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B Back Pain Low Back Pain (LBP) is one of the most prevalent health problems in our society and is the cause of considerable disability, use of health services and lost work hours (1). It has been estimated that LBP affects 60% to 85% of the population at some point in their lives (2,3) and up to 15%-30% of the population at any given time (1). During any six month period 72% of adults in the general population will report LBP (1), and 8% of the working population will be disabled in any given year resulting in 40% of all total lost work days (3). LBP is the second most common cause of medical consultation (4,9).
Most episodes of LBP will be short-lived with 80%-90% of episodes resolving within 6 weeks (3). However, high recurrence rates have been reported; with between 60% and 86% of LBP patients experiencing a recurrence of pain within one year. (2,8).
LBP is a multifactorial disorder with many possible causes. Factors such as heavy physical strain, repetitive lifting, poor posture, age, gender, obesity, static positioning, previous history, physical fitness and genetics have all been mentioned as risk factors (2,3). Additionally, many anatomical structures can contribute to LBP including muscles, joints, nerves, discs, tendons and ligaments.
Treatment for LBP varies considerably. Health care practitioners often prescribe a generalized exercise program for the treatment of LBP. There is, however, strong evidence from the literature that a combined physical therapy approach consisting of manual therapy, specific muscle training and education is effective in producing functional and symptomatic improvement in acute and chronic LBP (4-10). Indeed, physical therapy including a specific evaluation of individual characteristics such as posture, strength and flexibility and a tailored exercise program, has been shown to be more effective than a generalized exercise program (5,8,9,10). Furthermore, patients who were given tailored exercise programs experienced fewer recurrences of LBP. One year after treatment recurrence was 30% in individuals who were given specific exercises versus an 84% recurrence in those given only advice and medication (control group). Two to three years after treatment, recurrence in the specific exercise group was 35%, while the control group was 75%.(8) Bunion (Hallux Valgus) A bunion is an enlargement of the tissue and bone around the joint at the base of the big toe. As this progresses over time, it forces the big toe toward the second toe. Some causes are: inefficient foot biomechanics like excessive pronation, "bad" shoes, etc. There may be an inherited tendency. (A Tailor's Bunion is similar, but at the base of the little toe.) It is often quite painful, with redness and swelling. Other medical conditions need to be ruled out, such as gout, rheumatoid arthritis, infection, among others. Treatment is always conservative initially: supportive shoes, pads, orthotics, etc. Physical therapy may be of help. The last resort is always surgery, done by an orthopedic surgeon or a podiatrist (DPM). Bursitis A bursa is a sac-like structure that cushions soft tissue (like tendon) against bone. Bursae are lined with synovial cells that secrete a lubricating fluid. It can be traumatized by a direct blow/fall or can be irritated by overuse. Many joints have bursae. In the shoulder, the Subacromial bursa is commonly painful. In the knee, it is the Pre-patellar and the Pes Anserine bursae; in the ankle, the Retrocalcaneal bursa. When irritated, the bursa fills with inflammatory cells. The treatment is always conservative: identify and stop the provoking factors, optimize the biomechanics and muscles around the joint, daily icing and anti-inflammatory medication where prescribed. A Physical Therapist can help with this condition, by prescribing stretches, strengthening exercises and modalities. Very rarely is surgery considered. (Trochanteric) Bursitis This is an inflammation of the bursa on the outer side of the hip joint. The pain can radiate down the outer side of the thigh. A fall or direct blow can be causative, but it is often a repetitive friction condition of the Iliotibial Band (ITB). It is often seen in runners. There may be biomechanical factors involved. A physical therapist can demonstrate the proper stretches and selective strengthening exercises to balance the mechanical forces around the hip. Modalities may prove helpful. As a last resort, a surgeon can be consulted to consider, among other alternatives, a cortisone shot.
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