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| Division of Occupational Therapy - OT Connect Low Back Injury
Low Back Injury/Low Back Pain (LBP). Low back injury is a musculoskeletal problem caused by a number of disorders and diseases associated with the lumbar spine and often presents with sciatica (i.e. “pain that involves the sciatic nerve and is felt in the lower back, the buttocks, and the backs of the thighs”) (Frey, 1999). Common Symptoms/ Course of Disease Low back injuries are characterized by four different types of pain:
Furthermore, LBP may be either acute or chronic.
Age of Onset: This diagnosis most commonly presents during adulthood, specifically between the ages of 25-55 years (Pedretti, 1996). Sex Bias: LBP is highly prevalent and may potentially affect everyone at some point during his or her lifetime. There is no sex bias as men and women are equally affected (Saunders, 1990). Cultural Biases/Ethnic Differences: There are no documented trends pertaining to culture or ethnicity; however, individuals who practice poor postural habits, improper body mechanics, faulty work habits or lose flexibility and fail to maintain good health/ physical fitness are more prone to develop low back problems (Saunders, 1990). Current Medical Treatment: A thorough doctor’s evaluation including a client interview and physical examination is typically the initial procedure. The evaluation should include a review of medical history, symptoms, and functional limitations. Clinical observation of “posture, gait, trunk mobility, strength, reflexes, and sensation” and palpation are also conducted (Pedretti, 1996). Imaging studies and related diagnostic tests are only ordered if symptoms suggest more than muscle strain or overuse and if acute management techniques are unsuccessful (Frey, 1999). These must be performed by a specialist, often a neurosurgeon or orthopedist. Such tests include: x-rays, magnetic resonance imaging (MRIs), computerized tomography (CTs), discograms, myelograms, bone scans, nerve conduction velocities (NCVs), or electromyographs (EMGs) (Pedretti, 1996). All treatments are aimed to relieve symptoms or prevent hindrances to the healing process.
Occupational Therapy Involvement When relief is not achieved through acute measures, the primary care physician may refer the client for occupational therapy services. OT evaluation includes a review of medical history and symptoms, observation, and physical assessment. OT assessment determines the effect of the injury on functional abilities, activities of daily living, and work-related tasks or if pre-existing factors such as faulty body mechanics and postures may have facilitated the problem. Actual observation of tasks in real or simulated environments is ideal to target functional limitations or problem areas (Pedretti, 1996). As with other diagnoses, the main goal of OT treatment is for the client to achieve their maximum potential with functional independence. Treatment interventions may include:
Therapy interventions are based on the biomechanical approach and occupational performance frame of reference. Biomechanical concerns include the strength, endurance and physical dysfunction aspects of low back injury rehabilitation. The occupational performance model in a sense defines occupational therapy practice. Also, the OP model concentrates on performance areas and components, an integral focus of treatment. Other Low back pain is currently the leading cause of disability for individuals between ages 19 and 43 in the United States, and is the second most common reason for Americans to visit their physician next to the common cold (Pedretti, 1996). LBP is rarely caused by only one accident, injury, incident, or other contributing factor. The pain normally occurs as a result of cumulative problems or repetitive stress. The most common back disorders are:
osteoarthritis (Saunders, 1990) Other less common back disorders include: “facet joint locking, joint instability, traumatic fractures, stress fractures, compression fractures, tumors, sacroiliac sprains, coccyx fractures or sprains, inflammation, and/or disease and illness elsewhere in the body” (Saunders, 1990). References
How OT Makes a Difference: Evidence-Based Practice Guzman,J. et.al. (2001). Multidisciplinary rehabilitation for chronic low back pain: systematic review. British Medical Journal. 322: 1511-1516. According to a systematic review of twelve available, randomized controlled trials published up to the year 1998, multidisciplinary treatment ("a minimum of the physical dimension and one of the other dimensions including psychological, social or occupational") of an intensive form (at least one hundred hours of therapy) with functional restoration produces more significant improvements in pain and function for patients dealing with disabling, chronic low back pain than less intrusive therapies. Liebenson, C. (2000). The state of the art - "evidence-based care" from guidelines to practice: What is the new benchmark? Retrieved on-line: http://www.chiroweb.com/archives. This article reviews evidence-based medical literature to outline best practice guidelines for the treatment of low back pain. With acute low back pain patients, a concentration of fitness and the resumption of activities achieved a better outcome than a prescription of rest and relaxation. Graded exercise has been found to reduce long-term disability. With chronic low back pain patients, light activity and exercise have been found to speed recovery times. Patients who received modalities, self-care intervention, and functional reactivation achieved more successful outcomes. Sarkis, K. (2000). Early therapy heals back injuries. Occupational Hazards. Retrieved on-line: http://www.findarticles.com According to this study in the Journal of Occupational and Environmental Medicine, patients with work-related low back injuries who received rehabilitative intervention early post-injury averaged on the whole, fewer physician visits, less restricted work duty, less work absence, and reduced prolonged disability in comparison with two other groups who received interventions later in the injury process. Mr. S. is a 45 year old male who sustained a low and mid back injury in 1995. He has five herniated discs (T8-9, T9-10, L3-4, L4-5, and L-5-S1).He was injured on the job while working as a mechanic in a car dealership. This accident involved a car motor falling from an engine hoist. Mr. S states, "I have been to rehabilitation three times since my injury. Each time, it was about the same routine: three times a week for about one hour. The duration was about three months each time." Services, per this gentleman, were secured at an out-patient facility. He indicates that an Occupational Therapist was the primary service provider. In relation to his satisfaction with the treatment her received he reports the following: "Everyone really wanted to help me, but my own needs and wants could never be fully accomplished because of the nature of my injury. I wanted a miracle cure that would permanently make me feel better, and although therapy helped me, i will never be exactly the same as i was before my injury. This has become a harsh reality that I have learned to deal with. I am thankful for everything the therapists did for me. i live a happy, productive life and experience less pain than I used to. i got some relief at the clinic and think that just being there relaxed my mind. i believe everyone helped me as much as they could. They tried everything. For example, every session included treatment to relieve pain. i know I'd be worse off now if I never went to therapy. It wasn't that the doctors didn't understand my injury, but I found that the rehabilitation workers were more attuned to my physical linits and to what I was truly capable of doing. The workers encouraged me to do my best, but didn't over-push my boundaries. it is certainly not the therapist's fault, but i was never able to return to work. I know that my life is better because of what i experienced while i was there, and because of the things they taught me, i am able to function as "normally" as possible".
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