Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort,...
-
Upload
gertrude-james -
Category
Documents
-
view
216 -
download
1
Transcript of Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort,...
![Page 1: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/1.jpg)
Occupational low back pain
Dr mehdi habibollahi
![Page 2: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/2.jpg)
Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain (sciatica) (Omokhodion et al, 2002),
and as “pain limited to the region between the lower margins of the 12th rib and the glutei folds” with or without leg pain (sciatica) (Manek and Macgregor, 2005)
LBP definition
![Page 3: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/3.jpg)
Back pain is second to the common cold as a cause of lost days at work .
About 80% of people have at least one episode of low back pain during their lifetime.
The most common age groups are the 30s - 50s.
It usually feels like an ache, tension or stiffness in back.
Low Back Pain epidemiology
![Page 4: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/4.jpg)
Annual prevalence is 15-20% 2nd most common symptomatic reason for visits
to primary care physicians. 90% of all episodes will resolve within 6 weeks
regardless of treatment 90% of all persons disabled for more than 1 year
will never work again without intense intervention
Low Back Pain epidemiology
![Page 5: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/5.jpg)
Most common cause of disability in people younger than 45.
1% of population is chronically disabled due to back problems.
Low Back Pain epidemiology
![Page 6: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/6.jpg)
Acute LBP: Back pain <6 weeks duration Sub acute LBP: back pain >6 weeks but <3
months duration Chronic LBP: Back pain disabling the patient
from some life activity >3 months Recurrent LBP: Acute LBP in a patient who has
had previous episodes of LBP from a similar location.
Definitions
![Page 7: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/7.jpg)
1-non specific LBP 2- specific LBP
Categories of low back pain
![Page 8: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/8.jpg)
1- mechanical LBP 2- non mechanical LBP
Categories of low back pain
![Page 9: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/9.jpg)
Lumbar Strain or Sprain (70%) Degenerative processes of disc and facets
(10%) Herniated disc (4%) Osteoporotic Compression Fracture (4%) Spinal Stenosis (3%) Spondylolisthesis (2%) Traumatic Fractures (<1%) Congenital disease (<1%)
Severe Kyphosis or Scoliosis Transitional Vertebrae
Spondylolysis Internal Disc Disruption/Discogenic Back Pain Presumed Instability
Differential: Mechanical LBP
![Page 10: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/10.jpg)
Neoplasia (0.7%) Multiple Myeloma Metastatic Carcinoma Lymphoma and Leukemia Spinal Cord Tumors Retroperitoneal Tumors Primary Vertebral Tumors
Infection (0.01%) Osteomyelitis Septic Discitis Paraspinous Abscess Epidural Abscess Shingles
Inflammatory Arthritis (0.3%) – note HLA-B27 association. Ankylosing Spondylitis Reiter Syndrome Inflammatory Bowel Disease
Scheuermann Disease (osteochondrosis) Paget Disease
Differential - Nonmechanical LBP:
![Page 11: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/11.jpg)
Pelvic organ involvement: Prostatitis Endometriosis Chronic Pelvic Inflammatory Disease
Renal involvement Nephrolithiasis Pyelonephritis Perinephric Abscess
Aortic Aneurysm Gastrointestinal involvement
Pancreatitis Cholecystitis Penetrating Ulcer
Differential – Visceral Disease:
![Page 12: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/12.jpg)
Symptoms of Benign LBP
Dull and achy quality Diffuse aching with
associated muscle tenderness
Exacerbated with movement
Relieved with rest in recumbent position
No radiation, paresthesias
No dermatomal pattern Pt. is able to find a
position of comfort DTR are within normal
limits
![Page 13: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/13.jpg)
Gradually in onset.
Throbbing in nature.
Morning stiffness.
Exacerbates by rest and relived by activity.
Intensity increase in night and early morning.
It is chronic backache.
