Low Back Pain

Introduction

             

Low back pain (LBP) is the sixth most prevalent reason for doctor visits and affects around 50-75% of people at some point in their lives. According to some research, up to 23% of the world's adults suffer from persistent low back discomfort. This group also has a one-year recurrence rate ranging from 25% to 70%. Some estimates of lifetime prevalence in the adult population are as high as 82%. A comprehensive study found an annual rate of 11.8% to 33% of teenagers suffering from back pain. Low back discomfort affects 11-12% of the population.

Depending on the source, there are several meanings of low back discomfort. Low back pain is described as "pain and discomfort situated below the costal margin and above the inferior gluteal folds, with or without leg pain" by the European Guidelines for Prevention of Low Back Pain.  Another description, according to S.Kinkade, which fits the European recommendations, is that low back pain is “pain that arises posteriorly in the region between the lower rib edge and the proximal thighs”. The most frequent type of low back pain is "non-specific low back pain," which is defined as "low back pain that is not ascribed to recognized, known particular disease.

Acute, sub-acute, and chronic low back pain are the three kinds of low back pain. This classification is determined by the length of the back discomfort. Acute low back pain is defined as discomfort lasting less than 6 weeks, subacute low back pain lasting 6 to 12 weeks, and chronic low back pain lasting 12 weeks or longer. [3]

Chronic low back pain is defined as having been present for more than three months. Chronic Low Back Pain accounts for more than 80% of all healthcare expenses. After an acute episode, over one-third of persons seeking treatment for low back pain will experience chronic moderate discomfort for one year. Seven million adults in the United States are projected to be affected.

A new study examined low back pain and its treatment with a lengthy course of antibiotics in a specific demographic. A prior disc herniation, >6 months of back discomfort, and type 1 Modic alterations next to the previous herniation on an MRI scan were required for inclusion. Modic alterations occur when there is edema in the vertebral body. These patients were given antibiotics for 100 days, and there was a statistically significant improvement in their pain levels at the reassessment and one-year follow-up. As a result, this is something to think about in this group. Recent clinical guidelines produced by the NICE in the United Kingdom, the Danish Health Authority, and the American College of Physicians do not include the use of antibiotics in therapy.

Assessment of Low Back Pain

    

The initial goal of a physiotherapy examination for a patient with back pain is to classify the patient based on the diagnostic triage outlined by worldwide back pain guidelines.Serious illnesses (such as fracture, malignancy, infection, and ankylosing spondylitis) and specific causes of back pain with neurological abnormalities (such as radiculopathy and caudal equine syndrome) are uncommon, although screening for these conditions is critical. Serious diseases account for 1-2% of persons who arrive with low back pain, and 5-10% have specific causes of Low Back Pain with neurological deficits. Individuals are considered having non-specific (or basic or mechanical) back pain once significant and specific causes of low back pain have been ruled out.

Non-specific low back pain accounts for more than 90% of patients coming to primary care, and this is also the majority of people with low back pain who seek physiotherapy. The goal of physiotherapy evaluation is to detect deficiencies that may have led to the onset of pain or increase the chance of acquiring chronic pain.

 These include biological (e.g., weakness, stiffness), psychological (e.g., depression, fear of movement, and catastrophist), and social (e.g., work environment) factors. 

The evaluation does not rely on identifying anatomical structures (such as the intervertebral disc) as the source of pain, as it may in peripheral joints such as the knee. Previous studies and international recommendations indicate that identifying the particular tissue source is neither possible nor essential.

Prevention of Low back pain

Prevention is also classified into three types:

Primary prevention

 Is described as "particular approaches for illness or mental disorder prevention in sensitive people or communities." These include health promotion, including mental health; protective actions, such as communicable disease management; and environmental pollution monitoring and regulation. Secondary and tertiary prevention should be separated from primary prevention.

Secondary prevention 

Is described as "the avoidance of recurrences or exacerbations of a previously identified illness." This also involves the avoidance of side effects or problems of medicine or surgical operation.

Tertiary prevention 

is defined as "measures aimed at providing appropriate supportive and rehabilitative services to decrease morbidity and increase the quality of life following the presence of a long-term sickness or injury.

The suggestions go through many ways to avoid low back discomfort. Physical activity is suggested to avoid the repercussions of low back pain, such as missed work and the recurrence of new episodes. Physical activity, in conjunction with regular aerobic training, is very beneficial in training back extensors and trunk flexors. There are no set guidelines for exercise frequency or intensity.  In terms of back school programs, a high-intensity program is recommended for individuals with recurring and chronic low back pain, but not for avoiding low back discomfort. The curriculum includes workouts as well as an educational skills program. Education and knowledge alone, or when combined with the biomechanical model, have a minor impact. In a treatment, education and information are used in conjunction with other treatments.