Lumbago

Epidemiology

The lumbagos affect a strong majority of the population. In France, they touch 70% of the population françaiseà one moment or with another. With the the United States only, the lumbagos involving an incapacity to turn over to work represent direct and indirect costs evaluated between 40 and 50 billion dollars US. Only with the Quebec, the evils of back accounted for 30% of the whole of the compensated lesions; for the year 2003 only, these lesions involved outlays of more than 500 million Canadian dollars. Among certain patients lombalgic, the pain perdure and worsens at the point to limit their daily activities considerably, including work. Studies showed that the frequency and the gravity of the accidents to the back are three times higher in the workers of construction than at those of the other sectors of economic activities. The evils of back constitute the leading cause of incapacity to work at less than 45 years and the third at the 45 years and more. It is about an health issue more expensive than the AIDS, the cancer or the diseases of the heart. In fact, the lumbagos constitute a so important problem that the the World Health Organization (WHO) made years 2000 with 2010 “the decade of the bones and articulations”.

Symptoms

Pain of the lumbar area, often out of bar.
Occurred brutally at the time of an effort.
possible Irradiation towards the Buttock S, the Thigh S, the Knee X.
Increase of the pains at the time of the movements and the efforts.
Reduction in the pains at the time of the care or the rest.
Accompanied by radiculalgies or Sciatic nerve.
the duration of the symptoms is variable, often a few days (acute lumbago), sometimes several years (chronic lumbago).

Examinations paraclinic

The examinations paraclinic are usually useless with the diagnosis, which remains clinical.

In all the cases, a Radiographie standard of the lumbar rachis will be carried out: stereotype of profile of the lumbar Vertebra S and large stereotype of of Sèze .

Causes

Treatment

Moderation of the efforts requesting the back.
strict Rest with the bed disadvised , except briefly in the event of intense pains.
Analgesic S of level I according to the criteria of WHO (Paracetamol and Ibuprofène)
Myorelaxant
Physical-activity, stretchings, muscular reinforcement of the lombo-pelvic belt.

During 20 last years, knowledge evolved/moved on the clinical aspects of the lumbagos. In 1986, a group of international specialists, under the direction of Dr. Walter O. Spitzer had as a mandate to describe the frequency and the distribution of the vertebral affections in the Québécois workers, to propose a classification of pathologies and interventions, to establish estimates of intervention, to define criteria of diagnosis and quality standards of the care, to recommend measurements making it possible to evaluate the quality of the care and to identify priorities of research in this field. The work group examined more: 3000 files representative of workers compensated for problems of back, and reviewed more than 700 scientific articles. The Spitzer report/ratio in particular called in question several preconceived ideas. Contrary to the popular belief, the work group affirmed that it was in the interest of the patient afflicted with an evil of back to turn over to an adapted work, in spite of the residual pains. It indicated that the utility of radiography was limited and that a clinical examination is usually enough to identify the majority of the patients needing a therapy. Ten years later, a study of Department off Health and Human Services of the United States confirmed these astonishing results. A few years later, of the British researchers arrived at the same conclusions. Then, the turn came from the Australiens, at the end of the the Nineties, to encourage their workers lombalgic, in particular by a publicity campaign on television, not to remain lying for long periods and to remain with work. In 2007, a study of the federal Center of expertise on the health care of the Belgium concludes that the rest worsens the chronic evil of back. This Belgian government organization prescribes to make physical exercise, to take again its activities quickly and recommends not to multiply the useless treatments, nor to subject a patient lombalgic to a multitude of tests, including radiographies.

Follow-up of the lumbagos

Essential to avoid the passage to chronicity
Adaptation of the behavior to the effort ( school of the back )
Adaptation of the work station
recent Bed linen
Physical-activity (Gymnastic and Swimming).

The chronic incapacity touches only one small proportion of the lombalgic people. However, the consequences of such an incapacity prove to be detrimental as much for the company as a whole that for the worker and his close relations (prolonged absence of work, loss of productivity, stun pain, loss of quality of life, difficulties marital and family, costs of compensation increased, fresh medical substantial, etc). The prevention of the chronic incapacity thus remains a major concern. Studies make it possible however of to better include/understand the complex dynamics of the development of the chronic incapacity related to the evils of back. They recently clarified that the exposure to factors of stress, combined with the belief which the physical-activity is harmful for the evil of back, contributes to the emotional distress of a person. In this situation, a victim of lumbago avoids any physical-activity, which results in to support the increase in incapacities. Research reveals that a negative perception of the practices in SST increases the fears compared to employment; the worker fearing a return to work, just as the possibility of being wounded there again.

Moreover, the results suggest that the chronic incapacity to turn over to work would be associated with a reduction in the secretion of the hormones preparing the organization to face the Stress. Although it will have to be confirmed by other studies, this assumption could carry out to determine which are the mechanisms which explain, for example, the bond between the psychological distress and the chronic or prolonged incapacity.

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