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					What are the causes of low back pain?

Low Back Pain
NOTE: This information sheet is for your general information and is not a substitute for medical advice. You should contact your physician or other healthcare provider with any questions about your health, treatment or care.
Low back pain is not a specific disease. It is a symptom that can be experienced due to a number of different reasons. In up to 85% of people with low back pain, no specific cause of the pain can be identified despite a thorough medical examination.
• Work. Most experts recommend that people with back pain continue to work if it is possible to avoid prolonged standing or sitting, heavy lifting and/or twisting. Exercise. Back exercises or stretching routines should not be used during a sudden episode of back pain as this could worsen or prolong the pain. However, after the symptoms have subsided, there is significant benefit from a programme of exercises to increase back flexibility and to strengthen the muscles that support the back. Recommended activities include those that involve strengthening and stretching, such as walking, swimming, use of a stationary bicycle and low-impact aerobics. Avoid activities that involve twisting, bending, are high impact or make the back hurt more. Manipulation is a technique used by physical therapists, chiropractors, osteopaths, massage therapists and others to treat acute and chronic back pain. It involves moving a joint (spinal column) beyond the normal range of voluntary movement. Acupuncture involves inserting very fine needles into specific points, as determined by traditional Chinese maps of the body's flow of energy. It has benefits in relieving pain in people who have a high expectation of success of the therapy. Physical therapy. A healthcare provider may recommend working with a physical therapist if low back pain is still present after four weeks. A physical therapist can teach muscle-strengthening exercises for the back and abdomen and can also use treatments such as heat, ice, massage, manipulation and ultrasound to relieve pain. Massage and yoga. A few studies have evaluated massage and yoga for treatment of low back pain. The benefit of massage or yoga was found to be greatest in people with chronic back pain who expected to improve with one of these treatments. Other treatments: - Injections of a steroid medication are sometimes recommended for chronic low back pain. - Surgery. Only a small minority of patients suffering from chronic low back pain will require surgery. - Bed rest. It is becoming increasingly evident that bed rest should only be used in severe cases and then for not more than two days.

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What are the causes of low back pain?
There are several factors that increase the risk of developing back pain. These could include things like obesity, smoking, older age, female gender, physically strenuous work, sedentary work, a stressful job, job dissatisfaction and psychological factors such as anxiety or depression. Other causes could be: • Spondylolisthesis - a condition in which one of the vertebrae of the lower spine slips forward in relation to another. • A herniated disc - caused by too much wear and tear on spinal discs which can then lead to a herniation of a disc. • Lumbar spinal stenosis - a condition in which the vertebral canal (the open space inside the vertebrae) is narrowed. • Less common causes of back pain. Rarely, back pain is caused by a serious spinal condition such as an infection, a tumor or a disorder called cauda equina syndrome. Other potential causes include spinal compression fractures whereby one or more vertebrae become fractured as a result of weakening and thinning of the vertebrae due to osteoporosis. • Back pain and work. Factors that may contribute to low back pain at work include: - poor posture whilst sitting or standing - sitting or standing for long periods of time - driving long distances - improper lifting techniques - frequent lifting - lifting excessively heavy loads. •

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How is low back pain treated?
• Pain medication. Your doctor will prescribe pain medication such as aspirin, paracetamol, ibuprofen or naproxen.

What can I do to prevent back pain?
Once the low back pain has settled and your general functioning has improved, there are ways of preventing recurrences. Perhaps the most important are exercise and physical conditioning: • Regular exercise that improves cardiovascular health combined with specific exercises to strengthen the muscles of the hips and torso. The abdominal muscles are particularly important in supporting the lower back and preventing back pain. • Bend and lift correctly. Appropriate methods for bending and lifting are important in preventing back pain. Lifting should always be done with the knees bent and the •

abdominal muscles tightened, to avoid straining the weaker muscles in the lower back. Take a break. Standing and sitting for long periods should be avoided and can be overcome by changing positions often and by using a chair with appropriate support for the back. Taking brief but frequent breaks to walk around will also prevent pain due to prolonged sitting or standing.

References:
1. 2. 3. 4. eMedicinehealth Uptodate Spine Universe Spine Health

INFORMATION TO KEEP AT HAND FOR THE SPINAL PROGRAMME
The purpose of the following table is to record your condition-specific measures. Please read through it carefully and record the requested data, providing as detailed and correct input as possible. One of our case managers may call you and request this information to record it on our system. This will assist us in observing the patterns of your condition, identifying serious changes and allowing us to give you feedback and personalised information pertaining to your condition. If you are unsure about the information requested in the table, please do not hesitate to ask one of our case managers to explain it to you.

DATE

EMERGENCY ROOM ADMISSION

HOSPITAL ADMISSION

RED FLAGS*

YELLOW OSWESTRY DISABILTY FLAGS** INDEX SCORE***

NOTES

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Red flags are indicators of increased risk of serious back disease and pathology. Red flags include major trauma (e.g. a vehicle accident or fall from a height), minor trauma or even just strenuous lifting in people with osteoporosis.

anxiety and stress), as well as problems and/or dissatisfaction at work. It is important that you inform your healthcare provider if you experience any one of these feelings. *** The Oswestry Disability Index Score is a useful means of measuring your difficulty in functioning due to your back pain. Select from each section an option that accurately describes your experience. Follow the instructions at the end of the table to determine your score. Record it in the table provided.

** Yellow flags are the psychological aspects of back pain that delay recovery if not resolved. These include "sickness behaviour" such as extended rest, the belief that pain and activity are harmful, social withdrawal, emotional problems (e.g. negative mood, depression,


				
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