DR. RAJENDRAN T,
CONSULTANT ORTHOPEDIC AND JOINT REPLACEMENT SURGEON,
APOLLO REACH HOSPITAL, KARAIKUDI
Common problems in orthopedics
BACK PAIN
The physical structure - anatomy
Total of 33 vertebrae
 5 segments
 Lumbar vertebra
carries maximum
weight


Soft tissues around the spine –
 The longitudinal ligaments
 The muscles
 Other tissues
The biomechanical stresses
Scenario 1
25 year old college
student
 Presents with pain over
the back over a
period of hours to
days.
 Usually an act of
“acute straining”
triggering the onset of
pain

Case 1
The 25 year old college
student with back pain.
 Most commonly caused
by straining of the
muscles supporting the
back – the mechanical
back ache.
 Usually due to improper
posture / undue loading.

Scenario 2
A 35 year old
housewife
 Pain over the back
that started mildly
 Progresses over days
to become severe
 After some time, no
relief even with rest.

Case 2
A 35 year old housewife
with prolonged back
pain.
 Usually due to repeated
straining +/ Lack of adequate
exercises to strengthen
back muscles and
repeated straining of
the muscles.

Case 3
Perimenopausal
woman with long
standing back ache.
 Easily fatigued
muscles.
 Wear out of bone-tobone and bone-tomuscle joints.

Case 3 (contd…)


Hormonal changes
around this time also
weaken bone (postmenopausal
osteoporosis).
Mechanical instability
may result.
Scenario 3
A 45 year old lady,
usually around
menopause.
 Constant back pain,
even at night.
 Pain exaggerates
after even trivial
activity.

Scenario 4
A 70 year old lady
 Constant and severe
back pain
 Accompanied with
bending of the back
(the crouching old
lady)

Case 4
The frail old lady
 Loss of bone
 Degeneration of joints
 Weakening of muscles
 Neurologic changes

What we will not discuss here…

Injuries to spine

Diseases of bones / joints of spine

Cancers



Low back ache affects at least 50% of the
population during their lifetime.
It is an expression of a huge and varied number of
problems.
The ‘imprinting’ of pain makes treatment more
difficult.



Barring a few conditions, the majority (~85%) of
patients coming to our hospital just have deranged
mechanics of the back.
THIS IS A MECHANICAL PROBLEM, NOT TREATABLE
WITH MEDICINES OR INJECTIONS.
Understanding the principles that are gone wrong
crucial to recovering the health of the back.

Commonest complaint:
 I have pain for last 3 years.
 I took medicines from Dr. X 
I had no relief from pain.
 I took medicines from Dr. Y 
the pain disappeared.
 Now the pain has come back,
the medicines are not working
as they used to.
 I am now here to try your
medicines!!!
A man’s first enemy is himself 
Obesity – the perpetrator
Avoiding back ache …..
Avoiding back ache….
How to avoid back ache…..
Exercise – a healthy way to back care
Walking – a versatile exercise




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Improves muscle strength and
tone
Improves spine alignment and
mechanics.
Improves flexibility and strain
tolerance.
Strengthens bone and reduces
osteoporosis – bone loss.
Helps lose excess weight.
Walking bad???

Even the best intentions cause harm when executed
poorly
Mistakes in walking

Overstriding
 The farther the heel is
from the center of
gravity, the more the
injury to the knee and
hip.
Mistakes in walking

Overpronation and underpronation
Always prepare for the walk
Before walking
After walking
Walking supports
Strength training
Other options

Cycling

Swimming

Aerobics

Yoga
India has produced several body
builders…..