A

PROJECT REPORT

ON

MECHANICAL BACK PAIN

SUBMITTED TO

JYOTI RAO PHULE

SUBHARTI COLLEGE OF PHYSIOTHERAPY

ACCREDITED WITH GRADE “A ” NAAC

GUIDED BY :- SUBMITTED BY:-

INTERN COMMITTEE- SCPT KAVITA SINGH

Dr. MUKESH KUMAR INTERN

Dr. SHIVANJALI BATCH - 2014
Dr. GAURAV PRATAP TYAGI
 Certificate

This is to certify that this project “mechanical back pain” is submitted to

JRP Subharti Coleege Of Physiotherapy Swami Vivekananda University
meerut.
This project eork is carried by Kavita Singh Intern BPT Batch-2014 in
her internship under my guidance.
Submitted by :-
Kavita Singh (Intern)
Batch- 2014
(signature)

Guided by:- Submitted To:-

Intern Committe- SCPT Dr. R.K Meena
Dr.Mukesh kumar (Principal)
Dr.Shivanjali
Dr.Gaurav Pratap Tyagi (signature)

(signature)
 Acknowlegement

I would like to express my special thanks of gratitude to

my guide Dr.Mukesh Kumar Dr.Shivanjali Dr.Gaurav
Pratap Tyagi as well as our principal
Dr.R.K. Meena who gave me this opportunity to do this
wonderful project through which i come to know about
many new things. I am really thankful to them.
Secondly I would also like to thanks my parents, family
and friends who helped me a alot to finalize this project
within limited time
 CONTENTS

INTRODUCTION
1. Anatomy
2. Pathology
3. Causes
4. Sign and Symptoms
5. Diagnosis
6. Assessment
7. Management
8. Physiotherapy treatment
9. Prevention
10. Case Study
11. Conclusion
12. Bibliography
 MECHANICAL BACK PAIN

DEFINITION:-
Mechanical pain is the general term that refers to any
type of back pain caused by placing abnormal stress and
strain on muscles of the vertebral column.
Typically,mechanical pain results from bad habits, such
as poor posture, poorly-designed seating, and incorrect
bending and lifting
The habits cab be autonomously
correctd by maintaining proper
posture, adapting proper lifiting
and bending technicques, as well
as the use of ergonomic chairs to
alleviate back pain. If the pain
persists, the pan may not be due to
mechanical pain, indicating a more
serious underlying back problem.
 ANATOMY
Column is the spinal the body’s main support
structure contains the spinal cord.
The brain and spinal cord are known as the
central nervous system, while the nerves that
connect the spinal cord to the body are known
as the peripheral nervous system.
The nerves that carry information from the
brain to the muscles are called motor neurons.
The nerves that carry information from the
body back to the brain are called sensory
neurons. Sensory neurons carry information to the brain about skin
temperature, touch, pain and joint position.
The spinal column is formed by 33 bones; and divided into 5 regions:
cervical (7), thoracic(12), lumbar(5), coccygeal(4) .It has alsso other
components such as intervertebral disc (shock absorbers),paravertebral
muscles (flexors, extension and oblique) and ligaments (stablizers).
from the brain, the spinal cord passes down the center of the back and is
surrounded and protected by the body spinal columun.the spinal cord is
surrounded by a clear fluid called cerebrospinal fliud (CSF), which act
as a cushion to protect the delicate nerve tissue damage by impact
against the inside of the vertebrae.
The spinal cord consist of millions of nerve fibers that transmit electric
information to the limbs,trunk and organs of the body, back to and from
the brain.The nerve exiting the spinal at the top of the neck, control
breahing and arms.the nerves that leave the spinal cord in the middle and
lower back, control the trunk and legs,bladder,bowel and sexual
function.
 PATHOPHYSIOLOGY

There are many structures in the lumbar spine that can cause pain; any
irritations to the nerve roots that exist the spine, joint problems, the disc
themselves, the bones and the muscles.

many lumbar spine conditions are interrelated. for example, joint

instability can lead to disc degenaration, which in turn can put pressure
on the nerve roots.

