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    Materi Dr. Ibrahim Agung, SPKFR

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    Ghea Putri Hendriani
    Low back pain is a common musculoskeletal problem, especially among workers due to ergonomic stressors. It can be caused by structural, biomechanical or neurological factors. Comprehensive rehabilitation management includes finding the source of pain, medication, exercises, orthotics, physical modalities or manipulation, and surgery if conservative treatments fail. The goal is to help patients stay active, prevent disability, and recover quickly from this work-related disorder.

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    Materi Dr. Ibrahim Agung, SPKFR

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    Ghea Putri Hendriani
    70 views30 pages
    Low back pain is a common musculoskeletal problem, especially among workers due to ergonomic stressors. It can be caused by structural, biomechanical or neurological factors. Comprehensive rehabilitation management includes finding the source of pain, medication, exercises, orthotics, physical modalities or manipulation, and surgery if conservative treatments fail. The goal is to help patients stay active, prevent disability, and recover quickly from this work-related disorder.

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    Materi dr. Ibrahim Agung, SpKFR

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    Low back pain is a common musculoskeletal problem, especially among workers due to ergonomic stressors. It can be caused by structural, biomechanical or neurological factors. Comprehensive rehabilitation management includes finding the source of pain, medication, exercises, orthotics, physical modalities or manipulation, and surgery if conservative treatments fail. The goal is to help patients stay active, prevent disability, and recover quickly from this work-related disorder.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    70 views30 pages

    Materi Dr. Ibrahim Agung, SPKFR

    Uploaded by

    Ghea Putri Hendriani
    Low back pain is a common musculoskeletal problem, especially among workers due to ergonomic stressors. It can be caused by structural, biomechanical or neurological factors. Comprehensive rehabilitation management includes finding the source of pain, medication, exercises, orthotics, physical modalities or manipulation, and surgery if conservative treatments fail. The goal is to help patients stay active, prevent disability, and recover quickly from this work-related disorder.

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    of 30

    Rehabilitasi Komprehensif:

    Nyeri Punggung Bawah pada


    Pekerja

    KSM Kedokteran Fisik dan Rehabilitasi, Akupunktur Medis


    dr. Ibrahim Agung, SpKFR dan Kedokteran Okupasi
    RSCM
    Overviews

    • Definition of low back pain


    • Causes of Back pain
    • Red Flag in low back pain
    • Yellow Flag in low back pain
    • Finding ‘Source of Pain’ & Possible Cause of Back Pain
    • Comprehensive management
    • Conclusion
    Low Back Pain
    • Most commonly reported musculoskeletal problem
    • Prevalence as high as 84%
    • Low back pain is a symptoms
    • Back pain is defined as chronic or acute pain, pain in the lumbar or
    buttock area, between costal margin and gluteal folds, or in the
    upper leg region  major work-related disorder
    • Major problem  disability, poor services, sickness absences

    Wami et al., Work-related risk factors and the prevalence of low back pain among low wage workers: results from a cross-sectional study. BMC Public Health. 2019. 19:1072; Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 711-712
    Low Back Pain
    • Related to
    • Ergonomic stressors at work
    • Environmental
    • Psychosocial
    • Personal risk factors

    • Most patients have short attacks of pain that are mild or moderate
    and do not limit activities, but these tend to recur over many years 
    10-15% becomes chronic pain

    Wami et al., Work-related risk factors and the prevalence of low back pain among low wage workers: results from a cross-sectional study. BMC Public Health. 2019. 19:1072; Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 711-712
    Causes of Back Pain
    Referred
    Mechanical Neurogenic Non-Mechanical Visceral Pain

    • Vertebral • Herniated • Neoplastic • GIT disease


    fracture Disc • Inflammatory • Renal
    • Spondylosis • Cauda LBP disease
    equina
    syndrome

    Steven P Cohen, Charles E Argoff, Eugene J Carragee.Management of Low Back Pain. BMJ Jan 2009 Vol. 338.
    Red Flag

    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 719


    Yellow Flag

    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 719


    Source of Back Pain
    • Structural problems

    • Biomechanical changes

    • Abnormalities/ postural
    misuse/injury to tissue  tensional
    balance changes  stress on
    muscle contraction & surrounding
    tissue

    Scarr, Graham. Biotensegrity: the structural basis of life. 2014. 11; https://www.physio-pedia.com/Thoracolumbar_Fascia; Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 715-716
    Assessment
    • History taking:
    • Location • Onset • Frequency • Cancer
    • Severity • Duration • Signs of infection
    • Timing • Alleviating and • Fracture
    aggravating factors

