1. Step 9
1.1. Review session 3
1.2. visualize the data and theory
1.2.1. http://www.youtube.com/watch?v=zEOlXmUeK7o
1.3. literature review and use of evidence
1.3.1. 6 studies about CT
1.3.1.1. sensitivity 77.4 % , specifity: 73% to diagnose any lumbar pathology
1.3.1.2. It can have false negative and false positive for herniation
1.3.2. 2-4 YEARS no difference between the surgical and non surgical
1.3.3. 90% recover within first 2 weeks
1.4. 20 minutes
2. Step 10
2.1. Management (for the individual)
2.1.1. goals of treatment
2.1.1.1. pain relief
2.1.1.2. function restoration
2.1.2. Prognosis
2.1.2.1. 70% of low back pain patients have it as self limiting
2.1.2.2. first,rest recommendation then begin activity
2.1.2.3. reduce the BMI will be helpful
2.1.3. Not interventional
2.1.3.1. NSAIDs
2.1.3.1.1. e.g.: ibuprofen
2.1.3.1.2. significant side effects
2.1.3.1.3. for short term pain relief
2.1.3.2. Acetaminophen
2.1.3.2.1. used by experience
2.1.3.2.2. first-line therapy
2.1.3.3. Antidepressants
2.1.3.3.1. tricyclics
2.1.3.3.2. beneficial for some patients with chronic back pain
2.1.3.3.3. short term trials
2.1.3.4. Opioids
2.1.3.4.1. not evidence
2.1.3.5. systematic glucocorticoids
2.1.3.5.1. not effective
2.1.3.6. muscle relaxants
2.1.3.6.1. with NSAIDs during the day time
2.1.3.6.2. before bedtime
2.1.3.7. yoga
2.1.3.7.1. for chronic pain patients
2.1.3.7.2. as effective as excersice
2.1.3.8. acupuncture
2.1.3.8.1. moderate evidence for short term use
2.1.3.9. spinal manipulation
2.1.3.9.1. old way of treatment
2.1.3.9.2. return the spinal to its normal position
2.1.3.9.3. stretch the joints beyond their normal range
2.1.3.9.4. Grade 2b
2.1.3.10. referral
2.1.3.10.1. physiotherapist
2.1.3.10.2. occupational
2.1.3.11. self care
2.1.3.11.1. rest for the first 2 days with acute severe pain
2.1.3.11.2. avoid heavy lifting for the first 6 weeks
2.1.3.11.3. relaxant techniques
2.1.3.11.4. use simi hard mattress
2.1.3.11.5. exercise
2.1.4. Interventional but not surgical
2.1.4.1. epidural steroid injection
2.1.4.1.1. pain relief with short time (less than 3 months)
2.1.4.1.2. some side effects
2.1.4.1.3. Grade 2B
2.1.4.2. chemonucleolysis
2.1.4.2.1. not recommended in US
2.1.4.2.2. enzymes for nucleuos lysis
2.1.5. Surgical
2.1.5.1. with progressive neuropathy
2.1.5.2. early surgery improves adjusted life years
2.1.5.3. criteria
2.1.5.3.1. identify the problem
2.1.5.3.2. not responding to other treatment
2.1.5.3.3. progressive symptoms
2.1.5.4. for shert term improvment
2.1.5.5. it's the same as non-interventional in the long run
2.1.5.6. discectomy
2.1.5.6.1. most effective
2.1.5.6.2. microdiscectomy
2.1.5.6.3. open discectomy
2.2. Prevention (for the population)
2.2.1. primary
2.2.1.1. no supportive studies
2.2.1.2. exercise to strength the muscles
2.2.1.3. education about how to lift thing
2.2.1.4. having good posture wile sitting
2.2.1.5. avoid risk factors
2.2.2. secondary
2.2.2.1. reduce the pressure in the spine
2.2.2.2. self care
2.2.2.3. exercise
2.2.2.4. work environment modification