Lower back pain - Deferential diagnosis

LBP is a disorder affecting the soft tissues (muscles, nerve, and ligament] bone and articulation of the lumbar, sacral and coccyx area) the pain varies between, dull aching, gradual onset, and sudden onset. Most LBP is troublesome but not progressive, not life-threatening, but at the same time, it is important to identify those who have a serious case of LBP (RED FLAG) which require specific, rapid and skillful examination, diagnosis and treatment

Some example of the red flag cases is

- back pain associated with fever, nausea, fatigue, diarrhea, and loss of weight

- back pain with bladder and bowel dysfunction

- back pain with progressive lower limb muscles weakness and wasting

- persistent pain not related to activity

Types of LBP

Mechanical and postural LBP which represent more than 95% of the cases which includes

1. Lumbar muscles strain and ligaments sprain

more common in young active people mostly due to

· sudden, fast or forced change of movement,

· wrong lifting of a heavy object or trying to over lifting

· poor carrying and pushing technique

· it’s also common in the last stage of pregnancy and frequent pregnancy

· disc-related work with long sitting and standing with poor ergonomic facility

2. Degenerative disc and facet joint

which are more age-related disorders but it can be predisposed by

· Work and activity which requires multiple and frequent impacts

· Repeated loaded hyperextension and hyperflexion activity, such as big vehicle driver, road drilling worker, cross country runner, and cyclist, gymnastic and weight lifter

3. Bulged and herniated disc

4. Lumbar spinal stenosis LSS

· Which is common after the age of 50, compresses the nerves and blood vessels at the level of the lumbar vertebrae, Lumbar spinal stenosis can cause pain in the low back or buttocks, abnormal sensations, and the absence of sensation (numbness) in the legs, thighs, feet, or buttocks

5. Spondylolisthesis,

· Forward slipping of the vertebra above over the vertebra below

Congenital disease

· lordosis

· kyphosis

· scoliosis

Non-mechanical spinal related LBP

· Ankylosing spondylitis

· Psoriatic spondylitis

· Scheuermann’s Disease

· Paget’s Disease

· Septic Arthritis

· Osteomyelitis

· Carcinoma

· Lamour’s

· Lymphoma and leukemia

Visceral Related LBP

· Prostatitis

· Chronic Pelvic inflammation

· Renal Disease

· Pancreatitis

· Cholecystitis

Stay tuned for our follow-up explaining mechanical LBP and applied physiotherapy of each case and the role of DBC technique in LBP management