Lower Back Pain

Lower Back Pain

1. anatomy of the vertebral column

   • 5 regions
     • cervical
       • 7 vertebrae
     • thoracic
       • 12 vertebrae
     • lumbar
       • 5 vertebrae
     • sacral
       • 5 vertebrae
     • coccygeal
       • 2-5 vertebrae
   • joints
     • zygapophyseal joints (facet joints)
       • synovial joints
       • between the inferior articular process of superior vertebrae and the superior articular process of inferior vertevrae
       • control flexion, extension, rotation and cervical and lumbar bertebrae
     • atlanto occipital joint
       • between C1 (atlas) and occipital codyles (skull)
       • flexion and extension of the neck (saying yes)
     • atlanto axial joint
       • synovial
         • pivot
       • rotation of the atlas and the skull around the axis (saying NO)
       • between C1 (atlas) and C2 (axis)
   • ligaments
     • anterior longit ligament
       • prevent hyperextension
     • posterior longit ligament
       • prevent hyperflexion
     • ligamentum flavum
       • preserve the normal curvature
     • interspinal ligament
     • supraspinous ligament
   • muscles of the back
     • superficial layer
     • intermediate layer
     • Deep layer
       • Splenius
         • action
           • Extend neck and head
           • rotate in unilateral action
       • erector spinae
         • 1. spinalis (medially)
         • 2. longissmus (intermeiate)
         • 3. iliocostalis (laterally)
       • transverso-spinalis
   • movements
     • extention
     • rotation
     • flexion
     • lateral flexion
   • curvatures of the back

2. anatomy of the spinal cord

3. sacral plexus

   • sciatic nerve
     • supplies sensation to the skin of the foot and the lower leg except for the inner side
     • roots
       • L4, L5, S1, S2, S3
     • common peroneal nerve (common fibular nerve)
       • supply the muscles of the anterior and lateral compartments
   • supply the pelvis and the lower limbs

4. alleviating factors

   • standing, walking

5. aggravating factors

   • sitting, lifting, coughing and sneezing

6. has many causes

   • causes
     • disc breakdown
     • spasms
     • injuries ( fractures, falls)
     • tumors
     • spinal stenosis
     • scoliosis

7. intervertebral disc

   • anatomy
     • between the bodies of vertebrae
     • 2 parts
       • outer: annulus fibrosis
         • parallel collagen bundles
       • inner: nucleus pulposus
         • soft gelatinous material
   • disorders
     • herniated disc
       • protrusions of the nucleus pulposus occur posterolaterlly
       • commonly occur in th lumbar region
       • symptoms
         • localised pain
         • if nerve root iscompressed
           • sciatice
             • management
               • physiotherapy
                 • knee to chest stretch
                 • sciatic mobilising stretch
                 • back extension
                 • standing hamstring
                 • lying deep gluteal stretch
               • Alternative management
                 • acupuncture
                 • massege
                 • chiropractic therapy
               • surgery
                 • partial discectomy
                   • the fragments of the ruptured disc are removed
                 • types
                   • spine fusion
                   • disc replacment
                 • indication for surgical intervention
                   • spinal cord compression
             • compression on the sciatic nerve
             • cause
               • general wear and tear
       • stages
         • degeneration
         • prolapse
         • sequestration
         • extrusion

8. placebo effect

   • defenition
     • a substance or other kind of treatment that looks just like a regular treatment but it is inactive
   • nocebo effect
   • conditioning effect
   • expectation effect

9. physical examination

   • special tests
     • femoral nerve stretch test
     • straight leg raising
     • schober's test
   • look
   • feel
   • palpate

10. Epidemiology

    • Highest YLDs and DALYs worldwide
      • Europe
    • Highest YLDs in MENA
      • Morocco for men
      • Iran for Women
    • most common cause
      • mechanical injuries

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