the most common cause of back pain is muscle strain or other muscle
problem. Strain due to heavy lifting, bending, or other repetitive use can
be quite painful, but muscle strains usually heal within a few days or
weeks.
causes of mechanical back pain generally are attribute to an acute
traumatic event, but they may also include cumluative trauma.
the severity of an acute traumatic event varies widely, from just twisting
the back to being involved in a motor vehicle collision.

mechanical back pain due to cumulative trauma tends to occur more

commonly in the worlplace.
The lumbar spine position most at risk for producing lower back pain is
forword flexion , rotation, and attempting to lift a heavy object with
outstretched hands.
Repetitive compressive loading of the discs in flexion risk for an annular
tear and internal disc disruption.likewise, torsion forces on the discs can
produce shear force that may induce annular tear.
In Lumbar Flexion the heighest strains are recorded within the
interspinous and supraspinous ligament followed by the intracapsular
ligament and the ligamentum flavum.
In Lumbar Extension the anterior longitudional ligament experiences the
heighest strain.
Lateral Bending produce the highest strain in the ligaments contralateral
to the direction of bending.
Rotation generation the highest strains in the capsular ligaments.
Degenerative changes are seen as decreased signal intensity and bulging
of the disc in the lumbar spine.
 CAUSES

1- Back or Neck Sprain and Strain

A back or neck sprian occurs when a spinal ligament is
overstretched or torn. In contract, back or neck strain involves a
muscle and/or tendon attachment. It can be difficult to identify
the source of the pain.

2- Disc Herniation
Intervertebral disc seprate the drum-shaped vertebral bodies.
Each disc is anchored into place by endplates; a fibrous
connective tissues that is part of the disc. Discs are made of
fibrocartilage and allow a small amount of movement at each
vertebral segment(2 vertebrae and one disc). The disc’s outer
ring (annular fibrosus) protects the inner gel-like center (nucleus
pulposus).
Disc herniated occurs when the gel-like material breaks through
the outer ring, often causing nerve compression, irritation,
inflammation, and pain.

3- Vertebral Compression Fracture (VCF)

A vertebral compression frature occures when force causes a
vertebral body to collapse.Trauma (fall) is s cause although
VCF is often associated with osteoporosis, a disease causing
loss of bone mineral density and strengh.

4- Lumbar Spinal Stenosis (LSS)

 bone and/or tissue to grow into nerve pathways Spinal stenosis
in the low back develops when nerve root passageways and/or
the spinal canal narrow. The term stenosis means narrow. When
nerve structures are compressed the dominate symptom is pain;
and pain can radiate into one or both legs (sciatica). LSS usually
affects older adults and can be associated with degenerative
changes that cause or compress the spinal canal.

Causes

5- Spinal Osteoarthritis (Spondylosis)

Spondylosis is the medical term for degenerative spinal
osteoarthritis; common in older adults. Similar to other types of
arthritis, spondylosis can affect the spine’s facet joints—
inflammation, stiffness, pain. It may develop in the neck (cervical
spondylosis), mid back (thoracic spondylosis) and/or low back
(lumbar spondylosis). Spondylosis is part of other degenerative
changes too that cause spinal stenosis and disc herniation.
 6- Spondylolisthesis
When one vertebral body moves forward over the vertebra
beneath, the diagnosis is spondylolisthesis. While the disorder more
commonly affects the lumbar spine, it can occur in the neck. The
diagnosis includes the degree of the vertebral slip. Grade 1 mean the
vertebra has slid forward by ~25% and Grade 5 is a complete slip
(spondyloptosis). Grade 5 may be caused by fracture of the bone that
helps stabilize the position of the vertebral body. Besides pain, that
can be severe, muscle spasms,and sciatic-type symptoms may
develop.

Risk Factors

Anyone can develop back pain, even children and teens. These factors
might put you at greater risk of developing back pain:

 Age. Back pain is more common as you get older, starting around

age 30 or 40.
 Lack of exercise. Weak, unused muscles in your back and
abdomen might lead to back pain.
 Excess weight. Excess body weight puts extra stress on your back.
 Diseases. Some types of arthritis and cancer can contribute to back
pain.
 Improper lifting. Using your back instead of your legs can lead to
back pain.
 Psychological conditions. People prone to depression and anxiety
appear to have a greater risk of back pain.
 Smoking. This reduces blood flow to the lower spine, which can
keep your body from delivering enough nutrients to the disks in
your back. Smoking also slows healing.
 SYMPTOMS

Signs and symptoms of back pain can include:

 Muscle ache.

