Causes of Low Back Pain –

1. Mechanical or Activity Related Causes:

i.Degenerative Changes of Disc

ii.Soft tissue injury, disorder or strain

iii.Herniated Disc

iv.Vertebral body fractures

v.Spinal Canal or recess stenosis

vi.Spondylosis

2.Systemic Disorders

i.Primary or metastatic neoplasm

ii.Osseous, discal or epidural infection

iii.Inflammatory spondyloarthropathy

iv.Vascular disorders – atherosclerosis or vasculitis

3.Neurologic Syndromes

i.Myelopathy

ii.Lumbosacral plexopathy – from Diabetes mellitus

iii.Mononeuropathy

iv.Myositis and metabolic causes

4.Referred pain

i.GI disorders

ii.Genitourinary disorders – infections of renal tract

iii.Hip pathology

iv.Psychosocial causes

v.Psychiatric syndromes – delusional pain

vi.Drug addiction

vii.Abusive relationships

Management of Low Back Pain

A.In cases of evidence for improvement

i.Advise to stay active and continue usual activities

ii.Non Steroidal Anti Inflammatory Drugs

iii.Physiotherapy in the first 4-6 weeks only.

B.In cases of evidence of no improvement

i.Bedrest for more than 2 days

ii.TENS

iii.Traction

iv.Specific Back Exercises

v.Educating about low back symptoms

C.In cases of some improvement in clinical outcome

i.Conditioning exercises for trunk muscles

ii.Aerobic conditioning

iii.Epidural steroid injections

iv.Acupuncture

v.Shoe lifts

vi.Lumbo-sacral corsets

vii.Physical Modalities – Icing – Cryotherapy, Heat, Shortwave Diathermy, Ultrasonic therapy.