Pain in the back confined to the region between the lower edge of the rib cage and buttock, with or without radiation to the legs.
Low income and education level.
Altered muscle size, composition, and coordination.
From the tectorial membrane at the body of the axis to the intervertebral disc between L3/4.
Lower health literacy, reduced availability of health care services, routine and manual occupations, increased physical workload.
30 - 50 degrees.
Low back pain.
From children to the elderly.
<p>• Depression,</p><p>• anxiety,</p><p>• catastrophizing,</p><p>• fear-avoidance,</p><p>• kinesiophobia</p>
L1 and L2 are taller dorsally, while L4 and L5 are taller ventrally.
Progressive degeneration of the disc throughout adulthood.
<p>Changes in specific corticol and subcorticol areas</p><p>Altered functional connectivity in pain related area following painful stimulation</p>
They typically increase in diameter.
Acute LBP is classified as lasting less than 3 months (12 weeks).
20 - 40 degrees.
In concentric rings.
65˚ to vertical, with alternating inclination between lamellae.
Superficial layer and deep layer.
20 - 40 degrees.
Progressive calcification occurs, compromising the nutrient source.
Vertebrae, intervertebral discs (IVD), ligaments, muscles, spinal cord, and nerves.
Grumbling debilitating back pain.
<p>O: pubic symphysis & pubic crest</p><p>I: Xiphoid process & Costal cartilage 5-7</p><p>N: Ventral rami T6-T12</p><p>A: flex</p>
<p>O: Thoracolumbar fascia, Anterior iliac crest, lateral inguinal ligament</p><p>I: ribs 10-12, linea laba, pectin pubis</p><p>N: Ventral rami T6-L1</p><p>A: flex & rotate trunk</p>
Primarily collagen, except for the ligamentum flavum which contains elastin.
Obliquely in the sagittal plane.
<p><span>- </span>Can lead to micro- or gross-fracture, which cause back pain</p><p><span>- </span>History: grumbling debilitating back pain, initiated by some minor mechanical event such as lifting</p><p><span>- </span>Clinically: widespread pain, +ve percussion, neurological change rare</p><p><span>- </span>Risk factors:</p><p>◦ Female > male (4:1)</p><p>◦ Caucasians & asians</p><p>◦ Small body size</p><p>◦ +ve family history</p><p>◦ Surgically initiated oestrogen deficiency (oophorectomy)</p><p>◦ Lifestyle factors: smoking, alcohol consumption, excessive coffee,sedentary, poor nutrition</p>
<p>Largely avascular, only runs to the endplate. It approaches annular fibrosis at the periphery but does not penetrate.</p>
It is transitional in height characteristics.
10 facet joints plus 2 with the thoracic vertebrae.
It consists of collagen fibers arranged in 10 to 20 sheets.
The outer few millimeters of the annulus fibrosis.
They are thick anteriorly and laterally, and thin posteriorly.
Signs or symptoms that indicate a potentially serious underlying condition.
4 intervertebral discs plus 1 at T12/L1.
Widespread pain and positive percussion; neurological changes are rare.
The inner annulus enters the end plate.
Continuation of the cruciform ligament of the atlas to the sacral canal.
Nociceptors and mechanoreceptors.
Chronic LBP is classified as lasting more than 3 months (12 weeks).
Smoking, alcohol consumption, excessive coffee, sedentary lifestyle, and poor nutrition.
Cervical (Cx), thoracic (Tx), and lumbar (Lx) vertebrae.
<p>O: ribs 5-12</p><p>I: Ant. iliac crest, linea alba, pubic tubercle</p><p>N: Ventral rami T6-T12, subcostal N</p><p>A: flex & rotate trunk</p><p></p>
They absorb energy.
<p>Axial rotation, accompanied by shearing force.</p>
Midway between flexion and extension.
Between 0 - 33%, increased up to 70%.
80% elastin fiber.
Low back pain that does not have a specific diagnosis.
Side flexion, rotation, and extension.
12 thoracic vertebrae (Tx).
