Lower back pain in computer

professionals

Dr Hemant K. KalyanMBBS, MS(Orth), DOrtho, FCPS,

DSportsMed(Edin)Consultant in Orthopedic Surgery and Sports

Medicine, Bangalore

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Schematic cross-section of Schematic cross-section of an an inter-vertebral discinter-vertebral disc

Herniated disc Herniated disc

Causal factors for back pain…

Spinal fracture

Herniated disc

TB spine

Mechanical low back pain - Diagnosis of exclusion – 75-80% of cases.

Spinal FractureSpinal Fracture

Herniated DiscHerniated Disc

TB SpineTB Spine

Trigger factors

Excessive load on normal back

Long / erratic hours

Poor workplace ergonomics

Stress: Physical, mental and emotional

Travel

Normal load on weak or unprepared back

Fatigue

Improper posture/ chronic malpositioning

Lack of exercise, poor physical conditioning

Weight control problems

Poor postureTrigger factors (contd)…

Three phases of management strategy…

Treatment of acute episodes.

Amelioration of chronic condition.

Prevention of exacerbation/ reinjury.

The case against protracted rest

Deconditioning: Loss of muscle strength and endurance

Chance of micro traumatic injury

Protracts recurrent episodes

Maintains chronic disability

Decreased flexibility Adversely modifies spinal biomechanics

Physiology of disc hydration affected

“Avoid pill popping”

Exercise - for which patients?

Central focus in 95% cases

“YES” in mechanical causes

“NO” in non-mechanical causes

Exercise types…

Back-specific exercises

Peri-pelvic and LL flexibility and strengthening

Aerobic conditioning

Double knee to chest stretch

Pelvic tilt

Some exercises for the back…

Lower trunk Lower trunk rotation stretch rotation stretch

Trunk Flexion Stretch

Trunk flexion stretchTrunk flexion stretch

Prone lumbar extensionProne lumbar extension

Some exercises for the back…

Alternate Prone Leg ExtensionAlternate prone leg extensionAlternate prone leg extension

Aerobic conditioningAerobic conditioning

Abdominal StrengtheningAbdominal strengtheningAbdominal strengthening

Lower Limb StretchesLower limb stretchesLower limb stretches

Complementary therapy

Back hygiene and back school

Correction of biomechanical factors

Posture

Weight control

Weight trainingWeight training

YogaYoga

YogaThe right chairThe right chair

Counter heightCounter height

Working PosturePosture at workPosture at work

The right posture…

Sitting PostureSitting posture

Forward bendingForward bending

Pulling an ObjectPulling an objectPulling an object

Thank youThank you