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mechanical includes:
- lower back muscle strain
- spondyloisthesis
- herniated disc
- OA/spinal stenosis

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S1 Radiculopathy

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Education: on back pain- what to do vs. what not to do.
Reassurance: encourage patient that there is a favourable prognosis- reduce stress around this injury (look at biopsychosocial model of treatment).
Self-management- encourage patient to manage pain through simple analgesics and exercise mostly (McKenzie exercises are useful to continue with even after acute pain has based to reduce chance of recurrence)

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No red flags on initial assessment
Try conservative management
May consider imaging if pain does not improve after 6 weeks and has persistent radiculopathy

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l  72% of patients with acute low back pain had completely recovered by 12 months,

l  42% of those with persistent low back pain recovered within 12 months.

l  Of those presenting with acute pain who recovered, 33% had a recurrence within the next

12 months.

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- Acute onset: overstretching / overreaching
- Prolonged periods of sitting
- Increased BMI

- lifting and heavy loads (and poor biomechanics)

-  Poor posture especially sitting

-  Weak lumbar extensors/core musculature

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A range of biological, psychological, societal, and work factors are linked to poor outcomes
e.g.:
 Higher disability,
 presence of sciatica,
 older age,
 poor general health,
 increased psychological or psychosocial distress (e.g. Des' anxiety)
 negative cognitive characteristics,
 poor relationships with colleagues,
 heavy physical work demands,
 presence of compensation.

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Overweight
Anterior pelvic tilt
R lumbar, buttock & LL pain in activity

Pain with flexion

48% on Oswestry Low Back Pain Disability Questionnaire (severe disability)

Loss of sensation in low pinky toe

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- Working closely with physio
- Prescribed McKenzie exercise to help back extension

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- Pain at the back of right leg and numbness in little toe (first time). Pain at worst is 7/10 in R LL and buttock
- Aggravating factors: sitting for too long, flexion of the back (coughing, sneezing, shaving at the basin, putting on socks and shoes)
- Easing factors: lying prone (but back pain persists), walking, analgesics. Pain subsides to 3/10
- intermittent back pain for 10 years

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Herniated Disc b/w L5/S1 with Radiculopathy
S1 nerve root affected

Posterior (dorsal) or Anterior ventral nerve root affected)

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Not covered by workcover
Likely got medicare and GP referral to cover physio

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Chronic
- flexion injury
- 10 years of overloading from work

Acute
- Recently overreaching heavy suitcases

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- lives w/wife and 3 kids
- wife casual cleaner private hospital
- Misses family and wife's cooking
- worried about missing work and income (stressed)
- eating fast food by himself (weight gain?)

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Taxi-driver after coming to Aus
prolonged hours of sitting, carrying heavy suitcases
works 60 hrs/wk as family struggles to "make ends meet"

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43 years old
Taxi driver
was once a vet
Wants to get back to work