 Shooting or stabbing pain.

 Pain that radiates down your leg.

 Pain that worsens with bending, lifting, standing or walking.

 Pain that improves with reclining.

 Diagnosis

A complete medical history and physical exam can usually identify any
serious conditions that may be causing the pain.
Imaging tests are not warranted in most cases. Under certain
circumstances, however, imaging may be ordered to rule out specific
causes of pain, including tumors and spinal stenosis. Imaging and other
types of tests include:
X-ray:- is often the first imaging technique used to look for broken
bones or an injured vertebra. X-rays show the bony structures and any
vertebral misalignment or fractures. Soft tissues such as muscles,
ligaments, or bulging discs are not visible on conventional x-rays.
Computerized tomography (CT):- is used to see spinal structures that
cannot be seen on conventional x-rays, such as disc rupture, spinal
stenosis, or tumors. Using a computer, the CT scan creates a three-
dimensional image from a series of two dimensional pictures.
Myelograms:- enhance the diagnostic imaging of x-rays and CT scans.
In this procedure, a contrast dye is injected into the spinal canal,
allowing spinal cord and nerve compression caused by herniated discs or
fractures to be seen on an x-ray or CT scans.

Magnetic resonance imaging (MRI):- uses a magnetic force instead of

radiation to create a computer-generated image. Unlike x-ray, which
shows only bony structures, MRI scans also produce images of soft
tissues such as muscles, ligaments, tendons, and blood vessels. An MRI
may be ordered if a problem such as infection, tumor, inflammation,
disc herniation or rupture, or pressure on a nerve is suspected.
Electrodiagnostics:- are procedures that, in the setting of low back pain,
are primarily used to confirm whether a person has lumbar
radiculopathy.
Bone scans:- are used to detect and monitor infection, fracture, or
disorders in the bone. A small amount of radioactive material is injected
into the bloodstream and will collect in the bones, particularly in areas
with some abnormality. Scanner-generated images can be used to
identify specific areas of irregular bone metabolism or abnormal blood
flow, as well as to measure levels of joint disease.
Ultrasound imaging:-, also called ultrasound scanning or sonography,
uses high-frequency sound waves to obtain images inside the body. The
sound wave echoes are recorded and displayed as a real-time visual
image. Ultrasound imaging can show tears in ligaments, muscles,
tendons, and other soft tissue masses in the back.
Blood tests:- are not routinely used to diagnose the cause of back pain;
however in some cases they may be ordered to look for indications of
inflammation, infection, and/or the presence of arthritis.
 Management
Medications
- Anti-inflammatory medications (NSAID’s)
Diclofenac
meloxicam

- Narcotic Pain Relievers

More effective than NSAID’s
Hydrocodone
meperidine

- Muscle Relaxants
Can decrease pain and improve mobility.
Methocarbamol
Cyclobenzaprine

Surgical Intervention
Surgical interventions for mechanical low back pain (LBP) are the last
choice for treatment.Better results occur with open excisions compared
with percutaneous diskectomies.
 PHYSIOTHERAPY MANAGEMENT

AIMS:-
-To relieve pain.
-TO promote muscle relaxation.
-Relieve swellingh of the part.
-Relieve pressure from neurological structures.

-Teaching patients.

PHYSICAL AGENTS
THERMOTHERAPY
Heat causes vasodilatation there by reducing the muscle ischaemia.

- This decreases the painand relieve the muscle spasm.

- It is also know to act through counter irritation.
Superficial heat:
-This is given through the hydrocollateral packs, infrared rays, heating
pads and whirpools.
-The heat generated by these penetrates only up to the level of
subcutaneous tissues.

Infrared rays:-
The amount of given depend upon the size of the bulb and distance from
the skin.
The duration of therapy is usually 30 min.

Hydrocollator packs:-
This is wrapped into towels and placed on the patient back for 30 min.

Deep heat:-
-The two common mode of deep heat therapy is ultrasound and the short
wave diathermy.

-These to heat structure below the subcutaneous tissue.

