57 Backache: Chronic Low Back Strain and Pain 22 Definition Pain usually caused by weakening or stretching of the muscles and ligaments in the lum- bosacral area. Caused by a variety of conditions and often associated with lifestyle factors including overall level of physical fitness, lumbar mobility, lumbar strength, tobacco use, non-work physical activities, past history of low back disorders, poor posture, body mechan- ics, conditioning, stress, repetitive use, pregnancy, and obesity. An injury, usually to the lower back, can be caused by trauma, heavy lifting, poor lifting techniques, twisting or trip- ping, awkward musculoskeletal alignment or postures, and sitting or standing for long peri- ods of time. Degenerative changes of the spine with aging also can produce low back pain. Low back pain may result from musculoskeletal disturbances such as spina bifida and spondylolisthesis, but also can be caused by kidney disorders, pelvic problems, retroperi- toneal tumors, abdominal aneurysms, and psychosomatic problems. Pain related to muscu- loskeletal dysfunction will increase with activity. Jobs requiring frequent lifting of objects weighing 25 pounds or more seem to be associated with an increase in risk, as are sudden, unexpected maximal lifting efforts. Low back pain is among the most common health complaints among working-aged popula- tions around the globe, ranking second to respiratory illnesses as a symptom-related reason for visits to a physician. In the United States, 70–80 percent of adults will experience a significant episode of low back pain at least once in their lives. Data from the National Health Interview Survey indicate that there are over 22 million cases of back pain annually in the United States that last 1 week or more, resulting in almost 150 million lost workdays. Although common, low back pain is usually a benign condition. Only a small fraction of back pain episodes involve nerve root impingement and even for those cases the natural history favors recovery. Nonetheless, low back pain is a major cause of disability, limitation of activity, and economic loss (Evanoff, 2005). Characteristics If acute, mild to moderate pain extending over a wide region of the low back and related to a specific event or injury occurs. If chronic, manifestations range from mild discomfort over a region of the lower back to chronic debilitating pain. Other signs include an altered gait and preference for “good” side. The pain can radiate along the sciatic nerve. Policy Evaluate thoroughly and carefully in the occupational health unit any employee with symp- tomatic chronic low back pain. Refer for medical evaluation, and monitor to ensure effective treatment. Ensure that prevention programs for all employees are an integral component of the health and safety program. Objectives Clinical Assessments and Interventions Referral for Medical Action Any change or increase in pain not relieved by previously successful treatment. Severe and/or disabling pain. Sciatica. Potentially serious conditions (e.g., fractures, tumors, infection, or neu- rological compromise) requiring di- agnostic examination by bone scan, Determine extent of injury or problem. Obtain an accurate history. Conduct a back assessment, including straight-leg raises, gait, range of motion, and the like. Check for splinting, spasms, restricted motion, pain production, foot drop, and straight leg raising. Determine if there is leg pain or bowel or bladder symptoms. Guideline continues on next page
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