bodies of the back are connected to each
other by multiple ligaments which include:
 • posterior longitudinal ligaments
 • anterior longitudinal ligaments
 • intertransverse ligaments
 • interspinous ligaments
 • supraspinous ligaments
LOW BACK BAIN

 Also known as lumbago (at times referred to as waist pain) is pain (as
name implies) in the lower back (lumbar) region.
 Typically, the commonest area of back pain is the low back (lumbar
region) and sometimes it spreads to the buttocks or thighs.
 WHY THE LOWER BACK?
 Lumbar region because:
 It bears most of the body’s weight
 Most movements of the spine occur there.
 Most bouts of back pain ease quickly, usually within a week (acute back
pain). When symptoms persist for several months (over 3 months) chronic
back pain results. Back pain could be mechanical, pathologic or
physiologic
 FACTS:- Low Back Pain
 Second most common cause of missed work days
 Leading cause of disability between ages of 19-45
 Number one impairment in occupational injuries
 Referred LBP Is Remote From Source of Pain
 LBP may radiate into
 • groin • buttocks • upper thigh (posteriorly) areas that share an
interconnecting nerve supply
 Source of somatic referred pain is a skeletal or myofascial structure of the
lumbar spine
 Source of visceral referred pain is within a body organ
 • ovarian cysts may refer pain to low back • cancer of head of pancreas
can present as low back pain becoming excruciating at night
 Muscular Pain
 Most back pains are caused by strain or sprain of the back muscles &
ligaments
 Pain will be in discrete area & tender to touch
 It is of aching quality & may involve muscle spasm
EPIDEMIOLOGY

 Back pain, especially low back pain (LBP), most often affects people
between the ages of 25 and 60 years and those aged between 50 and 60
years are likely to become disabled (Corbin et al, 2002).
 Up to 70%-85% of the population in the United Kingdom (UK) experience
back pain at some point in their lives.
 The annual years of healthy life lost per 100,000 people from low back pain
in Malaysia has increased by 23.4% since 1990, an average of 1.0% a year.
CAUSING FACTOR

 Causes may be anatomical or even psychological

 Pain may be due to:
 Sitting for long periods of time
 Standing for long periods without moving
 Poor sitting or sleeping posture
 The back is prone to a range of problems most of them caused by ;
 Obesity
 Lack of regular exercises
 Bad posture
CONT..

 Lifting heavy objects incorrectly

 Carrying a heavy backpack on one shoulder
 Activities which involve excessive bending of the waist
 LBP Psychological Factors
 Psychological factors that may contribute to or be caused by chronic LBP
include
 • depression
 • anxiety
 • post-traumatic stress disorder
 • pre-existing disorders
PT ASSESSMENT
 AGE: 23
 SEX: female
 RACE: chinese
 OCCUPATION: family restaurant owner – waiter, chef, cashier
 D.O.A: 13/06/2017 (10th follow-up for physiotherapy)
 DR. DIAGNOSE: lumbar spondylolisthesis
 DR. MX: conservative
 CHIEF COMPLAINT: pt complaint of pain on her back coming down to her
left leg.
 CURRENT HX: pt was involved in a MVA where she sat back in the
passenger’s seat with her dog and the driver had accidentally made a
break which cause her to jump forward and hit herself at the front
passenger’s seat.
 She states that the accident causes her to feel the pain arise on her lower
back.
 Date: ??
 PAST HX: patient suddenly woke up from sleep and felt very painful on her
lower back. She stayed on her bed until the pain subsides but never went to
receive medical treatment.
 PAST MEDICAL HX: nil surgery, nil medication
 SOCIAL HX:
 Graduated from her studies and is currently helping her family business –
restaurant. Restaurant opens at 8.00am till 10.00pm.
 Lives with her brother who is still studying in university.
 Manages both of the housework and the family restaurant but due to
her condition, pt delays
 Pt tries to sleep on the unaffected side to reduce the back pain
 PAIN ASSESSMENT:
 SITE: posterior – lumbar region
 SIDE: left
 ONSET: gradually increases
 DURATION: >3 months
 NATURE: constant
 TYPE: sharp pain (when doing heavy work); aching (when performing
light work)
 SEVERITY: moderate
 AGGRAVATING FACTOR: prolong standing, prolong walking, carry
heavy objects
 RELIEVING FACTOR: rest, sleep
 VAS: 3/10 resting; 6/10 active
 OBERSERVATION
 BODY BUILT: ectomorphic
 POSTURE: normal
 GAIT: normal
 ATTITUDE OF LIMB: normal
 TROPICAL CHANGES: nil
 Ms wasting: nil
 Deformity: nil
 ON PALPATION
 Tenderness: grade 1
 Temperature: normal
 Edema: nil
 Ms spasm: left side of lower back
 ON EXAMINATION:

LUMBAR Before After  RANGE OF MOTION:

MOVEMENT Active Passive active passive  Interpretation:
Flexion AFROM AFROM AFROM AFROM  Extension limited ROM with
pain at mid range
Extension Limited Limited
ROM ROM  Left side rotation limited
due to pain
Left side flexion Limited Limited
ROM ROM  Trunk rotation was not
performed
Right side flexion AFROM AFROM AFROM AFROM
Left trunk rotation - - - -
Right trunk - - - -
rotation
  MANUAL MUSCLE TESTING:

LUMBAR MOVEMENT GRADE

FLEXION 4/5
 SPECIAL TEST
EXTENSION 3/5
 SLUMP TEST:
LT SIDE FLEXION 3/5  PRONE KNEE BEND: (-)ve

RT SIDE FLEXION 3/5  Modified PKB: (+)ve

 SLR TEST: (-)ve
LT TRUNK ROTATION 3/5

RT TRUNK ROTATION 3/5

 Interpretation: muscle power are

reduce d/t pt withstand the pain
 INVESTIGATION:
 X-RAY: Dr finds lumbar spondylolisthesis at L4-L5,
 Grade: ???

 PROBLEM LISTING:
 Pain d/t PID(?)
 Ms spasm d/t repetitive and excessive work load
 Limited ROM d/t pain
 SHORT TERM GOAL
 Reduce pain
 Improve muscle strength

 LONG TERM GOAL

 Prevent secondary complication
PLAN OF TREATMENT

 Ultrasound
 5 mins
 Site; lt side of low back region
 TENS
 20 mins
 Site: lt buttock and lat side of lt thigh
 Traction: lumbar
 20 mins
 Back care exercise
 SLR, piriformis exercise, pelvic tilt, pelvic rolling, abdominal contraction
 Home education program
 Prevent from carrying any heavy objects
 Allow to have resting period in between work
 Use comfortable shoes – no high heels or flat slippers
 Bed positioning –
 Side lying - Lie on the unaffected side and apply pillow in between the legs
 Supine lying – apply pillow underneath the low back and knee
THANK YOU

 REFERENCES
 MOB Olaogun (1999):Pathomenchanics and force analysis at the low back
during physical tasks (JNMRT), vol 4 (7). Pp 7-11
 Clark MA, Russell AM. Low back pain: a functional perspective. Thousand
Oaks, CA: National Academy of Sports Medicine; 2002.
 Hodges PW. Core stability exercise in chronic low back pain. Orthopedic
Clinics of North America. 2003;34:245-254.
 Kendall FB, McCreary EK. Muscle Testing and Function. 4th ed. Baltimore,
MD: Williams & Watkins; 1993: 215-226, 284-293.