Symptoms of Inflammatory back pain
![Page 14: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/14.jpg)
Low back pain is a multifactor problem It is a biopsychosocial problem
LOW BACK PAIN RISK FACTORS
![Page 15: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/15.jpg)
NON OCCUPATIONAL genome Poor posture Poor conditioning Weakness Stiffness Faulty body mechanics Poor work, sleep, or eating habits Smoking Psychosocial--bad attitude, stress, emotional Other pathology (i.e. fibromyalgia, chronic
fatigue or pain syndrome, osteoporosis)
BACK PAIN RISK FACTORS
![Page 16: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/16.jpg)
BACK PAIN RISK FACTORS
Heavy Lifting
Sitting or Standing
Awkward PosturesCarrying & Lifting
Twisting
Reaching & Lifting
Slips, Trips & Falls
Vibration
Occupational risk factors
![Page 17: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/17.jpg)
![Page 18: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/18.jpg)
DIAGNOSIS
Specific diagnosis is impossible in 80% Differentiation of muscle, joint, ligamentous
structures Mechanical versus systemic disorders is possible Categorize by clinical symptoms Subtyping will improve therapy
![Page 19: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/19.jpg)
Physical Examination
Inspection Palpation Range of motion Strength testing Neurologic examination Special tests
![Page 20: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/20.jpg)
Ideally with back and legs exposed. Posture ?Scoliosis ? Kyphosis Skin café-au-lait spots, hairy patches, signs
of psoriasis. Prolapsed disc may cause a lumbar scoliosis,
flattening or reversal of normal lumbar lordosis
Inspection
![Page 21: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/21.jpg)
Check for bone tenderness – this may indicate serious pathology eg infection, fracture, malignancy
With patient leaning forwards check for tenderness between the vertebral spines and paraspinal muscles. Eg prolapsed disc, mechanical back pain
SI joints Palpable steps may indicate
spondylolisthesis
Palpation
![Page 22: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/22.jpg)
Flexion – schobers test <5cm = abnormal Extension – pain and restricted extension in
prolapsed disc and spondylolisthesis Lateral Flexion Rotation – seated, movement is thoracic
Movements
![Page 23: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/23.jpg)
Check hip joints for pain and limitation – internal rotation is often the earliest sign hip disease.
FABER test. Place foot across knee of opposite leg, apply gentle pressure to knee and opposite ASIS. Pain in SI area may indicate a problems with these joints.
Hip and SI joint examination
![Page 24: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/24.jpg)
Consider non musculoskeletal causes of back pain
Abdominal and Cardiovascular examination
![Page 25: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/25.jpg)
Looking for nerve root irritation L5- S1- Patient supine, passively raise leg with knee
extended, stop when back or leg pain. <45o positive
Lower leg until the pain disappears then dorsiflex foot, pain or paraesthesia aggravated.
Straight leg raising
![Page 26: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/26.jpg)
Patella (L3-4) Achilles (L5- S1) reflexes Lower Limb power Test sensation to pin prick
Look for further evidence of neurological involvement
![Page 27: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/27.jpg)
Straight Leg Raising
![Page 28: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/28.jpg)
•L4•L5•S1
![Page 29: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/29.jpg)
Age < 15 or > 50 Fever, chills, UTI Significant trauma Unrelenting night pain; pain at rest Progressive sensory deficit Neurologic deficits
Saddle-area anesthesia Urinary and/or fecal incontinence Major motor weakness
Unexplained weight loss Hx or suspicion of Cancer Hx of Osteoporosis Hx of IV drug use, steroid use,
immunosuppression Failure to improve after 6 weeks conservative
tx
“Red Flags” in back pain
![Page 30: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/30.jpg)
management
![Page 31: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/31.jpg)
![Page 32: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/32.jpg)
Back Pain Management ToolsCare
Manager
Physical Therapy
Chiropractic Clinic
NeurosurgeryPain Management
NeurologyEMG
Medicine
![Page 33: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/33.jpg)
Different time frames Multiple therapies at one time
Different starting points
Pain Management:A More Flexible Approach*
NSAIDs,over-the-counterdrugs
Physical therapy,TENS
Corrective surgery
Long-termoralopioids
Intrathecaltherapy orneurostimulation
NeuroablationChronic PainPatient
Complementary medicine, behavioral
programs,adjuvant
meds
![Page 34: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/34.jpg)
Initially rest - perhaps with a board under the bed - was recommended for back pain. The new guidelines recommended active rehabilitation. The new principles of management involve keeping the patient active and giving analgesia to facilitate this.
Give information, reassurance and advice. DO NOT prescribe bed rest. Advise to stay as active as possible. Prescribe regular pain relief (paracetamol, non-
steroidal anti-inflammatory drugs) and consider a short course of muscle relaxants.
Management
![Page 35: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/35.jpg)
acupuncture – fine needles are inserted into your skin at certain points on the body
exercise classes – aerobic exercise, muscle strengthening and stretching
manual therapy – your back is massaged or manipulated
Other treatment options
![Page 36: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/36.jpg)
If red flags suggest a serious condition, refer with appropriate urgency. This means immediately for CES.
If there is progressive, persistent or severe neurological deficit, refer for neurosurgical or orthopaedic assessment, preferably to be seen within 1 week.
If pain or disability remain problematic for more than a week or two, consider early referral for physiotherapy or other physical therapy.
If, after 6 weeks, sciatica is still disabling and distressing, refer for neurosurgical or orthopaedic assessment, preferably to be seen within 3 weeks.
