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Lumbar Spine

Low back pain (LBP) is the fifth most common reason for physician visits, which affects nearly 60-80% of people throughout their lifetime. The lifetime prevalence of low back pain is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with 11-12% of the population being disabled by low back pain.

There are different definitions of low back pain depending on the source. According to the European Guidelines for prevention of low back pain, low back pain is defined as “pain and discomfort, localized below the costal margin and above the inferior gluteal folds, with or without leg pain”[2]  Another definition, according to S.Kinkade, which resembles the European guidelines is that low back pain is “pain that occurs posteriorly in the region between the lower rib margin and the proximal thighs”.[3]  The most common form of low back pain is the one that is called “non-specific low back pain” and is defined as “low back pain not attributed to recognizable, known specific pathology”[2].

Low back pain is usually categorized in 3 subtypes: acute, sub-acute and chronic low back pain. This subdivision is based on the duration of the back pain. Acute low back pain is an episode of low back pain for less than 6 weeks, sub-acute low back pain between 6 and 12 weeks and chronic low back pain for 12 weeks or more.[2]

Low back pain that has been present for longer than three months is considered chronic. More than 80% of all health care costs can be attributed to chronic LBP. Nearly a third of people seeking treatment for low back pain will have persistent moderate pain for one year after an acute episode[4][5][6]. It is estimated that seven million adults in the United States have activity limitations as a result of chronic low back pain[7].

A fairly recent study looked at low back pain and the treatment with a long course of antibiotics in a certain population. The inclusion criteria was a previous disc herniation, >6 months back pain and type 1 modic changes adjacent to the previous herniation on MRI scan. Modic changes are where oedema is present in the vertebral body. These patients were treated with 100 days of antibiotics and at reassessment and 1 year follow up there was a statistical significant improvement in their pain levels. Therefore this is potentially something to consider in this population.

from physiopedia http://www.physio-pedia.com/Low_Back_Pain

 

Anatomy and Neurology Review

Lumbar Examination

  • I rarely use this method and prefer the eyeball or using a measurement from the floor

Low Back Pain Guidelines

Lower Extremity Cutaneous Innervation

Protocols

Lumbar Fusion - TMI Spinal Specialists

Lumbar Discectomy - Rehab 3

Lumbar Total Disc Replacement - M6  * limited resources at this time, MD dependent

Lumbar Laminectomy - Dr. Jenkins

Common Surgical Videos

Other Great Resources and Articles:

Better Core Training - Stuart McGill

Low back Pain in Young Athletes - Laura Purcell, MD and Lyle Micheli, MD

Is it Time to Stop Inappropriate Imaging - Ben Darlow, Bruce B Forster, Kieran O’Sullivan, Peter O’Sullivan

Anatomy, Biomechanics and Pathology of the Lumbar Spine - Beth K. Deschenes, PT, MS, OCS

Waddell Signs for Malingering Symptoms