Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Therapeutic management for
Low Back Pain
Dr. SM Arman Hossain
MD Resident (Phase-A)
Physical Medicine And Rehabilitation
D...
Low Back Pain
Pain that occurs in an area with boundaries between the
lowest rib and the crease of the buttocks
Low Back Pain
• most common musculoskeletal complaint worldwide
• 85 percent of all people experiencing LBP during their
l...
Anatomy of Lower back
• Lumbar Vertebrae
• Sacrum
• Coccyx
• Ilium
• Sacro-iliac Joint
Anatomy of Lower back
pars interarticularis
Lumbar vertebrae
Anatomy of Lower back
Intervertebral Disc
Disc Problems
Anatomy of Lower back
Soft tissue (Muscles)
• Psoas Major/minor
• Quadratus lumborum
• Intertransversalis
• Multifidus
• E...
Anatomy of Lower back
Soft tissue(Ligaments)
• Anterior longitudinal
ligament
• Posterior longitudinal
ligament
• Interspi...
Classification of LBP
LBP Dutation
Acute < 6 Weeks
Sub-acute 6 - <12 weeks
Chronic 12 or >12 weeks
Recurrent having previo...
Treatment of Acute LBP
• Analgesics (Acetaminophen, NSAIDs, Opioids)
• Activity(Should continue their usual activity withi...
Treatment of Sub-acute & chronic LBP
• Pharmacological (Acetaminophen, NSAIDs, Opioids)
• Psychological (Watch out for moo...
Exercise-based therapy for low back pain
Goals of Exercise-based therapy for low back pain
• To stress both damaged and he...
Therapeutic exercises for nonspecific chronic LBP(NCLBP)
90/90 rest position
• The 90/90 rest position for patients with l...
Therapeutic exercises for nonspecific chronic LBP(NCLBP)
Posterior pelvic tilt
• The posterior pelvic tilt is a basic mane...
Therapeutic exercises for nonspecific chronic LBP(NCLBP)
Abdominal curl
• This exercise strengthens abdominal muscles. It ...
Therapeutic exercises for nonspecific chronic LBP(NCLBP)
Single knee to chest
• Lie on your back with your knees bent and ...
McKenzie Method
• It is a philosophy of active patient involvement and education
for back, neck and extremity issues
• The...
Exercise 1: Lie Prone
• Lie prone, arms down the side of body, face turned to either
side
• Take a few deep breaths and th...
Exercise 2: Prone on Elbows (Elbow drop)
• Now move further into spinal extension by placing elbows
under the shoulders
• ...
Exercise 3: Prone on Hand (Lumbar Extension in Lying)
• Put hands under shoulder and straighten the elbows and push
the up...
Exercise 4: Standing Back Extension
• With feet slightly apart, hands on the low back with
fingers pointed down & towards ...
Exercise 5: Flexion in Supine (Knee to chest)
• Supine with bent knees and feet on floor/bed
• Bring knees to the chest
• ...
Exercise 6: Flexion in Sitting
• Only start this exercise after complete at least one week of Exercise #5:
Flexion in Supi...
Exercise 7: Flexion in Standing
• Only start this exercise after complete at least two weeks of Exercise #5:
Flexion in Su...
Exercises: What to Look For
• Exercising Correctly if:
- Pain centralizes and decreases
- ROM increases
• Exercising Incor...
NASS Guideline
National Ankylosing Spondylitis Society (NASS) recommend
some exercise which is useful in different disease...
1. Exercises in lying
• Starting position: Lying on your back, both knees bent, feet
on floor
• Bridging: Lift your hips o...
1. Exercises in lying
• Spinal Rotation: Lift your arms up in front towards the
ceiling, with fingers linked
• Take your a...
2. Exercises in 4 point kneeling
• Starting position: Kneel on all fours. Keep your hands
shoulder width apart and directl...
2. Exercises in 4 point kneeling
• Superman Stretch (spinal extension):
Keeping your head looking forward, raise your righ...
3. Chair Exercises in sitting
• Starting position: Sit on a stable kitchen/dining
room chair with your feet on the floor, ...
3. Chair Exercises in sitting
• Spinal Rotation: With your hands clasped on your forearms at
shoulder level, turn your upp...
3. Chair Exercises in sitting
• Neck Rotation: Hold the sides of the chair seat. Turn your
head to the right as far as pos...
4. Leg Stretches
• Hamstring stretch: Stand facing a kitchen chair, with a
padded seat for comfort. Place your right heel ...
4. Leg Stretches
• Hip flexor stretch
Face the side of the chair and hold the
chair back with your right hand
Bend your ri...
4. Leg Stretches
• Place your left foot forward as far as possible
• Now place both hands behind your back. Bend
Your left...
5. Posture Stretch
• Stand with your back to the wall, shoulders and
buttocks against the wall and heels as close to
the w...
Clearing up the terms
Spondylosis
Degenerative joint disease affecting the vertebrae and
intervertebral disc
Spondylolysis...
Spondylolysis & Spondylolisthesis
Therapeutic exercises specific for Spondylolysis & Spondylolisthesis
Following are specific
exercises for Spondylolysis &
...
Therapeutic exercises & ADL for nonspecific LBP
• Patient should remain active- movement helps to relieve
muscle spasms an...
ADL for nonspecific LBP
Body Mechanics
• Push vs. Pull
• Keep Work Within “Strike Zone”
• Keep Load Close To Body
• Use Ab...
ADL for nonspecific LBP
Sitting Posture
• As you sit down, you should pull these sit bones away from each
other.
• Your pe...
ADL for nonspecific LBP
Sleeping posture
• Bed rest may be necessary for a short period
of time, generally no more than on...
ADL for nonspecific LBP
Proper Lifting Technique
• Wide base of support
• Feet shoulder width apart
• Back straight
• Head...
Therapeutic exercises for nonspecific LBP
Aerobic exercise
• Bicycling, swimming, treadmill walking, and elliptical traine...
Therapeutic exercises for nonspecific LBP
Pilates
• Technique of exercise that focuses on performing controlled
movements ...
Therapeutic exercises for nonspecific LBP
Yoga
• Yoga refers to spiritual and physical practices that promote
controlled b...
Therapeutic exercises for nonspecific LBP
Tai Chi
• Chinese martial art practiced for both its defense training and its
he...
How do we take care of our back?
• Body Mechanics
• Proper Lifting Techniques
• Maintain safe postures
• Keep physically f...
There are 1440 minutes in every
day...Schedule 30 of them for
physical activity
Thanks for your patience listening
Upcoming SlideShare
Loading in …5
×

