A Discussion On Back Pain - TotalSolution Pain & Rehabilitation

advertisement
A Discussion On Back Pain
By: Hsiu-Hsien (Tom) Ling, M.D.
TotalSolution Pain & Rehab Center
1661 Hanover Road, Suite 227,
City of Industry, CA 91748
626-384-3268
1
4/13/2015
The objective of today’s
presentation is as follows:

Let’s gain a better understanding of back
pain


Why we have it and how we can prevent it?
If you already have back pain, let’s discuss
what are some of the treatments out there?
2
4/13/2015
Pain is Undesirable

It negatively impacts your







Quality of life
Daily functions
Mood
Sleep
Social Interaction
Work
Play
3
4/13/2015
What is spine, anatomically?

Bunch of joints (cushioned)

Designed for mobility and movement




Kinetic chain
Provide structural support for the upper body
Protection of the spinal cord
Shock absorber for the brain
4
4/13/2015
Kinetic Chain of the Spine




The integrity of each individual vertebra will
impact the overall function of spine
Each link has a role in support, movement,
stability, and shock reduction
In fact, the joints of the appendages
(arms/legs) are also linked, and act as shock
absorbers for the spine during jumping, landing,
or falling
Every link in the kinetic chain matters over time!
5
4/13/2015
Young vs. Old Spine

Young Spine






Strong bones
Healthy, well-hydrated, elastic disks
Flexible vertebral segments
(ligaments/disks/muscles/tendons/joints)
Load tolerant (intensity & duration)
Able to repair damages
Older Spine




Weaker bone (osteopenia/osteoporosis)
Less elasticity and water in disks
Reduced mobility of vertebral segments
Degenerative changes (bone spurs, loss of disc height,
herniated/bulging disks, hypertrophy of ligaments,
6
stenosis, pinched nerves, slipped vertebrae)
4/13/2015
Who gets back pain?


Although it’s more prevalent with the
elderly, younger adults are getting back
pain these days due to stress from work,
inactivity, or obesity
Back pain is unusual in kids
7
4/13/2015
Causes of pain & impaired
function





Compression fractures of vertebrae
(Osteoporosis)
Sciatica (lumbar radiculopathy; pinched nerve)
Neurogenic claudication (pain with walking) a/w
spinal stenosis
Arthritis of facet joints and tear of disc
Reduced mobility in one segment of the spine
will accelerate the use of adjacent segments,
causing greater wear and tear
8
4/13/2015
Other factors affecting spine





Body weight / cross sectional area of
abdomen
Congenital factors (6th lumbar vertebra;
small spinal canal, gender)
Systemic disease
Posture & Body mechanics
Occupation; Sedentary lifestyle, Stress
9
4/13/2015
What can we do to prevent
back pain?

Slow down the aging phenomenon



Maximize spine health
Preserve function
Minimize pain
10
4/13/2015
The Key is to strengthen the
muscle around the spine by
lengthening it !

Exercises, such as Yoga, will add to the muscles
that protect the (lumbar) spine






Flexibility
Strength
Endurance
Balance
Superman stretch (in soccer)
General principle

Active stretch opposite direction of the natural
curvature of the particular spine segment
11
4/13/2015
Diagnosis and Treatment for
back pain


Getting an X-Ray and/or MRI will help your
doctor diagnose the problem.
Treatment:






Exercise / Physical Therapy
Modalities –
ice/heat/TENS/ultrasound/massage/acupuncture
Brace / Corset
Medication
Steroid injection
Surgery
12
4/13/2015
Specific Treatment depends
on actual pathology






Disc herniation
Lumbar stenosis
Sciatica / lumbar radiculopathy
Lumbar spondylolisthesis (slippage)
Compression fracture(s) from
osteoporosis
Sacroiliac joint pain / facet joint pain
13
4/13/2015
Lumbar Disc Herniation

Acute herniation –




Bed rest x 2-3 days
Pain medications
Abdominal binder for stabilization
Gradual mobilization and strengthening
exercises for protection & healing; avoid
exacerbation

Flexion based lumbar stretching and strengthening
14
4/13/2015
Lumbar stenosis / sciatica

Generally speaking –




Pain medications
Flexion based lumbar stretching and
strengthening; Physical therapy
Steroid injection
Surgery
15
4/13/2015
Lumbar spondylolisthesis



Avoid lumbar Hyperextension
Flexion based lumbar lengthening and
stretching to try to restore natural
alignment and curvature
If instability or neurologic deficit beyond
numbness or tolerable pain, then surgical
stabilization
16
4/13/2015
Osteoporotic Compression
Fracture


Usually thoracic, esp near thoracolumbar
junction
Dowager’s hump / progressive kyphosis
+/- scoliosis
17
4/13/2015
Osteoporotic Compression
Fracture

Treatment:






Opioids / pain medications
Thoracic extension exercises (superman)
TLSO brace or body shell
Kyphoplasty / vertebroplasty
Surgery
Tx underlying osteoporosis
18
4/13/2015
Sacroiliac joint pain

Unilateral



Trauma
Leg-length discrepancy, causing asymmetric
stress
Bilateral


Weakness of stabilizers of the SI joints
Rule out autoimmune disease in younger pts
19
4/13/2015
Facet joint pain



Axial pain worse with lumbar flexion, extension,
or rotation
Imaging correlation on MRI
Tx





No treatment; exercise
Medication
Steroid injection
De-innervation of the joint
Surgical fusion, facectomy, etc.
20
4/13/2015
Prevention is the key!

Proper posture and body mechanics





Lifting technique
Activities modification
Workplace ergonomics evaluation; occupational
specific training
Abdominal binder / corset (more than just the
beauty of thin waist)
Low impact exercises to strengthen the core

Yoga, swimming, marshal arts, for example
21
4/13/2015
Knowledge is power! Help
yourself and others

Wise to enlist healthcare professional’s
help in the quest for health and wellness

Thank you for your attention.
22
4/13/2015
Q&A
23
4/13/2015
Download