licina low back pain
TRANSCRIPT
acuteLBP≠chronicLBP
LOWBACKPAIN
• acutetissuetrauma• self-limiting• stayactive,bepositive
• dysfunctioninnervoussystem• long-lasting• multidisciplinaryinterventions
genetic
psychosocial
What causesbackpain? SEGMENTALINSTABILITY
DISCOGENICPAIN
FACETOGENICPAIN
SOFT-TISSUERELATEDUNKNOWNCAUSE
CHRONICLOWBACKPAIN
SEGMENTALINSTABILITY
DISCOGENICPAIN
FACETOGENICPAIN
SOFTTISSUE/UNKNOWNCAUSE
CHRONICLOWBACKPAIN
What causesbackpain?
DISEASE DIAGNOSISsymptomsandsigns
Hx,Ex&Ix
TREATMENTCUREdirectedatpathology
THEMEDICALMODEL
DISEASE DIAGNOSISsymptomsandsigns
Hx,Ex&Ix
functionaloverlay
15%normaldegenerative processvspathology
notdiscreteillness
THEMEDICALMODEL
USUALNONOPERATIVETREATMENTSGENERALLYINEFFECTIVE
CHRONICLOWBACKPAIN
multidisciplinaryapproach
SEGMENTALINSTABILITY
DISCOGENICPAIN
FACETOGENICPAIN
SOFTTISSUE/UNKNOWNCAUSE
CHRONICLOWBACKPAIN
What canwetreat
surgically?
DECISIONWHETHERTOOPERATEISDIFFICULT
surgeryisnotuniversallyeffective
DEGENERATIONDOESNOTALWAYS
EQUALPAIN
incidenceofdegenerativechangesonx-raybackpainpopulation=normalpopulation
CHRONICLOWBACKPAIN
• 38yearoldfemale• 18/12ofworseninglowbackpain• Conservativetreatmentforpastyear• Simpleanalgesics• Flaresofbackpainbecomingmorefrequent• Fit,activelifestyle• Recentlyceasedrunningandregularsport• Workingbutwithdifficulty• NoWorkCover/legalclaim
• Mildrestrictionofforwardflexion• Normalneurologicalexamination
• 76y.o.retiredfarmer• Longhistoryofmildbackache• Recentchangewithsharp,catchingleft-sidedbackpain
• Vaguelegdiscomfortcausingnofunctionallimitations
• Tenderleftlowback• Painonhyperextension• Noneurologicaldeficit
• 32yearoldmanualworker• Suddenbackpainwithrepetitivelifting• Offworksinceinjury,9monthsago• WorkCoverclaim,consideringlitigation• Highnarcoticintake• Spendsmajorityoftimeinbed,resting
• VeryrestrictedROMinalldirections• Markedabnormalillnessbehaviour