14

Share

Download to read offline

Therapeutic management for Low Back Pain by Dr Arman Hossain

Download to read offline

Therapeutic management for Low Back Pain By Dr Arman MD (Course) Physical Medicine & Rehabilitation, Dhaka Medical College, Bangladesh.

Related Books

Free with a 30 day trial from Scribd

See all

Related Audiobooks

Free with a 30 day trial from Scribd

See all

Therapeutic management for Low Back Pain by Dr Arman Hossain

  1. 1. Therapeutic management for Low Back Pain Dr. SM Arman Hossain MD Resident (Phase-A) Physical Medicine And Rehabilitation Dhaka Medical College Olive Unit, Rheumatology, BSMMU
  2. 2. Low Back Pain Pain that occurs in an area with boundaries between the lowest rib and the crease of the buttocks
  3. 3. Low Back Pain • most common musculoskeletal complaint worldwide • 85 percent of all people experiencing LBP during their lifetimes • Increasing incidence between age 35- 55 yrs • 90% resolve within 4 to 6 weeks
  4. 4. Anatomy of Lower back • Lumbar Vertebrae • Sacrum • Coccyx • Ilium • Sacro-iliac Joint
  5. 5. Anatomy of Lower back pars interarticularis Lumbar vertebrae
  6. 6. Anatomy of Lower back Intervertebral Disc
  7. 7. Disc Problems
  8. 8. Anatomy of Lower back Soft tissue (Muscles) • Psoas Major/minor • Quadratus lumborum • Intertransversalis • Multifidus • Erector spinae
  9. 9. Anatomy of Lower back Soft tissue(Ligaments) • Anterior longitudinal ligament • Posterior longitudinal ligament • Interspinous ligament • Supraspinous ligament • Ligamentum flavum
  10. 10. Classification of LBP LBP Dutation Acute < 6 Weeks Sub-acute 6 - <12 weeks Chronic 12 or >12 weeks Recurrent having previous episodes with pain free intervals
  11. 11. Treatment of Acute LBP • Analgesics (Acetaminophen, NSAIDs, Opioids) • Activity(Should continue their usual activity within the limits permitted by pain) • Cold Packs or Heat(Recommend for first 72 hours) • Multidisciplinary Treatment Programs
  12. 12. Treatment of Sub-acute & chronic LBP • Pharmacological (Acetaminophen, NSAIDs, Opioids) • Psychological (Watch out for mood disturbances, substance use, behavioral problems): Low dose antidepressant have a small to moderate effect • Procedural (Epidural Steroid Injections) • Physical • Rehabilitation
  13. 13. Exercise-based therapy for low back pain Goals of Exercise-based therapy for low back pain • To stress both damaged and healthy supporting tissue to promote tissue repair • Improves structural impairments in our spine and pelvis • Relieves pain or modifies our current pain experience • Return us to our normal activities as quickly as possible
  14. 14. Therapeutic exercises for nonspecific chronic LBP(NCLBP) 90/90 rest position • The 90/90 rest position for patients with low back pain is achieved by lying on a flat surface and flexing both hips and knees to 90 degrees.
  15. 15. Therapeutic exercises for nonspecific chronic LBP(NCLBP) Posterior pelvic tilt • The posterior pelvic tilt is a basic maneuver in back rehabilitation. The abdominal and gluteal muscles are contracted to flatten the lumbar spine. This position is held for 5 to 10 seconds and can be repeated frequently.
  16. 16. Therapeutic exercises for nonspecific chronic LBP(NCLBP) Abdominal curl • This exercise strengthens abdominal muscles. It should be performed on a firm surface with knees bent. • The subject raises the trunk no more than 6 inches from the surface. Arms may be folded across chest or stretched forward as shown. • Hold position for ten to 20 seconds and breathe. Repeat 6 to 10 repetitions
  17. 17. Therapeutic exercises for nonspecific chronic LBP(NCLBP) Single knee to chest • Lie on your back with your knees bent and your feet flat on the floor • Bring one knee to your chest, keeping the other foot flat on the floor • Relax and lower the knee to the starting position • Repeat 2 to 4 times with each leg
