acuteLBP≠chronicLBP

LOWBACKPAIN

• acutetissuetrauma• self-limiting• stayactive,bepositive

• dysfunctioninnervoussystem• long-lasting• multidisciplinaryinterventions

genetic

psychosocial

What causesbackpain? SEGMENTALINSTABILITY

DISCOGENICPAIN

FACETOGENICPAIN

SOFT-TISSUERELATEDUNKNOWNCAUSE

CHRONICLOWBACKPAIN

SEGMENTALINSTABILITY

DISCOGENICPAIN

FACETOGENICPAIN

SOFTTISSUE/UNKNOWNCAUSE

CHRONICLOWBACKPAIN

What causesbackpain?

DISEASE DIAGNOSISsymptomsandsigns

Hx,Ex&Ix

TREATMENTCUREdirectedatpathology

THEMEDICALMODEL

DISEASE DIAGNOSISsymptomsandsigns

Hx,Ex&Ix

functionaloverlay

15%normaldegenerative processvspathology

notdiscreteillness

THEMEDICALMODEL

USUALNONOPERATIVETREATMENTSGENERALLYINEFFECTIVE

CHRONICLOWBACKPAIN

multidisciplinaryapproach

SEGMENTALINSTABILITY

DISCOGENICPAIN

FACETOGENICPAIN

SOFTTISSUE/UNKNOWNCAUSE

CHRONICLOWBACKPAIN

What canwetreat

surgically?

DECISIONWHETHERTOOPERATEISDIFFICULT

surgeryisnotuniversallyeffective

DEGENERATIONDOESNOTALWAYS

EQUALPAIN

incidenceofdegenerativechangesonx-raybackpainpopulation=normalpopulation

CHRONICLOWBACKPAIN

• 38yearoldfemale• 18/12ofworseninglowbackpain• Conservativetreatmentforpastyear• Simpleanalgesics• Flaresofbackpainbecomingmorefrequent• Fit,activelifestyle• Recentlyceasedrunningandregularsport• Workingbutwithdifficulty• NoWorkCover/legalclaim

• Mildrestrictionofforwardflexion• Normalneurologicalexamination

• 76y.o.retiredfarmer• Longhistoryofmildbackache• Recentchangewithsharp,catchingleft-sidedbackpain

• Vaguelegdiscomfortcausingnofunctionallimitations

• Tenderleftlowback• Painonhyperextension• Noneurologicaldeficit

• 32yearoldmanualworker• Suddenbackpainwithrepetitivelifting• Offworksinceinjury,9monthsago• WorkCoverclaim,consideringlitigation• Highnarcoticintake• Spendsmajorityoftimeinbed,resting

• VeryrestrictedROMinalldirections• Markedabnormalillnessbehaviour