SHORTWAVE DIATHERMY
This is known to deeper structure like muscle,ligaments and bones.
-There are two modes,1 is continous (preferred in chronic low back
pain)and other is pulsed mode (preferred during acute pain).
-Though effective other deep heating modality like ultrasound are
preferred over SWD.

ULTRASOUND THERAPY
This penetrate deeper than SWD.
-Though it is used for both acute and chronic pain,it use in acute
condition is not recommended as it is known to cause vasodilatation.
-Usage 20min. at 3 times a week for 3-4 weeks.

TENS (transcutaneous electrical nerve stimulation)

This is effective in relieving both acute and chronic pain.
mode:-2-4 Hz at 50mA pulse rate at 2 pulse/sec. between 30-60 min.
pulse widths.

INTERMITTENT TRACTION
Most popular method of traction
-Here through a mechanical devices weight is applied and released for
short period of time.
-It is very effective as it produces a massaging effect over the spine and
this provide relaxation.
-It is tolerated very well by the patient.
-Intermittent tractin can provide gentle compression and elongation of
collagen fibers, thus augmenting disc heating.
-Flexion should be increases graduallu in the form of isometrics to the
abdominals.

EXERCISE PROGRAM
-Spinal isometric exercises
-Spinal bridging

-SLR
-lumbar rotation stretch
-Spinal flexion
-Spinal extension
-Cat stretch
-Hamstring stretch
-Gluteal stretch
-Quadruped arm/leg raise
-Partial curl
-Side plank
spinal isometric:- spinal exercise is an effective way to built strength
and joint stability.

spinal bridging:-
The basic bridge isolates and strengthens your gluteus (butt)
muscles and hamstrings (back of the thigh).

1. Lie on your back with your hands at your sides, knees bent, and
feet flat on the floor under your knees.
2. Tighten your abdominal and buttock muscles.
3. Raise your hips to create a straight line from your knees to
shoulders.
4. Squeeze your core and pull your belly button back toward your
spine.
5. Hold for 20 to 30 seconds, and then return to your starting position.
6. Complete at least 10 reps.
 SLR:- Exercises may be prescribed to improve mobility of your leg.
Sit or lie down on your back with your legs straight out in front of
you.

1. Bend the knee of your non-operated leg to a 90-degree angle

keeping your foot flat on the floor.
2. Tighten the muscles on your straight leg by trying to contract
your quadriceps.
3. Keep your quad tightened, and then slowly lift the operated leg six
inches off the floor (by contracting the front thigh muscles.)
4. Hold for three seconds.
5. Slowly lower your leg to the floor.
6. Relax and repeat 10 more times.
LUMBAR EXTENSION STRETCHES:-

Prone Press Up: Begin by lying on your stomach with your

elbows bent underneath you and palms flat on the
surface. Keeping your hips and pelvis in contact with the
surface, lift your upper torso off the mat with your arms,
keeping your back muscles relaxed. Only go as high as
you are comfortable. Perform 10 repetitions holding each
one for 10 seconds each, Generally these are good for
individuals who may have a disc herniation. They should
be performed working your way to 30 seconds.

LUMBAR FLEXION STRETCHES:-
Generally, the flexion based stretches are good for those with spinal
stenosis or tightness through the lower lumbar musculature.
Single Knee to Chest: Begin by lying on your back with both knees bent.
Bring one knee up towards your chest. Perform 2-3 repetitions, holding
each one for 15-30 seconds. You may feel a stretch along the lower back
or buttocks area. You may also perform this with both legs up towards
your chest if it is comfortable.
 Cat Stretch:  This stretch can incorporate both an extension and a
flexion component. You may perform either way or just one way if that
is more comfortable for you. On your hands and knees, let your belly sag
towards the table to increase extension through your spine (lumbar
extension picture). To increase flexion through your spine, arch your
back upwards, bringing your spine away from the table (lumbar flexion
picture). You may hold each position for 5-20 seconds and repeat
several times.
Hamstring stretch:-
If you prefer to stretch while lying down, the towel hamstring stretch may
be a good option. To perform this stretch:

 Lie on the floor with one leg flat.

