Common Muscuskeletal ProblemsAcute Low Back PainAcute Low Back PainThenumberofmedicalvisits resultingfromlowbackpainis secondonlytothenumberofvisits for upper respiratory illnesses.tiologyMost low back pain is caused by one of many musculoskeletal problems! including"acute lumbosacral strainunstable lumbosacral ligaments and weak musclesosteoarthritis of the spinespinal stenosisintervertebral disk problemsune#ual leg length.$lder patients may e%perience back pain associated with osteoporotic vertebral fractures or bone metastasis.$ther causes include"kidney disorderspelvic problemsretroperitoneal tumorsabdominal aneurysmspsychosomatic problems.&naddition!obesity!stress!and occasionallydepressionmaycontributeto low back pain.Backpainduetomusculoskeletal disordersusually is aggravatedby activity! whereaspainduetootherconditionsis not.Patientswithchroniclowbackpainmay developadependenceonalcoholor analgesicsinanattempttocopewithand self'treat the pain.Clinical ManifestationsAcuteorchronicbackpain(lastingmore than)monthswithoutimprovement*and fatigue.Painthatradiatesdowntheleg+presence ofthissymptomsuggestsnerveroot involvement.,ait!spinalmobility!re-e%es!leglength! leg motor strength! and sensory perception may be a.ected.Paravertebralmusclespasm(greatly increasedmuscletoneofbackpostural muscles* occurs with loss of normal lumbar curve and possible spinal deformity.Assessment and /iagnostic Methods0ealth history and physical e%amination (back e%amination! neurologic testing*1pinal %'rayBone scan and blood studiesComputed tomography (CT* scanMagnetic resonance imaging (M2&*lectromyogram and nerve conduction studiesMyelogram3ltrasound4ursing ManagementAssessmentncouragepatienttodescribethediscomfort (location!severity!duration!characteristics! radiation! associated weakness in the legs*.$btainhistoryofpainorigin!previouspain control!andhowbackproblemisa.ecting lifestyle+ assess environmental variables! work situations! and family relationships.$bservepatient5sposture!positionchanges! and gait.Assessspinalcurves!pelviccrest!leglength discrepancy! and shoulder symmetry.Palpateparaspinalmusclesandnotespasm and tenderness. 4otediscomfortandlimitationsin movementwhenpatientbendsforward and laterally.valuatenerveinvolvementbyassessing deeptendonre-e%es!sensations!and musclestrength+backandlegpainon straight'legraising(withthepatientin supineposition!thepatient5slegislifted upwardwiththekneee%tended*suggests nerve root involvement.Assess for obesity and perform nutritional assessment.Assesspatient5sresponsetoanalgesic agents+evaluateandnotepatient5s responsetovariouspainmanagement modalities.&nterventions6ithseverepain!limitactivityfor7to8 days.Advise patient to rest on a 9rm! nonsagging mattress.0elppatienttoincreaselumbar-e%ionby elevatingtheheadandthora%):degrees usingpillowsorafoamwedgeandslightly -e%ingthekneessupportedonapillow. Alternatively!thepatientcanassumea lateralpositionwithkneesandhips-e%ed (curledposition*withapillowbetweenthe kneesandlegsandapillowsupportingthe head.&nstructthepatienttogetoutofbedby rolling to one side and placing the legs down while pushing the torso up! keeping the back straight As the patient achieves comfort! help patient gradually resume activities! and initiate an e%ercise program+ begin with low'stress aerobic e%ercises then after 8 weeks! begin conditioning e%ercises+ each e%ercise period should begin with rela%ation.ncourage patient to adhere to the prescribed e%ercise program.ncourage patient to improve posture and use good body mechanics and to avoid e%cessive lumbar strain! twisting! or discomfort (eg! avoid activities such as horseback riding and weight lifting*.Teach patient how to stand! sit! lie! and lift properly"1hift weight fre#uently when standing and rest one foot on a low stool+ wear low heels.1it with knees and hips -e%ed and knees level with hips or higher. ;eep feet -at on the -oor. Avoid sitting on stools or chairs that do not provide 9rm back support.1leeponsidewithkneesandhips-e%edor supinewithknees-e%edandsupported+avoid sleeping prone.Liftob