  18. 18. McKenzie Method • It is a philosophy of active patient involvement and education for back, neck and extremity issues • The goal of McKenzie Method is to centralize the pain or move the pain from the leg into the low back • Useful In- - Lumber radiculopathy - HNP/Lumber Disc prolapse - Recurrent or chronic back pain
  19. 19. Exercise 1: Lie Prone • Lie prone, arms down the side of body, face turned to either side • Take a few deep breaths and then mentally relax the muscular tension from the lumbar area completely for 2-3 minutes • Done at beginning and end of each exercise session
  20. 20. Exercise 2: Prone on Elbows (Elbow drop) • Now move further into spinal extension by placing elbows under the shoulders • Take some deep breaths and continue to mentally relax all the lumbar muscles • Stay in this position 2-3 minutes • Always follows: Lie in Prone, done once per session • Useful for more severe low back pain
  21. 21. Exercise 3: Prone on Hand (Lumbar Extension in Lying) • Put hands under shoulder and straighten the elbows and push the upper body up as far as pain permits • Mentally relax the pelvis, hips and legs and let the back sag • After 1-2 seconds, return to the elbows position • Can be held longer if pain is centralizing • Move through each repetition smoothly 10 times and each time try to raise the upper body a bit higher until the back is extended as much as possible and the arms are straight
  22. 22. Exercise 4: Standing Back Extension • With feet slightly apart, hands on the low back with fingers pointed down & towards the spine (fingers should touch at the sacrum). Thumbs point forwards • Keeping your knees straight with hands acting as a fulcrum, bend backwards at the waist(trunk extension) • Hold the position 1-2 seconds • As with exercise 3, smoothly repeat the motion and try to increase the range of extension with each rep
  23. 23. Exercise 5: Flexion in Supine (Knee to chest) • Supine with bent knees and feet on floor/bed • Bring knees to the chest • Gently bring both knees to the chest with arms(as can tolerate) • Breathe out as pull knees to chest • Hold knees to chest 1-2 seconds, then return to supine with bent knees • Do NOT raise the head or straighten legs during this exercise
  24. 24. Exercise 6: Flexion in Sitting • Only start this exercise after complete at least one week of Exercise #5: Flexion in Supine • Less risk of re-injury in supine versus sitting • Sit on the edge of a chair with knees and feet more than shoulder width apart and let the hands • Hang down to the floor between the legs • Bend forwards at the trunk to touch the floor • Return immediately to the starting position. • Do reps smoothly and rhythmically, going further down each time as can tolerate
  25. 25. Exercise 7: Flexion in Standing • Only start this exercise after complete at least two weeks of Exercise #5: Flexion in Supine • Less risk of re-injury in sitting rather than standing • For the first three pain-free months, do NOT do this during the first four hours of your day • Stand with feet shoulder width apart and bend forward at the trunk, running hands down legs towards the ground • Return immediately to the starting position. • Do reps smoothly and rhythmically, going further down each time as can tolerate
  26. 26. Exercises: What to Look For • Exercising Correctly if: - Pain centralizes and decreases - ROM increases • Exercising Incorrectly if: - Pain moves away from the spine or increases (or stays the same) - ROM decreases
  27. 27. NASS Guideline National Ankylosing Spondylitis Society (NASS) recommend some exercise which is useful in different disease associated with low back pain like – - Ankylosing Spondylitis - Lumber Spinal Stenosis
  28. 28. 1. Exercises in lying • Starting position: Lying on your back, both knees bent, feet on floor • Bridging: Lift your hips off the floor as high as possible, hold for 5 seconds and lower slowly
  29. 29. 1. Exercises in lying • Spinal Rotation: Lift your arms up in front towards the ceiling, with fingers linked • Take your arms to the right as far as possible while taking your knees to the left as far as possible. Turn your head to the same side as your arms. Repeat to the opposite side
