Low back pain is the most common complaint after the common cold. Almost everyone has at least one episode of low back pain during their lives. In the USA, it accounts for around 3% of all visits to doctors.
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When we walk down a slope we assume a position of lumbar hyperlordosis to keep our balance. When we go up, we tend to flex our spine. Hyperlordosis reduces the diameter of the lumbar canal, exacerbating the symptoms…
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One way of distinguishing manipulation by the patient is to cause flexion of the leg with extension of the knee, while the patient is sitting. The manoeuver reproduces Lasègue’s test, but is not so well known…
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Acute low back pain with sciatic radiation and neu rological deficit in a young man.
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Around the compressed root, there is always some inflammatory reaction that exacerbates and perpetuates the pain. The fullest possible analgesia is important to prevent the vicious circle of pain and muscle spasm that plays an important role in these situations. Early, gentle exercise is important in facilitating the withdrawal of the herniated core. Regular, long-term exercise and care with posture are essential in preventing recurrences.
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Yes. Hypertension and heart failure can be aggravated by non-steroidal anti-inflammatories which can also result in edema and nitrogen retention. The diabetes would contraindicate the use of corticosteroids, if any other situation made them necessary. Type II diabetes and obesity reduce the risk of osteoporosis, which we should always consider in a patient aged 68.
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Inflammatory lumbosacral pain in a young man with no systemic manifestations. Probable sacroiliitis.
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Signs: dorsal kyphosis, Cushingoid facies, cutaneous atrophy, diabetes, hypertension. Protein strip: in a patient of this age, with bone pain associated with severe osteoporosis, the possibility of multiple myeloma requires appropriate studies.
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da Silva, J.A.P., Woolf, A.D. (2010). Regional Syndromes Low Back Pain. In: Rheumatology in Practice. Springer, London. https://doi.org/10.1007/978-1-84882-581-9_11
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