low back pain

An Important IssueOne of the most common reasons for seeking medical attention, second only to respiratory issues84% of adults will have low back pain at some pointWide variety of approaches for treatmentuggests that optimal approach is unsure!ost episodes are self"limitedome su#er from chronic or recurrent courses, with substantial impact on $uality of life%pidemiologyAlmost any structure in the back can cause pain, including ligaments, &oints, periosteum, musculature, blood vessels, annulus 'brosus and nervesIntervertebral discs and facet &oints most commonly a#ected8(% of those with isolated low back pain do not have a clear locali)ation*sually called +strain, or +sprain, no histopathology, no anatomical location!en and women e$ually a#ectedAge of onset -."(. years%pidemiology/eading cause of work disability in those 0 4( years!ost e1pensive cause of work disability in terms of worker2s compensation!ultiple known risk factors34eavy lifting, twisting, vibration, obesity, poor conditioningDeyo R and Weinstein J. N Engl J Med 2001;344:363-370Coon !at"oanatoi#al Conditions o$ t"e %&'a( )*ineDeyo R and Weinstein J. N Engl J Med 2001;344:363-370Di$$e(ential Diagnosis o$ %o+ ,a#- !ain4istoryAny evidence of systemic disease5Age 6especially 7(.8, h1 of cancer, une1plained weight loss, I9:*, chronic infection:uration;resence of nocturnal pain young age, nocturnal pain and worsening with rest are common in A4istoryAny evidence of neurologic compromise5?auda e$uina syndrome is a medical emergency*sually due to tumor or massive herniation compressing the nerves of the cauda e$uina*rinary retention with over@ow, saddle anesthesia, bilateral sciatica, leg weakness, fecal incontinenceciatica caused bynerve root irritationharpAburning pain down posterior or lateral leg to foot or ankleB can be associated with numbnessAtinglingIf due to disc herniation often worsens with cough, snee)e or performing the 9alsalva4istoryAny evidence of neurologic compromise5pinal stenosis is caused by narrowing of the spinal canal, nerve root canals, or intervertebral foramina!ost commonly due to bony hypertrophic changes in facet &oints and thickening of the ligamentum @avum:isc bulging or spondylolisthesis may also causeCack pain, transient leg tingling, pain in calf and lower e1tremity that is triggered by ambulation and improved with rest?an di#erentiate from vascular claudication through detection of normal arterial pulses on e1am;hysical %1aminationInspection of back and posture 6ieD coliosis, kyphosis8