  30. 30. 2. Exercises in 4 point kneeling • Starting position: Kneel on all fours. Keep your hands shoulder width apart and directly under your shoulders. Keep your knees hip width apart and directly under your hips • Cat Stretch (spinal flexion & extension): Keeping your elbows straight throughout, tuck your head between your arms and arch your back as high as possible
  31. 31. 2. Exercises in 4 point kneeling • Superman Stretch (spinal extension): Keeping your head looking forward, raise your right arm forwards as you raise your left leg backwards to be parallel with the floor. Hold for 5 seconds. Return to all fours and change to raising your left arm and right leg
  32. 32. 3. Chair Exercises in sitting • Starting position: Sit on a stable kitchen/dining room chair with your feet on the floor, hooked around the legs of the chair • Spinal side flexion: Place your hands by your sides. Hold the back of the chair with your left hand. Bend sideways as far as possible, without bending forwards, reaching your right hand towards the floor. Repeat to the opposite side
  33. 33. 3. Chair Exercises in sitting • Spinal Rotation: With your hands clasped on your forearms at shoulder level, turn your upper body to the right as far as possible. Repeat to the opposite side
  34. 34. 3. Chair Exercises in sitting • Neck Rotation: Hold the sides of the chair seat. Turn your head to the right as far as possible without letting your shoulders turn. Repeat to the opposite side
  35. 35. 4. Leg Stretches • Hamstring stretch: Stand facing a kitchen chair, with a padded seat for comfort. Place your right heel on the seat, keeping the knee straight, and reach forwards as far as possible with both hands towards your foot. Feel the stretch at the back of your right thigh. Hold for 6 seconds. Relax • Repeat twice, stretching a little further each time. Relax • Repeat with the opposite leg
  36. 36. 4. Leg Stretches • Hip flexor stretch Face the side of the chair and hold the chair back with your right hand Bend your right knee and place your right shin on the seat
  37. 37. 4. Leg Stretches • Place your left foot forward as far as possible • Now place both hands behind your back. Bend Your left knee as much as possible, keeping your head up and your back straight • Feel the stretch at the front of your right hip • Hold for 6 seconds. Relax • Repeat twice, stretching a little further each time. Relax • Turn round to face the other side of the chair • Repeat with the opposite leg
  38. 38. 5. Posture Stretch • Stand with your back to the wall, shoulders and buttocks against the wall and heels as close to the wall as you can. Tuck your chin in and push the back of your head towards the wall. Keep your shoulders down • Stretch up as tall as possible without lifting your heels. Hold this position. Raise your right arm forwards and upwards while keeping your elbow straight, your upper arm close to your ear and your thumb towards the wall. Lower and repeat with opposite arm
  39. 39. Clearing up the terms Spondylosis Degenerative joint disease affecting the vertebrae and intervertebral disc Spondylolysis Fracture in pars interarticularis Spondylolisthesis condition in which a fracture of the pars interarticularis causes one vertebral body to slip forward on top of the vertebral body below it.
  40. 40. Spondylolysis & Spondylolisthesis
  41. 41. Therapeutic exercises specific for Spondylolysis & Spondylolisthesis Following are specific exercises for Spondylolysis & Spondylolisthesis patients. Performing technique of these exercises are discussed previously.
