A. DEFINITIONS.
Low Back Pain perceived inconvenience associated with lumbar or sacral areas of the spine, around the network ataui (Randy Mariam, 1987).
Low Back Pain is a type of pain that requires medical treatment even if there is trauma often sudden and can become chronic in the problems of life such as physical, mental, social and economic (Barbara).
Low Back Pain is chronic pain in the lumbar, usually caused by the vertebral uscles, herniation and regeneration of the nucleus pulposus, osteoarthritis of the lumbar sacral spine (Brunner, 1999).
Low Back Pain occurs dilumbal lower lumbar or sacral region sacroiliaca, usually associated with the process of degeneration and tension musulo (Prisilia Lemone, 1996).
Low back pain can occur in the any one have musculoskeletal problems such as acute lumbosacral strain, the inability of lumbosacral ligament, muscle weakness, osteoarthritis, spinal stenosis and inter masalh the vertebrae and joints are not the same leg length (Lucman and Sorensen’s 1993).
Some understanding of the above can be concluded Low Back Pain is chronic pain in the lumbar or acut usually caused by trauma or muscle of the vertebrae or the pressure, herniation and degeneration of nuleus pulposus, muscle weakness, osteoarthritis dilumbal sacral spine.
B. Anatomy and physiology
To frame.
1. Prevent all parts of the body (supporting body).
2. Protect the delicate organs like brain, heart and lungs.
3. Place attach muscles and body movement through muscle.
4. place of production of blood cells especially red blood cells.
5. Give shape to the body building.
? Segments of the spine.
The shape of each vertebra is generally the same, there is only a little difference depending on the work at hand.
These sections consist of several parts:
1. body segment is part of the largest, forms a thick and strong, is adjacent to the front.
2. Broad arch.
Part of melingkaridan protect the spine area of the hole located next to the stripe and have a bulge that is:
a. processus spinosus / taju thorns.
There are in the midst of large curved, protruding backward.
b. Processus tranversum / taju wings.
There are left and right beside wide curves.
c. Process of articulation / taju penyendi.
Forming joints with the vertebrae (vertebral).
? Vertebra function.
1. Hold kepela and tools other body ..
2. Protects delicate equipment is therein (sum-sum back).
3. Place attach ribs and hip bones.
4. Determine posture.
Segments of the spine is composed of top down and between each segment are connected by cartilage called discs between the vertebra so that the spine straight and bend the bias. Besides, next to the front and rear are a collection of rubbery fibers that strengthen the position of the vertebrae.
The middle segments of the spine there is also a channel called the channel sum-sum back (spinal cord canal) in which there sum-sum spine.
? The parts of the vertebrae.
1. Sedrvikalis vertebrae (neck bones) 7 segment has a small segment of the body and a big hole ruasnya. In the wings there tagu hole syarap past called for Amentuam Versalis (Foramentuan Versorium). The first segment of the cervical vertebrae is called Atlas that allows the head rotates left and kekanan. The second segment is called the processus to 7 have called taju processus Prominan, taju ruiasnya rather long.
2. Thoracic vertebrae (spine) consists of 12 segments, body big and strong ruasnya. Taju long and curved bones, on the plains of the top joint, bottom, left and right are formed with rib joints.
3. lumbar vertebrae (bones pinggul0 consists of 5 segments, large ruasnya body, thick and strong. Taju thorns rather than picak for segment to segment 5 slightly prominent promontory called.
4. Koksigius vertebra (tail bone) consists of 4 segments. Ruasnya segment-small and became a bone called the Os Koksigialis can move slightly due to form a joint with the sacrum.
Curved spine seen from the side of the vertebral column 4 shows the curve or curves. Vertikel arch region forward curved neck arched backward torakal area. Curved lumbar region forward and backward curved regional pelvis. Cervical arch developed as a child. For example, when he crawled, stood erect and maintain berjlan.
Joints formed by the vertebral column of cartilage cushion that is attached between each vertebra luigamentum strengthened by walking in front of and behind the vertebrae along the vertebral column.
Disc between the pads of thick, fibrous cartilage located between vertyebra body that can move the joint movement is formed between the disc and vertebrae with limited movement and can move flexion, extension and lateral side of the left and right side.
The function of the vertebral body as a solid support while working as an intermediary buffer with the disc cartilage. The arches give the intervertebral flesibilitas allows bends without breaking.
Discs are also useful to absorb the shocks that occur when the body moves such as running and jumping time. Thus the brain and the sum-sum back protected by shock. Also support the vertebral column weight associated with muscle surface to form the posterior borders of the solid body cavities and related to the ribs.
