This document discusses mechanical low back pain, defining it as pain originating from the spine that may be acute or chronic. It describes potential causes like nerve root impingement from herniated discs, musculoskeletal pain syndromes involving the muscles, and skeletal issues. Treatment options discussed include bed rest and light exercise, medications like NSAIDs, chiropractic/osteopathic manipulation, massage, and physical therapy modalities.

1. MECHANICAL LOW BACK PAIN
FAIQ AQLI RAZALI (46)
AIZAT RUSLIN (42)
MUHAMMAD FAHMI (84)
MUHAMMAD HANIF (69)

2. Definition
 Low back pain originating from the disc, vertebral
body, or posterior elements or might be unrelated to
the spine.
 A common musculoskeletal symptom that may be
either acute or chronic.

3. Pathogenesis/ Pathophysiology
 Many causes of mechanical low back pain exist.
 Musculoskeletal causes:
1) Nerve root syndromes
2) Musculoskeletal pain syndromes
3) Skeletal causes

4. Nerve Root Syndromes
 Classic nerve root syndrome is
characterized by radicular pain
arising from nerve root
impingement due to herniated
discs.
 Impingement pain tends to be
sharp, well localized, and can
be associated with
paresthesia, associated with a
positive straight leg raising
sign

5. Nerve Root Syndromes
 Impingement syndrome is most commonly herniated
discs, but it may also be caused by spinal
stenosis, spinal degeneration, or cauda equina
syndrome.

6. Musculoskeletal Pain Syndromes
 Musculoskeletal pain syndromes that produce low
back pain include:
 Myofascial pain syndromes
 characterized by pain and tenderness over localized areas
(trigger points), loss of range of motion in the involved muscle
groups, and pain radiating in a characteristic distribution but
restricted to a peripheral nerve.

7. Musculoskeletal Pain Syndromes
 Fibromyalgia
 Pain and tenderness on palpation of 11 of 18 trigger
points, one of which is the low back area, Generalized
stiffness, fatigue, and muscle ache are reported.

8. Skeletal Causes
 Osteomyelitis
 Infectious processes involving the
bones of the spine.
 Sacroiliitis
 Inflammatory changes in the sacroiliac
joints.
 Malignancy
 Primary or metastatic

9. Differential Diagnoses
 Aneurysm, Abdominal
 Appendicitis, Acute
 Ectopic Pregnancy
 Endometriosis
 Neoplasms, Spinal Cord
 Ovarian Cysts
 Pelvic Inflammatory Disease
 Perirectal Abscess
 Prostatitis
 Renal Calculi
 Urinary Tract Infection, Female
 Urinary Tract Infection, Male

10. Acute Mechanical Low Back Pain
 Most commonly caused by a sprain or muscle tear.
 The pain is usually localized, and there may be
muscle spasms or soreness.
 The patient usually feels better when resting.

11. Chronic Mechanical Low Back Pain
 Caused by chronic strain on the muscles of the lower
back may be caused by obesity; pregnancy; or job-
related stooping, bending, or other stressful
postures.

12. Treatment of Mechanical Low Back Pain

13. Bed Rest & Exercise
• One or two days of bed rest if necessary
• Advice to stay active:
– ‘There is no evidence that advice to stay active is
harmful for either acute low back pain or sciatica.’
– Hurt does not equal harm
• Light activity, avoiding heavy lifting, bending
or twisting (ie. walking)
• No data on any particular exercises

14. Medications
• Anti-inflammatory medications (NSAID’s):
– Beneficial (relief pain) , watch side-effects
• Narcotic Pain Relievers:
– More effective than NSAID’s
– Many side effects
• Muscle Relaxants (ie. Flexeril®):
– Can decrease pain and improve mobility
– 70% with drowsiness/dizziness

15. Chiropractic/Osteopathic
• Spinal manipulation
• Conflicting evidence on the effects of spinal
manipulation
– ~75-90% improvement anyway within 4 weeks
• Greater patient satisfaction

16. Massage & Physical Therapy
1. Might be beneficial
2. Physical therapy modalities:
TENS, ultrasound, hot packs, massage

17. THANK YOU