Author: Back Care I a Clinical Approach
| Posted at: 4:06 AM |
Examination And Assessment
Every patient attending for therapeutic treatment must be assessed. This entails taking a careful history, past and present, followed by making a comprehensive active and passive physical examination and finally using clear clinical reasoning for a treatment plan. The scope of the examination is becoming more and more extensive but ‘look, feel and move’ still remains the overall protocol. There is need to look not only at articular test but also at relative flexibility, not only at strength of muscle activity but also at dysfunction,...read more
Every patient attending for therapeutic treatment must be assessed. This entails taking a careful history, past and present, followed by making a comprehensive active and passive physical examination and finally using clear clinical reasoning for a treatment plan.
The scope of the examination is becoming more and more extensive but ‘look, feel and move’ still remains the overall protocol. There is need to look not only at articular test but also at relative flexibility, not only at strength of muscle activity but also at dysfunction, not only at neural conductivity but also at pathodynamics, bearing al mechanism in mind. Articular test, neuropraxia tests and sensory – motion tests are all needed to identify any neuromusculoskeletal dysfunction.
Passive movements and palpatory techniques are essential to identify tissue disturbance and may accurately yield the tissue disturbance and may accurately yield the same information as more costly invasive medical equipment.
The source of every dysfunction must be addressed, even those that are less obvious: a general physical dysfunction such as an asymmetric walk, which may or may not be relevant to the patient’s presentation of pain, should be considered; a general lack of fitness should not be ignored.
Pain, pathology, sensitized neural tissue and altered proprioceptive input can all influence recruitment of stability muscles, affecting the patterns of movement and functioned stability, so function and dysfunction must be assessed in all components of the movements systems.
The type of pain that moves, that ‘pops up’ in various parts of the body in seemingly anatomically impossible ways, requires careful neural pathodynamic examination, not only of the obvious areas but of the entire body. On examination, people with headaches may be found to have limited SLR or in another patient, upper limb tension testing may elicit leg pain; in treatment, mobilization of C1/2/3 can change SLR.
The picture of the disorders becomes wider or more layered as chronic dysfunction in an area may eventually cause dysfunction in another area, either by change in gait or habitual movement pattern or an a more pathological level, as with the double crush phenomenon.
Certain unusual risk situations frequently present as causative factor in clinical practice.
Lifting after sitting for long periods
Lifting is a risk factors at any time but lifting after a period of long sitting is an infrequentlyrecognized precipitating factors for low back pain. The most common presentation is as a pre or post holiday accident. At the end of a long journey, after sitting still for hours in an flat-back posture, the passenger reaches to lift heavy suitcases from the boot of the car or off the airport luggage carousel, possibly using flexion/rotation/ lateral flexion combined movement. The result can be immediate pain or pain later that day or on waking the next morning.
Slouching after vigorous exercise
Slouching when grossly fatigued is a clinical encounter which to my knowledge has not been researched, but which appears too frequently in clinic to be ignored. After a hard day’s work, possibly followed b a game of squash or heavy activity in the garden, ending with a hot bath, the most provocative position. The fatigued tissues are put under stress but give no warning until rising from the chair our rising from bed the next morning. After strenuous activity, lying supine r prone for 10-15 minutes.
Reaching up or stretching
Reaching up or stretching suddenly in an off balanced position provides the abusive combined movements of rotating, lateral flexion and extension.
Smoking
There is evidence of a link between smoking and low back pain. Smoking may affect the nutrition of the disc
Back Pain In Pregnancy
Postural change, particularly the increase in lordosis, has been cited as the cause, but the pathophysiological mechanism of the pain production has not been reported. The sacroiliac area has been described as the most area of pain with or without symphysis pubis pain.
Progesterone and relaxin, two of the pregnancy hormones, induce changes in collagen which result in a softening and relaxing effect on the spinal ligements, especially those around the sacroiliac joints and sympysis pubis, which can widen by 3-4 mm. Woman with severe pelvic girdle pain in pregnancy have been found to have significantly higher serum levels of relaxin than those who are pain free. Pregnancy may also be a risk factor for post-partum disc prolapsed if there has been a preexisting conditions.
Increased abdominal bulk, fluid retention and postural change add extra strain at the very moments of vulnerability. There is frequently an increased thoracic kyposis, often enhanced by the increase in breast size as well as increased lordosis in the early stages of pregnancy.
Patients can present with low back pain, sometimes referring into the buttock and leg, thoracic spine pain, symphysis pubis pain and sacroiliac pain, often increased in side lying.
Epidural anaeshesia
The spectre of a link between epidural local anaesthetic in childbirth and CLBP has emerged but the survey data do not prove causation but the survey data do not prove causation. Epidural haematomas are rare but when they do appear they resemble lumbar disc herniation; post epidural symptoms can include headache, migraine, neck pain, paraesthesia and visual disturbances.