If pain or disability continue to be a problem despite appropriate pharmacotherapy and physical therapy, consider referral to a multidisciplinary back pain service or a chronic pain clinic.
Referral guidance
![Page 37: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/37.jpg)
Goal of the occupational medicine
Prevention
![Page 38: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/38.jpg)
Eliminate (Engineer Hazard Out)
Workplace design
Tool design
Preplan process
Engineer Controls
![Page 39: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/39.jpg)
Use mechanical lifts when possible
Eliminate the Lift
![Page 40: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/40.jpg)
Training of employees and management
Job rotation
Administrative Controls
![Page 41: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/41.jpg)
Rotate to non-lifting tasksJob Rotation
![Page 42: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/42.jpg)
1. Heavy lifting
2. Frequent lifting
3. Awkward lifting
Pay Special Attention
![Page 43: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/43.jpg)
60-70 pound wood pallet
“Substitute”
20 pound plastic pallet
Reduce Heavy Lifting
![Page 44: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/44.jpg)
Common sense controls
Reduce Size of Box
![Page 45: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/45.jpg)
Use mechanical assistance
Reduce Heavy Lifting
![Page 46: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/46.jpg)
Slide Instead of LiftSlide Instead of Lift
![Page 47: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/47.jpg)
Team Lifting* Reduce Heavy Lifting
![Page 48: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/48.jpg)
Mechanical Assistance
Reduce Frequency
![Page 49: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/49.jpg)
Use Mobile Storage*
Reduce Frequency
![Page 50: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/50.jpg)
Raise load mechanically
Reduce Awkward Lifting
![Page 51: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/51.jpg)
Add Handles
Awkward Lifting
![Page 52: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/52.jpg)
Rearrange Storage
Awkward Lifting
![Page 53: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/53.jpg)
Mechanical assistance
Stacker – stacks up to 12 feet high
Awkward Lifting
![Page 54: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/54.jpg)
To reduce twisting – use conveyors *
Awkward Lifting
![Page 55: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/55.jpg)
Make sure you can lift the weight.
Test load by picking up one end!
Size Up The Load
![Page 56: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/56.jpg)
Proper Lifting
Think defensively about your back
Use common sense
Follow good lifting techniques
Keep load close to body
![Page 57: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/57.jpg)
Baseball Strike Zone
Lifting Power Zone
![Page 58: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/58.jpg)
Lifting Techniques
Lift with your legs, not your back
Place your feet close to the object
Center yourself over the load
![Page 59: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/59.jpg)
Lifting Techniques
Bend your knees
Get a good hand hold
Lift straight up smoothly
![Page 60: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/60.jpg)
Don’t Twist or Turn
Feet facing the lift
Keep it steady
No twisting/turning
![Page 61: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/61.jpg)
Know Your Path!
Is your path clear?
Are there any holes?
Are there any spilled liquids?
Check your footing.
![Page 62: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/62.jpg)
Set it Down Safely
Just as critical to back safety as lifting
Bend knees slowly
Let legs do the work
Don’t let go of the load until it is secure on the floor
![Page 63: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/63.jpg)
Push vs. Pull
If the object is on rollers, push
Pushing puts less strain on your back
Uses largest muscle group
![Page 64: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/64.jpg)
I CANNOT RETURN TO WORK!!!!!!!
RETURN TO WORK
![Page 65: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/65.jpg)
![Page 66: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/66.jpg)
![Page 67: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/67.jpg)
Disc herniation
![Page 68: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/68.jpg)
![Page 69: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/69.jpg)
PEARLS
![Page 70: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/70.jpg)
Correlating Clinical and MRI Scan Findings in Low Back Pain
.
