Back Pain
What is the Lumbar Spine?
The Lumbar Spine is the section of spine which connects the torso/ ribs to the pelvis. For most people this is made up of 5 vertebra interconnected by ligaments and muscles, responsible for providing flexibility and strength. It also has an important role in protecting the spinal cord and exiting nerve roots. This complex structure is susceptible to injury and pain.
Making a Back Pain Diagnosis
An accurate diagnosis assists determine appropriate treatment options and the underlying cause of back pain. A thorough physiotherapy assessment begins with through conducting a thorough medical history, including
medical records and previous scans or tests, and a physical examination.
The physical evaluation includes the following components:,
* Observation of the patient’s posture and skin over the area of pain
* Palpation to identify tender areas and muscle spasm
* Range of Motion Tests
* Segmental Examination of the spine
* Neurological Examination, to identify muscle strength, skin sensation, reflexes, and cranial nerves.
Assessment of other areas to exclude referred pain may also be indicated.
When further tests are required for Back Pain?
Most cases of nonspecific back pain can be diagnosed and treatment started without the need for additional diagnostic tests. However, if a patient does not respond to initial treatment, (physical therapy, medications, ice, heat, ergonomic modification, and activity modification), further testing is indicated The types of diagnostic testing may include: X-ray, CT scan, MRI, Nerve Conduction Studies, Nerve Blocks.
Types of Back Injuries
Degenerative Conditions of the Spine
1. Degenerative Disc Disease is the formation of tears to the outer surface of the disc due to dehydration of the disc and loss of disc height.
2. Osteoarthritis occurs typically at the facet joints. The joint develops bone spurs as a result of wear to the cartilage. As the spurs progress and enlarge the joint inflammation and pain may result.
3. Spondylosis : Both these conditions frequently occur together due to the interdependence these structures share.
Spondylosis
Injury to the Disc
1. Disc Herniation - he disc’s nucleus pulposus starts to leak into cracks or tears in the outer layer
2. Disc Bulge -the disc’s protective outer layer (annulus fibrosus) bulges past the vertebral body
Nerve Pain
1. Radiculopathy - nerve root inflammation or damage causes a change in neurological function ie. numbness and/or weakness
2. Radicular Pain - nerve root becomes inflamed and radiates pain from the spine, but it does not involve neurological deficits.
