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How to deal with heterogeneity in people with low back pain? Khan MH

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Year : 2020  |  Volume
: 20 
Issue : 1  |  Page : 29-30

How to deal with heterogeneity in people with low back pain?

Moazzam Hussain Khan
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islmia, New Delhi, India

Date of Submission 12-Sep-2020
Date of Acceptance 20-Sep-2020
Date of Web Publication 18-Oct-2020

Correspondence Address:
Dr. Moazzam Hussain Khan
Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islmia, New Delhi
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DOI: 10.4103/sjsm.sjsm_25_20

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How to cite this article:
Khan MH. How to deal with heterogeneity in people with low back pain?. Saudi J Sports Med 2020;20:29-30

Dear Editor,

In the modern society and use of technology, about 70%–80% of the population experienced low back pain (LBP) once or more in their lifetime.[1] Socioeconomic status, personal habits, occupation, and psychological and mechanical factors are usually reported as a cause of initial development of LBP which also contributes further in their recurrences, and exacerbation leads to neurological symptoms.[2]

LBP may be acute or chronic, pathological or nonpathological which may cause local back pain or later may be involvement of neurological. Lack of lumbar spinal instability in the absence of bony defects is one of the most common and ignored which further may cause neurological symptoms due to involvement of disc and nerve.[3] Sometimes, a professional decides on the basis of radiological finding in which symptoms may or may not be present whatsoever showing in the radiological finding, and treatment should not totally be based on the radiological findings. There is an extensive list of differential diagnosis for LBP, however, most of the causes are infrequently seen in practice.[4],[5] It is reported that about 85% of the patients with LBP seen in a primary care have no identifiable cause, and so it is termed nonspecific LBP which may cause segmental instability.[4]

Different treatments are available for LBP but should be based on stages and individual specific because the same problem of different subject treatment responses may not be the same. Acetaminophen, nonsteroidal anti-inflammatory drugs, relative rest, coldness, heating, and massage therapy, and electrical modalities can be used to decrease the intensity of pain in patients with LBP for a short time in case of spinal instability. However, spinal stabilization exercise with conventional treatment will be helpful for proving spinal stability,[6] and neural mobilization with conventional treatment[7] is well established for chronic LBP (CLBP) without dispute to decrease pain and disability for long-term effects.[6],[7] Hence, apart from conventional treatment, we should also focus on spinal stability exercise for the prevention of neurological symptoms in CLBP and, if required, can add neural mobilization techniques.

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  References   Top

Grabiner MD, Jeziorowski JJ, Divekar AD. Isokinetic measurements of trunk extension and flexion performance collected with the biodex clinical data station. J Orthop Sports Phys Ther 1990;11:590-8.  Back to cited text no. 1
Chou R. Low back pain (chronic). BMJ Clinical Evidence 2010;10:1116.  Back to cited text no. 2
Long DM, BenDebba M, Torgerson WS, Boyd RJ, Dawson EG, Hardy RW, et al. Persistent back pain and sciatica in the United States: Patient characteristics. J Spinal Disord 1996;9:40-58.  Back to cited text no. 3
Deyo RA, Phillips WR. Low back pain. A primary care challenge. Spine (Phila Pa 1976) 1996;21:2826-32.  Back to cited text no. 4
Zaidi S, Nuhmani S, Jalwan J. Retrolisthesis: An update. Saudi J Sports Med 2015;15:111.  Back to cited text no. 5
  [Full text]  
Parveen A, Nuhmani S, Hussain ME, Khan MH. Effect of lumbar stabilization exercises and thoracic mobilization with strengthening exercises on pain level, thoracic kyphosis, and functional disability in chronic low back pain. Journal of Complementary and Integrative Medicine. 2020 Jul 27;1. (Ahead-of-print).  Back to cited text no. 6
Ahmed N, Tufel S, Khan MH, Bhatnagar P. Errata: Effectiveness of neural mobilization in the management of sciatica. J Musculoskelet Res 2013;16:1392001.  Back to cited text no. 7


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