    • Physical examination: • ROM • Postures • Stability test

    • Supportive findings: Imaging, EMG-NCV

    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 718-743


    • Movement analysis  ask either pain
    is increasing/ decreasing with specific
    movement  pain stimulation

    • The lower back is an anatomically


    diverse set of structures  many
    potential sources of pain

    • The degree of flexion of the lumbar


    spine affects the size of the
    intervertebral foramina and vertebral
    canal  potential for deforming the
    nucleus pulposus

    rd
    Neumann, Donald A. Kinesiology of the Musculoskeletal System 2 nd edition. Cahp 32 : 688-697
    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 720-728
    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 720-728
    Possible Causes of Back Pain
    Possible Causes of Back Pain

    Neumann, Donald A. Kinesiology of the Musculoskeletal System 3rd edition. 3 : 365-366.


    Possible Causes of Back Pain
    Possible Causes of Back Pain

    • Impaired muscle support / weak back


    muscle  causing pain

    • Weak back muscles  compensated


    by quadratus lumborum muscle 
    impaired muscle  Low Back Pain (QL
    Pain)

    Sions et al. 2017. Trunk muscle characteristics of the multifidi, erector spinae, psoas, and quadratus lumborum in older adults with and without chronic low back pain. Journal of orthopaedic & sports physical therapy. 47(3):173-179
    Asha Satish Barge, Satish Mahadeo Barge. Qudaratus lumborum: one of the many significant causes of low back pain. Indianjpain 2018 32(3): 184-186
    Management of LBP
    • Most patients have • Medications
    spontaneous recovery within 3 • Exercise to prevent deconditioning
    weeks
     stretching and strengthening
    • Physical Modalities/Manipulation/
    • Being active as normally as Manual Mobilization
    possible  quicker recovery
    and lead to less disability Multiple therapies
    • Orthosis

    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 718-743


    Treatment
    • Medicine
    • NSAIDs
    • Muscle relaxants
    • Antidepressants
    • Opioids
    • Anticonvulsants
    • Topical treatments
    • Exercises, Manipulations
    • Orthosis
    • Invasive therapy:
    • Steroid injections
    • Acupuncture

    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 718-743


    Exercises
    • 30 min of moderate aerobic, 5x/
    week
    • Regularly exercise
    • Lumbar stabilization programs 
    strengthening abdominal, low back,
    hip muscles, increasing flexibility
    • Yoga
    • Pilates
    Exercises
    Physical Modalities/Manual Mobilization /
    Manipulation
    • Traction
    • TENS
    • Massage
    • Laser
    • Diathermy
    • ESWT (Extra Corporeal Shockwave
    Therapy)

    Braddom. Physical Medicine& Rehabilitation. 5th edition. Chap 13: 276, 283; Chap 33: 718-743
    Manual Mobilization / Manipulation
    • Alexander tech: educational approach to
    posture and normalizing movement
    patterns

    • Feldenkrais method: combination of


    classes and hands-on work with
    therapeutic exercise to promote natural
    and comfortable movement patterns
    and improve body awareness.

    Braddom. Physical Medicine& Rehabilitation. 5th edition. 33: 718-743


    Orthotic consideration

    LSO Corset LSO Brace

    Cuccurullo. Physical medicine and rehabilitation board review. 3rd edition. 6 : 541-547; Braddom. Physical Medicine& Rehabilitation. 5th edition. 13: 281-2
    Orthotic Consideration

    Cuccurullo. Physical medicine and rehabilitation board review. 3rd edition. 6 : 541-547; Braddom. Physical Medicine& Rehabilitation. 5th edition. 13: 281-2
    Interventional Pain Management
    • Selective nerve root block
    • Medial Branch block
    • Facet joint injection
    • Sciatic nerve block
    • Piriformis injection
    • Transforaminal block
    • RFA (Radio Frequency Ablation)
    • PLDD (Percutaneous Laser Disc Disectomy)
    When to undergo surgery?
    • Persistent and severe sciatic pain
    • Disc Herniation
    • Cauda equina syndrome
    • Progressive and severe neurologic deficits
    Initial
    Management
    Pre and
    Source of
    Post
    Pain
    Surgery

    Working and
    Biomechanical
    IPM Comprehensive Change/Modific
    Rehabilitation ation
    Management

    Exercise Medication

    Therapeutic
    Orthotic
    Modality
    Conclusion
    • Low back pain is a symptoms
    • Work-related disorder esp. ergonomic stressors
    • Can cause limitation  10-15% becomes chronic pain
    • Know the signs (red or yellow flag)
    • Being active as normally as possible despite the pain
    • Seek for help !
    • Do some stretching/ exercises
    THANK YOU

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