<p>refer to lec pp</p>
Circled by a ring apophysis.
40 - 50% of adult disc volume.
<p>O: costal cartilage 7-12, thoracolumbar fascia, iliac crest, lateral inguinal ligament</p><p>I: Linea alba, pectin pubis, pubic crest</p><p>N: <span style="color: rgb(55, 65, 81)">Ventral rami T6-L1</span></p><p><span style="color: rgb(55, 65, 81)">A: support abdominal viscera & increase abdominal pressure</span></p>
The laminae of adjacent vertebrae from C2 to S1.
7 cervical vertebrae (Cx).
The transition from lumbar to sacral spine.
Extension.
At the lumbar region.
5 lumbar vertebrae (Lx).
Its body is taller ventrally.
5 vertebrae plus sacrum and coccyx.
Hyperlordosis, high and prolonged weight loading, and disc degeneration.
5 sacral (Sx) and 4 fused coccygeal vertebrae.
Sacral (Sx) and coccygeal (Coc) vertebrae.
Ligament strength decreases with age.
It prevents the spine from buckling.
Medial branch of the dorsal ramus of the nerve exiting at the same level and the medial branch of the nerve one level above.
<p>• Previous LBP</p><p>• Pre-existing chronic conditions: asthma, headache, diabetes</p><p>• Poor mental health: psychological distress, depression</p><p>• Lifestyle factors: smoking, obesity, low level of physical activity</p><p>• Genetic influence (twins)</p><p>• Body ergonomics: awkward postures, heavy manual tasks, higher exposures of lifting, bending, physically demanding tasks</p><p>• Heavy workload</p>
<p>30-50 degrees.</p>
<p>They follow a typical non-linear load-displacement curve. (stretch-strain curve)</p>
<p>From the occipital bone to the sacrum, broadening out caudally. Firmly bound to the vertebral bodies but not to the intervertebral discs.</p>
<p>1) It loses strength and elasticity, thickens, and may buckle towards the spinal cord —> spinal stenosis</p><p>2) calcification → hypertorphy</p><p></p>
<p>Mucoid material and <strong>proteoglycans</strong></p>
<p></p><p>C:</p><p>• Unknown aetiology</p><p>E:</p><p>• Commonly seen in children aged 2-6</p><p>• Common in lumbar spine, esp L4</p><p>S/S:</p><p>• Infant refuse to walk</p><p>• C/O hip or back pain in older children</p><p>• Restricted spinal mobility</p><p>• Paravertebral and hamstring spasm</p><p>• Pain on percussion over lumbar spine</p><p>• Natural history: restore disc height, end plate regain function</p>
<p><span>- </span>insidious onset of “discomfort”</p><p><span>- </span>Exacerbations and remissions</p><p><span>- </span>< 40 yrs</p><p><span>- </span>Persistence > 3/12</p><p><span>- </span>Morning stiffness</p><p><span>- </span>Limitation of spinal movement, progressive</p><p><span>- </span>Improve with exercise</p><p><span>- </span>From SIJ up or OC1 down</p><p><span>- </span>Iritis is early and recurrent</p><p><span>- </span>Course in <span>♀</span> is milder</p>
<p><span>- </span>Poor localisation</p><p><span>- </span>Referral pattern not somotomal</p><p><span>- </span>+ve autonomic responses (nausea, sweating)</p><p><span>- </span>Associated with strong motor reflex, esp spam in the gut</p><p><span>- </span>Many visceral problem can be agg by activity</p><p><span>- </span>GI – cyclical pattern (meals?)</p><p><span>- ♀</span> - link with hormonal cycle</p><p><span>- </span>Other symptoms like fatugue, malaise, loss of appetite, change bowel habits, abd distension , etc</p><p><span> </span>Easing factor:</p><p><span>- </span>Kidney: leaning to uninvolved side</p><p><span>- </span>Pleural: <span>↓</span> resp movement, lying on involved side</p><p><span>- </span>Gall Bladder: leaning forward</p><p><span>- </span>Pancreatic: leaning forward and sitting upright</p>
