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LOWER BACK PAIN

(Project Work)

By AFRANA SYIEMLIEHBPT (internship)Krupanidhi College of PhysiotherapySubmitted toDr. Deepshika Baruah (HOD)Little Sisters of the PoorDate: 27

November 2009

ANATOMY OF THE LOW BACK

Important structures of the low back includes the bony lumbar spine (vertebrae), discsbetween the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

•

Bony lumbar spine

(

vertebrae) - is designed so that vertebrae

"stacked"

together can provide a movable support structure while also protecting thespinal cord (nervous tissue that extends down the spinal column from thebrain) from injury. Each vertebrae has a spinous process, a bony prominencebehind the spinal cord, which shields the cord's nervous tissue. They alsohave a strong bony "body" in front of the spinal cord to provide a platformsuitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone in between the buttocks.On each side, the sacrum meets the iliac bone of the pelvis to form thesacroiliac joint of the buttock.

•

Discs

-The discs are pads that serve as

"cushions"

between each vertebralbody. They help to minimize the impact of stress forces on the spinal column. Each disc is designedlike a jelly donut with a central softer component (nucleus pulposus) and a surrounding outer ring(annulus fibrosus). The central portion of the disc is capable of rupturing (herniating) through theouter ring, causing irritation of adjacent nervous tissue andsciatica, as described below.

•

Ligaments

-Ligaments are strong fibrous soft tissues that firmly attach bonesto bones. Ligaments attach each of the vertebrae and surround each of the discs.

•

Spinal cord and Nerves

The nerves that provide sensation and stimulate themuscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) exit thespinal column through bony portals called "foramen.

•

Muscles

Many muscle groups that are responsible for flexing, extending, and rotatingthe waist, as well as moving the lower extremities, attach to the lumbar spine throughtendon insertions.

•

Internal organs of the pelvis and abdomen

Theaortaand blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis.Surrounding these blood vessels are lymph glands and involuntarynervous system tissues, which are important in maintaining bladder andbowel control. The uterus and ovaries are important pelvic structures infront of the pelvic area of women. Theprostate glandis a significant pelvicstructure in men. The kidneys are on either side of the back of the lower abdomen, in front of thelumbar spine.

•

Skin

The skin over the lumbar area is supplied by nerves that come from nerve rootsthat exit from the lumbar spine.

FUNCTIONS OF THE LOW BACK

The low back, or lumbar area, serves a number of important functions for the humanbody. These functions include

structural support, movement, and protection of certain bodytissues.

When we stand, the lower back is functioning

to hold most of the weight

of the body.When we bend, extend or rotate at the waist, the lower back is

involved in the movement

.Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles,tendons, and ligaments, often can be detected when the body is standing erect or used in variousmovements.

Protecting the soft tissues of the nervous system and spinal cord as well as nearbyorgans of the pelvis and abdomen

is a critical function the lumbar spine and its adjacent muscles.

DEFINITION OF LOW BACK PAIN

Low back pain (LBP)

is a common complaint—second only tocold and fluas a reason why patients seek care from their family doctor. Itmay be a

limited

musculoskeletal symptom

or caused by a variety of diseases and disorders that affect or extend from the lumbar spine. Lowback pain is sometimes accompanied by

sciatica

, which is pain thatinvolves the sciatic nerve and is felt in the lower back, the buttocks, thebacks and sides of the thighs, and possibly the calves. More seriouscauses of LBP may be accompanied by

fever

night pain

that awakens aperson from sleep,

loss of bladder or

bowel control

numbness

burning urination

swelling

sharp pain

COMMON CAUSES OF LOW BACK PAIN

There are several causes of low back pain (sometimes referred to as

Lumbago

). Someof the common causes are listed below.

1 .1 .

LUMBAR STRAIN

(acute, chronic)

A lumbar strain is a

stretching injury

to the ligaments,tendons, and/or muscles of the low back. The stretching incidentresults in microscopic tears of varying degrees in these tissues.Lumbar strain is considered one of the

most common causes

of low back pain. The injury can occur because of

overuse, improper use, or trauma

. Soft-tissue injury is commonly classified as

"acute"

if it has been present for

days to weeks

. If the strain lasts

longer than three months