Schematic cross-section of an inter-vertebral discHerniated disc

Causal factors for back pain

Spinal fracture Herniated disc TB spine Mechanical low back pain - Diagnosis of exclusion 75-80% of cases.

Spinal FractureHerniated DiscTB 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 affectedAvoid 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 conditioningDouble knee to chest stretch

Pelvic tiltSome exercises for the backLower trunk rotation stretch

Trunk Flexion StretchTrunk flexion stretchProne lumbar extensionSome exercises for the back

Alternate Prone Leg ExtensionAlternate prone leg extensionAerobic conditioning

Abdominal StrengtheningAbdominal strengthening

Lower Limb StretchesLower limb stretches

Complementary therapy Back hygiene and back school Correction of biomechanical factors Posture Weight control

Weight trainingYoga

YogaThe right chairCounter height

Working Posture

Posture at workThe right posture

Sitting Posture

Sitting postureForward bending

Pulling an Object

Pulling an object

Thank you

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