 Tighten the abdominal muscles while lifting the opposite leg, keeping
it straight.
 Wrap a towel or belt around the instep of the elevated leg, using it to
pull the leg back towards you.
 Once a stretch is felt, hold the position for 15 to 30 seconds.
 Switch legs and repeat at least 3 times per leg.
 Gluteal stretch:-
 tart by lying face up on the floor.
 Bring one leg towards the body, so the knee is directly above the
hip.
 Bring the other knee in and place the ankle on the fleshy part of the
opposite knee.
 Turn the knee outwards while keeping it in line with the ankle.
 Place both hands on the back of the thigh and bring towards the
body.
 If your leg starts to shake ease off the stretch slightly.
Lumbar rotation stretch:-
Lumbar rotation can be preformed in a supine position (lying on your
back) keeping your upper extremity fixed and rotating your lower
extremity. It is a twisting motion of your lower trunk area.

lumbar rotation stretch

Quadruped arm/leg raise:-

Sit on your hands and knees on an exercise mat.

The hands are directly beneath the shoulders. The knees are directly
beneath the hips.

The core is tight and the spine is neutrally aligned.

Partial curl:- To start, lie on your back with your knees bent and feet
flat on the floor. Don’t press your neck or lower back to the floor.
Breathe deeply. You should feel comfortable and relaxed in this
position:

 Cross your arms loosely.

 Tighten your abdomen and curl halfway up, keeping your head in
line with your shoulders.
 Hold for 5 seconds. Uncurl to lie down.
 Repeat 2 sets of 10. 
 Side plank:- Core Strength. This pose works your core to a huge
extent. .
 Strengthens Arms and Wrists. Side Plank requires you to balance
on one arm, so this is a great pose for strengthening your shoulders,
wrists, and arms. .
 Strengthens Legs. Side Plank is really a full-body pose.

Improvebalance

PREVENTION

-Promoting weight loss where indicated.

-Performing back strengthening exercises.
-Teaching proper lifting technique.
-Increasing overall physical conditioning.

CASE STUDY – 01

Name- Meenal Gupta

Age/Sex- 22Y/f
Chief Complaint- Pain in lower back
Provisional Diagnosis- Lumbar Strain

CLINICAL EXAMINATION
ON OBSERVATION:-
Body built- Mesomorphic
Posture- Normal
MOA- Independent
Redness- Absent
Swelling- Absent
Gait- Limping Gait (Slightly)

ON EXAMINATION:-
Tenderness- Present (L5-S1)
Spasm- Present (Paraspinal muscles)
ROM- Complete but painfull (spine)
Pain type- Sharp shooting
Pain nature- Continous
Neurological deficit- Absent
Aggravating factor- During forward bending of spine and Prolong sitting
Relieving factor- During rest and on medications
VAS:-

0 1 2 3 4 5 6 7 8 9 10

(0=no pain; 10= pain to death)

MEDICAL HISTORY:-
H/O pain in back x15 days
H/O Jerk x 15 days back
no H/O- DM, HTN
No Surgical history

SPECIAL TEST :-
SLR-(-ve) negative
FABER-(-ve) negative

PHYSIOTHERAPY TREATMENT:-
-SWD at lumbar region
-TENS
-US at tendor point
-Spinal isomertic exercises
-Spinal extension exercise
-SLR
-Spinal bridging exercise

HOME CARE/ERGONOMIC ADVISE &

PRECAUTIONS:-
-Hot fomentation
-Aviod forward bending
-Avoid lifting heavy weight

CASE STUDY – 02

Name- Ashwariya
Age/Sex- 19Y/f
Chief Complaint- Pain in lower back with rediculopathy
Provisional Diagnosis- Lumbar Strain

CLINICAL EXAMINATION
ON OBSERVATION:-
Body built- Ectomorphic
Posture- Normal
MOA- Independent
Redness- Absent
Swelling- Absent
Gait- Normal

ON EXAMINATION:-
Tenderness- Present at (PSIS)
Spasm- Absent
ROM- Complete but painfull
Pain type- Dull ache
Pain nature- Epsiodic
Neurological deficit- Absent
Aggravating factor- During forward bending of spine and prolong
sitting.
Relieving factor- During rest and on medications

VAS:-
0 1 2 3 4 5 6 7 8 9 10

(0=no pain; 10= pain to death)

MEDICAL HISTORY:-
H/O pain in back x10 days
H/O Jerk x 10 days back
no H/O- DM, HTN
No Surgical history

SPECIAL TEST:-
SLR- 600 B/L , L/L
FABER-(-ve) negative

PHYSIOTHERAPY TREATMENT:-
-MHP (Lower back)
-TENS
-US at tendor point
-Spinal isomertic exercises
-Spinal extension exercise
-Spinal bridging exercise
-Knee rolling
-Hamstring stretching

HOME CARE/ERGONOMIC ADVISE &

PRECAUTIONS:-
-Hot fomentation
-Aviod forward bending

-Avoid lifting heavy weight.