C. Etiology.
? Posture changes are usually due to primary and secondary trauma.
Primary trauma such as: Trauma spontaneously, for example an accident.
Secondary trauma such as: presence of HNP disease, osteoporosis, spondylitis, spinal stenosis, spondylitis, osteoarthritis.
? Lumbosacral ligamentous instability and muscular weakness.
? Procedure degeneration in elderly patients.
? Use the right shoes that are too high.
? Obesity.
? Lifting weights the wrong way.
? Sprain.
? Too long on the vibration.
? Gait.
? Smoking.
? Sitting too long.
? Lack of exercise (the body).
? Depression / stress.
? Sports (golp, tennis, soccer).
D. Clinical manifestations.
1. Changes in gait.
? Walking was stiff.
? No bias play back.
? Lame.
2. Persyarapan
? When tested with light and touch with a pin, the patient felt a sensation in both limbs, but having a stronger sensation on the areas that are not stimulated.
? Chapter uncontrolled and Bak.
3. Pain.
? Acute back pain and chronic more than two months.
? Pain when walking with a heel.
? Muscle pain in the.
? Pain gets spread down the back foot.
? Heat pain on the back of the thigh or calf.
? Pain in the middle of the buttocks.
? Severe pain in the feet increases.
E. Pathophysiology.
Old age (the degeneration)
(Reduction of calcium, vitamin D deficiency, disorders of the thyroid hormone function and calcitonin, obesity, abdominal muscle weakness, structural problems)
Intervertebral discs change to which fibrokartilago and irregular due to lack of calcium and other bone formation so as to comply will be taken from the nearest part of the bone.
Lumbar discs (L4 – L5 and L5 – SI) experienced the most severe stress and severe degeneration changes.
Disc protrusion (HNP) / kekerusakan facet joints and disrupt the blood supply kejaringan.
Emphasis on the nerve roots.
Pain spreading to extrimitas below.
F. RISK FACTORS FOR LOW BACK PAIN.
Risk factor Low back Pain:
1. Risk factors in physiology.
? Age (20 – 50 years).
? Lack of physical exercise.
? Less anatomical posture.
? Obesity.
? Severe scoliosis.
? HNP.
? Spondylitis.
? Spinal stenosis (narrowing of the spine).
? Osteoporosis.
? Smoking.
2. Environmental risk factors.
? Sitting too long.
? Too long on the vibration.
? Sprained or twisted.
? Sports (golp, tennis, gymnastik, and football).
? Vibration of the old.
3. Of psychosocial risk factors.
? Work inconvenience.
? Depression.
? Stress.
G. DIAGNOSTIC EVALUATION
Procedures need to be done on patients suffering from lower back pain.
1. Vertebral X-rays; may reveal a fracture, dislocation, infection, osteoarthritis or scoliosis.
2. Tomografhy Computed (CT): useful to know yangmendasari diseases such as lesions of the soft tissue around the vertebral column is hidden and problems intervertebral discs.
3. Ultrasonography: can help diagnose the narrowing of the spinal canal.
4. Magneting resonance imaging (MRI) allows visualization of the nature and location of spinal pathologies.
5. Meilogram and discogram: to find a degenerate discs or discs protrusi.
6. Venogram efidural: Used to assess lumbar disc disease by showing a shift efidural vein.
7. Electromyogram (EMG): used to evaluate disease spinal nerve fibers (Radikulopati).
H. Management.
Most back pain disappeared own bias and will heal in 6 weeks with tirah lie. Stress reduction and relaxation. Patients must stay put to bed with a mattress that is not solid and thick. For 2 – 3 days (can be used bed rafters). Position the patient made such that the larger lumbar flesi, which can reduce the pressure on the lumbar nerve fibers. The head of the elevated section 30 and the patient slightly bent knees. Facedown avoided because it will aggravate lordosis.
Sometimes patients need to be treated for the handling of “konserpatif active” and fisiotherafi intermittent pelvic traction load from 7 to 13 Kg. Traction allows the addition of lumbar flexion and the muscle relaxation.
Fisiotherapi untuik need to be given to reduce pain, muscle spasm, terafi bias terafi include cooling, heating infrared light, moist heat packs, ultrasound waves, diathermy, traction. Wave ultra heat will cause this berkontra indication in patients with cancer or people with bleeding disorders.
Drugs that may need to be given to treat acute pain, a narcotic analgesic used to make the muscles relax and the patients who experienced muscle spasms, anti implamasi drugs such as aspirin and non steroidal anti inplamasi (NSAIDs).
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