![Page 71: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/71.jpg)
Indications for MRI lumbar spine
• Progressive neurological deficit- weakness most important
• Cauda equina syndrome- bowel/bladder retention/incontinence, saddle anesthesia
• No significant improvement with 4-8 weeks of conservative therapy/PT
• Severe, intractable pain• Red flags- fever, weight loss, previous
cancer, IV drug use
![Page 72: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/72.jpg)
Lumbar Disc Anatomy
![Page 73: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/73.jpg)
Disk herniation grading
![Page 74: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/74.jpg)
Disc protrusion patterns
• Central disc protrusion• Lateral disc protrusion• Far lateral/Foraminal disc protrusion
![Page 75: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/75.jpg)
Central Disc Protrusion
![Page 76: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/76.jpg)
Central Disc Protrusion General Characteristics
• Frequent cause of recurrent mechanical/axial low back pain in the <50 year-old
• Frequently injured/aggravated by flexion• Pain is frequently worse with coughing,
sneezing, laughing or valsalva• Pain is frequently worse with prolonged
sitting/long car ride• Normal lower extremity neuro exam
![Page 77: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/77.jpg)
MRI scan slide #1
![Page 78: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/78.jpg)
MRI scan slide #2
![Page 79: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/79.jpg)
MRI scan slide #3
![Page 80: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/80.jpg)
MRI scan slide #4
![Page 81: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/81.jpg)
Lateral disc protrusion
![Page 82: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/82.jpg)
Lateral disc protrusion general characteristics
• Lower extremity radicular pain worse than low back pain
• Lower extremity pain follows radicular and dermatomal pattern
• Pain is generally worse with coughing and sneezing, valsalva maneuvers
• Pain is generally worse with flexion and sitting• L3-4 disc-L4 radicular pain, L4-5 disc- L5
radicular pain, L5-S1 disc- S1 radicular pain
![Page 83: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/83.jpg)
Lateral disc protrusion continued
• Careful lower extremity neuro exam may be able to identify specific nerve root lesion
• Straight leg raising usually reproduces radicular pain
• May respond to oral steroids or transforaminal epidural steroid injections
• Persisting pain may need discectomy to relieve lower extremity pain
![Page 84: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/84.jpg)
MRI scan slide #5
![Page 85: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/85.jpg)
MRI scan slide #6
![Page 86: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/86.jpg)
Far lateral/foraminal disk protrusion
![Page 87: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/87.jpg)
Far lateral/foraminal disk protrusion general characteristics
• Lower extremity radicular pain much worse with standing and walking, usually improved with sitting
• Lower extremity pain follows radicular and dermatomal pattern
• Usually not worsened by coughing or sneezing• Careful lower extremity neuro exam may be able
to identify specific nerve root involvement• Diskectomy can be difficult because of facet joint
blocking exposure
![Page 88: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/88.jpg)
MRI scan slide #8
![Page 89: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/89.jpg)
Spinal stenosis
![Page 90: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/90.jpg)
Lumbar Spinal Stenosis
Disc bulge, facet hypertrophy and flaval ligament thickening frequently combine to cause central spinal stenosis
![Page 91: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/91.jpg)
MRI scan slide # 12
![Page 92: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/92.jpg)
Spinal stenosis
• Low back pain with radiation to bilateral buttocks and lower extremities which is worse with prolonged standing and walking
• Neurogenic claudication may need to rule out vascular claudication first
• PT for stabilization and flexibility• Caudal epidural steroid injections• Surgical decompression for resistant cases
![Page 93: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/93.jpg)
MRI scan slide #13
![Page 94: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/94.jpg)
Lumbar Spine – AP View
![Page 95: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/95.jpg)
Lumbar Spine – Lateral View
![Page 96: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/96.jpg)
Adapted from: “Nomenclature and Classification of Lumbar Disc Pathology: Recommendations of the Combined Task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology,” 2001.
![Page 97: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/97.jpg)
ProtrusionProtrusion w/
migration
Protrusion w/migration +
sequestration
![Page 98: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/98.jpg)
Schmorl’s Nodes
![Page 99: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/99.jpg)
Confusing “Spondy-” Terminology
• Spondylosis = “spondylosis deformans” = degenerative spine
• Spondylitis = inflamed spine (e.g. ankylosing, pyogenic, etc.)
• Spondylolysis = chronic fracture of pars interarticularis with nonunion (“pars defect”)
• Spondylolisthesis = anterior slippage of vertebra typically resulting from bilateral pars defects
• Pseudospondylolisthesis = “degenerative spondylolisthesis” (spondylolisthesis resulting from degenerative disease rather than pars defects)
![Page 100: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/100.jpg)
Spondylolysis / Spondylolisthesis
![Page 101: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/101.jpg)
Spondylolysis
Spondylolisthesis
![Page 102: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/102.jpg)
Spondylolysis Stress fracture of pars interarticularis Repetitive flexion/extension LBP with occasional radicular
symptoms past buttocks and thighs, no neurologic deficits
![Page 103: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/103.jpg)
Spondylolisthesis “Slipping of vertebrae” 75% have LBP Restrictive ROM
![Page 104: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/104.jpg)
![Page 105: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/105.jpg)
Degenerative Disc (and Facet Joint) Disease
![Page 106: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/106.jpg)
Degenerative Disc (and Facet Joint) Disease
Foraminal stenosis
Thickening/Buckling of Ligamentum Flavum
![Page 107: Occupational low back pain Dr mehdi habibollahi. Low back pain was defined as pain and discomfort, localized below the costal margin and above the inferior.](https://reader035.fdocuments.us/reader035/viewer/2022062519/5697bfb81a28abf838c9f420/html5/thumbnails/107.jpg)