Lower Back Pain

Low back pain is a pain complaint that often occurs in society and is one of the most common reasons patients come for treatment. Statistics show that 85% of the population has experienced an attack of lower back pain at least once in their life. An estimated 619 million people experience lower back pain, which causes disability, reduced productivity and working hours worldwide due to this condition.

 

Signs and symptoms.

Low back pain can be divided into specific and non-specific pain. Specific low back pain is pain caused by a specific disease or structural problem in the spine. Meanwhile, non-specific low back pain occurs when the pain cannot be identified by a specific disease or structural problem of the spine.

Symptoms of back pain can include dull pain or sharp pain. This can also cause pain to spread to other areas of the body, especially to the lower extremities and can cause a feeling of tingling or numbness. Back pain can be acute (less than 6 weeks), subacute (6-12 weeks) or chronic (more than 12 weeks).

 

Causes and Risk Factors

Causes and risk factors for lower back pain are categorized based on the color of the flags.

●Red flags: problems with biomechanical factors resulting from organ pathology and comorbidities

●Yellow flags: psychosocial and habitual factors such as iatrogenic factors, stress, coping mechanisms, pain behavior, and family support problems

●Occupational blue flags: social and economic factors such as employment status

●Social and occupational black flags: occupational factors in the form of working conditions, social regulations and so on.

 

Patomechanics

Non-specific or mechanical low back pain occurs in almost 90% of cases. Mechanical low back pain occurs intrinsically from the spine, intervertebral discs, or surrounding soft tissues. This occurs because the lumbosacral spine is strongly supported by the hip bones in carrying out its main function of maintaining the upright position of the human body. The spine functions as the only pillar that maintains the body's weight in an upright position, but often the concentration of body mass is quite far in front of the spine. This situation causes the spine to have to make mechanical adjustments so that the forces acting are not too large, where the normal shape of the spine from the cervical to the lumbar region is in the form of a Lordotic - Kyphotic - Lordotic curvature.

Another mechanical consequence is that the center of human body weight is in the lumbosacral area so this area needs to be strengthened by very strong structures, namely ligaments, muscles and also the bones themselves. The most common mechanical causes of low back pain are excessive stress on these structures due to poor posture, excess weight, sitting too much, weakness and shortening of the muscles that support the spine and improper positioning of the pelvic bones.

In this case, rehabilitation therapy is essential to help patients return to their activities, supporting recovery and improving function.

 

Treatment and Management

Treatment for lower back pain depends on the nature of the pain and whether the pain is specific or non-specific. For specific low back pain, treatment management focuses on the underlying condition causing the pain.

Treatment for non-specific low back pain includes:

●physical therapy to increase muscle strength and ability to move and continue physical activity

●psychological and social support to help manage pain and return to activities

●reduces tension during work and physical activity

●lifestyle changes, including more physical activity, a healthy diet and good sleep habits.

 

Conclusion

Low back pain is a complaint that often makes patients seek treatment. Patients tend to come to the doctor because their complaints are unbearable. A specialist in physical medicine and rehabilitation will assess and carry out specific examinations to identify the source of the pain. Therapy will be carried out according to the source and what problems occur in the patient's condition, so the treatment for each patient will of course be different depending on his condition.

 

 

Reference

1. Wiltberger Br. Low back pain. Vol. 52, Ohio medicine: journal of the Ohio State Medical Association. 2023. p. 35–9.

2. Low back pain. - PMC [Internet]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2572532/

3. Will JS, Bury DC, Miller JA. Mechanical low back pain. Vol. 98, American Family Physician. 2018. p. 421–8.