  42. 42. Therapeutic exercises & ADL for nonspecific LBP • Patient should remain active- movement helps to relieve muscle spasms and prevents loss of muscle strength • Bed rest may be necessary for a short period of time, generally no more than one day • Using a heating pad can help with low back pain during the first few weeks. It is not clear if cold packs help as well. • Should avoid prolonged standing or sitting, heavy lifting, and twisting • While standing at work, stepping on a block of wood with one foot (and periodically alternating the foot on the block) may be helpful.
  43. 43. ADL for nonspecific LBP Body Mechanics • Push vs. Pull • Keep Work Within “Strike Zone” • Keep Load Close To Body • Use Abdominal Bracing • Team Work vs. Mule Work
  44. 44. ADL for nonspecific LBP Sitting Posture • As you sit down, you should pull these sit bones away from each other. • Your pelvis should be tucked into the back of the chair and slightly tilted forward. • Distribute weight evenly between both buttock cheeks and ensure that you do not lean to one side • Your upper back should remain up right. Do not hunch your back! Don’t be lazy! Sit up straight!
  45. 45. ADL for nonspecific LBP Sleeping posture • Bed rest may be necessary for a short period of time, generally no more than one day • If back pain is severe, the most comfortable position may be to lie on the back with a pillow behind the knees and the head and shoulders elevated • or to lie on the side with the upper knee bent and a pillow between the knees
  46. 46. ADL for nonspecific LBP Proper Lifting Technique • Wide base of support • Feet shoulder width apart • Back straight • Head and shoulders up • Bend at hips and knees - NOT BACK! • Keep load close to body • Tighten stomach muscles • Use leg, hip and buttock muscles • Breathe out with lift
  47. 47. Therapeutic exercises for nonspecific LBP Aerobic exercise • Bicycling, swimming, treadmill walking, and elliptical trainers • Simplest and most readily available form of exercise • Decreased pain intensity and improve the physical functioning over time in patients with chronic LBP Aquatic exercise • The aquatic exercise is well suited for many soft tissue conditions, including low back pain.
  48. 48. Therapeutic exercises for nonspecific LBP Pilates • Technique of exercise that focuses on performing controlled movements of the whole body • Start with the center or core (back and abdomen) and flow outward towards the limbs • Proponents report useful health benefits including body alignment, breathing, strength, coordination and balance • This form of exercise can be adapted to treat LBP
  49. 49. Therapeutic exercises for nonspecific LBP Yoga • Yoga refers to spiritual and physical practices that promote controlled breathing, specific stretches, body positions, and meditation • Associated with small improvements in pain • The effect did not reach the pre specified threshold for clinically meaningful improvement
  50. 50. Therapeutic exercises for nonspecific LBP Tai Chi • Chinese martial art practiced for both its defense training and its health benefits • mind-body exercise therapy that has been used to manage chronic pain conditions
  51. 51. How do we take care of our back? • Body Mechanics • Proper Lifting Techniques • Maintain safe postures • Keep physically fit • Good nutrition • Stretch and exercise
  52. 52. There are 1440 minutes in every day...Schedule 30 of them for physical activity
  53. 53. Thanks for your patience listening
  • NanaBempah

    Jul. 7, 2021
  • Amrrajab4

    Jan. 20, 2021
  • AdeyemiKehinde3

    Oct. 11, 2020
  • Sultanahnaif

    Sep. 9, 2020
  • KamilYldz1

    Jul. 17, 2020
  • nehaThakur242

    Jul. 4, 2020
  • BenitaLobo

    Jul. 3, 2020
  • UdbegMishra

    Jun. 9, 2020
  • RadhikaTalapalli

    Jun. 1, 2020
  • patespandan

    Apr. 15, 2020
  • DeepakGelot

    Feb. 21, 2020
  • nuhubankwhot

    Feb. 11, 2020
  • ZeinabShiravi

    Feb. 2, 2020
  • MANOCHITRAMuthusamy

    Dec. 12, 2019

Therapeutic management for Low Back Pain By Dr Arman MD (Course) Physical Medicine & Rehabilitation, Dhaka Medical College, Bangladesh.

Views

Total views

2,479

On Slideshare

0

From embeds

0

Number of embeds

3

Actions

Downloads

81

Shares

0

Comments

0

Likes

14

×