CASE STUDY- 03

Name- Chavi Maheshwari

Age/Sex- 55Y/f
Chief Complaint- Pain in lower back radiating to (left) leg
Provisional Diagnosis- Mechanical LBA

CLINICAL EXAMINATION
ON OBSERVATION:-
Body built- Mesomorphic
Posture- Normal
MOA- Independent
Redness- Absent
Swelling- Absent
Gait- Normal

ON EXAMINATION:-
Tenderness- Present (over spinous process)
Spasm- Present (Paraspinal muscles)
ROM- Complete but painfull (spine)
Pain type- Dull ache
Pain nature- Continous
Neurological deficit- Present (left) leg
Hamstring tightness- Present
Aggravating factor- During forward bending of spine and prolong sitting
Relieving factor- During rest and on medications

VAS:-
0 1 2 3 4 5 6 7 8 9 10

(0=no pain; 10= pain to death)

MEDICAL HISTORY:-
H/O pain in back x3 months
H/O- Asthma
No Surgical history

SPECIAL TEST:-
SLR-(+ve) B/L, LT>RT
FABER-(-ve) negative

PHYSIOTHERAPY TREATMENT:-
-MWD at lower back
-TENS
-US at tendor point
-All lower limb stretching
-piriformis
-abductors
-TA + hamstrings
- Pelvic rolling
HOME CARE/ERGONOMIC ADVISE &
PRECAUTIONS:-
-Hot fomentation
-Aviod forward bending

-Avoid lifting heavy weight

CASE STUDY -04

Name- Namtesh
Age/Sex- 40Y/M
Chief Complaint- Pain in lower back
Provisional Diagnosis- Mechanical low back ache

CLINICAL EXAMINATION
ON OBSERVATION:-
Body built- Ectomorphic
Posture- Normal
MOA- Independent
Redness- Absent
Swelling- Absent
Gait- Antalgic

ON EXAMINATION:-
Tenderness- Present at (L4,L5)
Spasm- Present (Paraspinal muscles)
ROM- Complete but painfull (spine)
Pain type- Dull ache
Pain nature- Continous
Neurological deficit- Present (radiating pain left side)
Tightness of hamstring muscles (B/L)
Aggravating factor- During forward bending of spine and prolong sitting
Relieving factor- During rest and on medications

VAS:-

0 1 2 3 4 5 6 7 8 9 10

(0=no pain; 10= pain to death)

MEDICAL HISTORY:-
Patient is having pain since 2 months
H/O - HTN
no H/O- DM, HTN
No Surgical history

SPECIAL TEST:-
SLR-(+ve) (left side)
FABER-(+ve) B/L (L/L)

PHYSIOTHERAPY TREATMENT:-
-SWD at lumbar region
-TENS
-US at tendor point
-Spinal isomertic exercises
-Spinal extension exercise
-SLR
-Spinal bridging exercise

HOME CARE/ERGONOMIC ADVISE &

PRECAUTIONS:-
-Hot fomentation
-Aviod forward bending
-Avoid lifting heavy weight

CONCLUSION

-Effective management of mechanical back pain that must overcome the

bone of its management must begain at the acute phase.
-Recognizing the role of the core stablizers in prevention of recurrence is
crucial to management success.
-Exercise of diverse nature are effective in combating chronicity.
- Proper evaluation is necessary.
-No substitute for healthy lifestyle.

BIBLIOGRAPHY

-Essential orthopedics by J.Maheshwari 3rd edition

-Essential orthopedics an applied physiotherapy by Jayant Joshi
-Textbook of anatomy by Inderbir singh
-Textbook of rehabilition by S.Sundar
-Textbook of therapeutic exercises by Carolyn kisner and Lynn Allen
colby