Precipitating factors are the direct and sudden causes of back pain which can provoke a previously pain-free back or trigger pain in a back which has previous history of trouble. Injury can range from a minor ‘sprain type’ facet join or soft tissue injury, to a disc lesion or to the more extensive bony and soft tissue damage of trauma.
New Use
Any previously unperformed and unpracticed activity can be structurally provocative (abnormal stress on normal back) and so can a familiar movement, not performed for some time and now beyond the capabilities of structures involved (normal on unprepared normal). Examples of these are: taking on a lifting job after a previously sedentary occupation; digging a new garden after years of living in a flat; playing a strenuous game of squash for the first time in middle age.
Misuse
Awkward movements
Accustomed movement performed in an awkward way can cause injury ranging from a disc protrusion to a ‘locked’ facet joint; for example, rotation in flexion, especially when holding a weight. No matter how light the object, an incorrect move can precipitate a problem when stability is diminished. Bending quickly to pick up a toy in a carpet on the carpet, reaching sideways and twisting to turn out the light and stretching upwards into a cupboard are all normal movements which cause injury only when performed without adequate stabilization and control.
Awkward object
Manual handling is a hazard at all times, no matter how small the load, but if the load I awkward, the potential for injury is greater; human being are particularly awkward to handle as they are mobile, floppy and unpredictable. It is therefore important to assess all object and plan to move before attempting any action. It is essential to have special training for all manual handling work.
Overuse
Non - stressful activityrepeated over a long period of time or stressful activity repeated too many times will finally fatigue structures beyond their ability to adapt to demands, and tissue injury result accompanied by severe pain. This can be initiated by low force repetitive strain or high force/ impact repetitive strain.
Abuse or trauma
Back injury can occur in any accident, violent movement or fall. Depending upon the severity of the trauma. Injury can include tissue bruising, damage to facet joint cartilage, ligamentous rupture, muscular strain, bony fracture, end-plate fracture or IVD damage. Whiplash is one of the most common traumatic presentation but even coughing and sneezing can precipitate injury.
The term ‘sprain’ in relation to the vertebral column is open to dispute. Research the date finds no evidence of the pathology of sprain occurring in the back. It is however, a useful term for a clinical picture involving a series of signs and symptom that cannot be accurately ascribed to any particular tissue of the back but which closely resemble the signs and symptoms evoked by a peripheral joint sprain such as a sprained ankle, something experienced by most people. Sprain type injuries can involve multiple joints, as in accidents, or a single joint if injury occurs whilst performing a minor movement.
Author: Back Care I a Clinical Approach
| Posted at: 3:54 AM |
Filed Under: Debilitating Conditions
Joint pain is frequently a symptom of a viral condition, for example influenza, through there is little research on the subject. Care should be taken of the back during the period of recuperation in order to avoid any possible risk of injury. Low back pain (LBP) presentation in clinics is often associated with an episode of a minor systemic illness.
Author: Back Care I a Clinical Approach
| Posted at: 2:16 PM |
Filed Under: lordosis,
Obesity
Chronic Low back pain and symptoms of discherniation appear to be more prevalent in instances where the fat distribution result in large abdomen. The weight of a large abdomen pulls the lumbar spine into an increased lordosis, possibly evoking the usual stresses of maintained extension; creep will increase and overload on the spine may accelerate wear and tear.
Obesity imposes a vast claim on medical facilities generally and it has been identified as a risk factor for coronary hearth disease.
A weight problem is best discussed with a doctor before entering into any dietary regime. Physical activity or a walking exercise program can lead to positive changes in the level of fitness of obese woman, aged 60 and over, including weight loss, a decrease of percentage of body fat, waist to hip ratio and body mass index and an increase in cardiovascular fitness.
Author: Back Care I a Clinical Approach
| Posted at: 2:11 PM |
Filed Under: Disuse,
loss of mobility
Disuse
Prolonged inactivity leads to muscle atrophy, loss of strength and adaptive shortening of soft tissue. Thus a sedentary lifestyle leads to poor muscle and a predisposition to osteoporosis. Mobility of the hips and knees plays a fundamental role in back care. Weakness and immobility of the hips and knees advances insidiously with age unless a concerted effort is made to counteract them. Exercising is one way but conscious attention to daily habits plays a vital and even more important role.
Poor recovery from episodes of back pain.
In episodes of low back pain poor recovery, inadequate treatment, lack of reeducation and continuing dysfunction may lead to loss of mobility. Restoration of full function is an essential part of recovery with the possibility of providing protection against recurrence chronicity.
Posts
