PowerPoint Presentation

Exercise Therapy in the Management of Low Back Pain

Johnson Olubusola

1

PreambleThere is very little relationship between physical pathology and associated pain and disability

We regard low back pain (LBP) as an injury, but most episodes occur spontaneously with normal everyday activities

High-tech imaging tells us very little about simple backache

It is essential to improve the efficiency of treatment of chronic/recurrent LBP

8/25/20152

Low Back PainLBP is a very common disorder (Woolf and Pfleger, 2003)LBP, identified as the leading disability contributor (Goubert et al, 2004) LBP reduces level of physical capacity (Hodges et al, 2009; Wang et al, 2014) Psychological effects (Gatchel et al, 2007; Nicholas et al, 2011) and reduction in the quality of lifePatients ought to undergo health care (Deyo et al, 2006, Haldeman and Dragenais, 2008)8/25/20153

3

Why LBPPercentage Restriction of Activity by Locations of painHead 6 %Neck / Shoulder 7 %Low back 11 %Knees 8%Ankle/Foot 5 %8/25/20154

Epidemiology84% of adults will experience an episode of LBP at some point during their lifetimes80-90% recover within 6 weeks with or without treatment80% become recurrent (Goubert et al, 2004;Weiner and Nordin, 2011)

8/25/20155

Classification by A etiology

Non- Specific: 90% of LBP cases is non-specific

Specific: Specific low back pain is related to specific pathologies and can be diagnosed early through warning signs including Neoplasm, Infectious, vascular, metabolic, or endocrine related (Wipf & Deyo RA, 1995). E.gs symptomatic herniated disk 3-4%, ankylosis 0.3 - 5%, compression fractures 4%, and spinal malignancy 0.7% (Van Tulder, 2004)

8/25/20156

8/25/20157 Classification by durationAcute: 6weeks or less

Intermediate: > 6 weeks< 12weeks

Long term: > 12 weeks

Acute and long term LBP warrant separate considerations as they may respond differently to the same interventions (Sierpina 2002; van Tulder 1999)

Chronic LBP20% 1st episode of LBP of these cases may develop into chronic LBP, lasting for at least three months or longer (Weiner and Nordin, 2011; Pengel et l, 2003; Wang et al, 2012)

Chronic LBP accounts for three-quarters of the total direct and indirect costs of medical care and lost productivity associated with LBP (Foumey et al, 2011)8/25/20158

Recurrent LBP

Recurrent LBP is defined as a new episode after a symptom-free period of 6 months, but not an exacerbation of chronic low back pain (van Tulder et al, 2004)

Multifidus and TrA are implicated

Multifidus recovery is not automatic after resolution of acute low back pain (Hides et al, 1996)

41 with LBP, 1st episode, unilateral,