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physical examination

Pregnancy-Related Back Pain: When Should I Worry?

Teaser: 

Dr. Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,

is a Family Physician practising Sport and Exercise Medicine at the Toronto Rehabilitation Institute, University Health Network. She is appointed at the University of Toronto, Department of Family and Community Medicine as an Associate Clinical Professor.

CLINICAL TOOLS

Abstract: Clinicians are often unsure if back pain during pregnancy is due to a musculoskeletal condition, an abnormality with the pregnancy or merely part of the common discomforts associated with gestational changes. Low back pain guidelines do not include pregnant women in their criteria and there have been no randomized clinical trials to determine specific causes of low back pain during pregnancy. This article will provide the clinician with a framework for identifying pregnancy-related back pain using a high yield history and key physical examination techniques to differentiate between mechanical back pain, sacroiliac instability and symphysis pubis separation. Risk factors for low back pain and warning signs for pregnancy complications will be identified. Appropriate management strategies will be provided for the management of pregnancy-related low back pain.
Key Words: pregnancy-related low back pain, pregnancy, pelvic pain, physical examination, management.

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1. Probable Risk Factors for Low Back pain during pregnancy include: • Pre-pregnancy and past pregnancy low back pain • Low Back and Pelvic Trauma • Poor general physical condition • Joint Hypermobility • Increase body weight
2. Pregnancy related low back or pelvic pain is defined as intermittent or constant pain in the lumbar, buttock, pelvis, groin and/or upper thigh area lasting for more than one week.
3. Exercise, education and postural advice are the mainstays of treatment and can be enhanced by short term therapy with a rehabilitation professional.
1. Patients who have low back pain, in any trimester, associated with vaginal bleeding, uterine contractions, fever or hematuria should be immediately referred for obstetrical consultation.
2. The three most common causes of low back pain in pregnancy are mechanical low back strain, sacroiliac instability and symphysis pubis separation; they often occur together.1,2
3. Patient with Symphysis Pubis Dysfunction complain of significant pain during most of these activities: • Walking • Climbing Stairs • Turning in Bed • Standing on one Leg • Rising from a Chair
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Making Sense of Low Back Pain

Making Sense of Low Back Pain

Teaser: 

Hamilton Hall, MD, FRCSC,1 Julia Alleyne, BHSc(PT), MD, CCFP, Dip. Sport Med MScCH,2 Yoga Raja Rampersaud, MD, FRCSC,3

1Professor, Department of Surgery, University of Toronto; Medical Director, Canadian Back Institute; Executive Director, Canadian Spine Society, Toronto, ON.
2Associate Professor, Department of Family and Community Medicine, University of Toronto, Medical Director, Sport CARE, Women’s College Hospital, Toronto, ON.
3Associate Professor Department of Surgery, University of Toronto, Divisions of Orthopaedic and Neurosurgery, University Health Network Medical Director, Back and Neck Specialty Program, Altum Health, Immediate Past President Canadian Spine Society, Toronto, ON.

CLINICAL TOOLS

Abstract: In 1987, the Quebec Taskforce noted, "Distinct patterns of reliable clinical findings are the only logical basis for back pain categorization and subsequent treatment." Identifying these patterns begins with the patient's history: "Where is your pain the worst?" "Is your pain constant or intermittent?" "Has there been any change in your bowel or bladder function?" This questioning establishes the mechanical nature of the pain, and a physical examination verifies or refutes the pattern established in the history. The examination involves two essential tests to detect upper motor and low sacral root involvement. A failure of the results to fit into one of four syndromes—two back dominant and two leg dominant—suggests a non-mechanical or more complex problem.
Key Words:patterns of back pain, pain location, pain characteristics, history, physical examination.

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eCME: The Latest in Back Pain Management

This CME activity offers interactive Videos, Animations, Pre- and Post-test Quizzes and you will be able to download a Certificate of Participation upon completion.

90% of Low Back Pain is not related to serious pathology and does not require surgical intervention.
Mechanical Low Back Pain can be categorized to patterns that are identified in history and confirmed in the physical examination.
Findings on radiological imaging including x-ray, CT scan and MRI have not been found to correlate to pain-generating pathology, can increase patient anxiety and detract from successful recovery.
A concise history starts with two questions: "Where is your pain the worst?" and "Is your pain constant or intermittent?"
The goal of physical examination is to verify or refute the diagnostic assumptions made on the basis of the history.
Managing low back pain is not a one-time event. Low back pain is a chronic condition that demands ongoing care and follow-up.
To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is only $20 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.