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
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4/13/2015
The objective of today’s
presentation is as follows:
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Let’s gain a better understanding of back
pain
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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?
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Pain is Undesirable
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It negatively impacts your
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Quality of life
Daily functions
Mood
Sleep
Social Interaction
Work
Play
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What is spine, anatomically?
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Bunch of joints (cushioned)
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Designed for mobility and movement
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Kinetic chain
Provide structural support for the upper body
Protection of the spinal cord
Shock absorber for the brain
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Kinetic Chain of the Spine
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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!
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Young vs. Old Spine
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Young Spine
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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
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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,
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stenosis, pinched nerves, slipped vertebrae)
4/13/2015
Who gets back pain?
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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
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Causes of pain & impaired
function
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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
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Other factors affecting spine
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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
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What can we do to prevent
back pain?
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Slow down the aging phenomenon
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Maximize spine health
Preserve function
Minimize pain
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The Key is to strengthen the
muscle around the spine by
lengthening it !
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Exercises, such as Yoga, will add to the muscles
that protect the (lumbar) spine
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Flexibility
Strength
Endurance
Balance
Superman stretch (in soccer)
General principle
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Active stretch opposite direction of the natural
curvature of the particular spine segment
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Diagnosis and Treatment for
back pain
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Getting an X-Ray and/or MRI will help your
doctor diagnose the problem.
Treatment:
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Exercise / Physical Therapy
Modalities –
ice/heat/TENS/ultrasound/massage/acupuncture
Brace / Corset
Medication
Steroid injection
Surgery
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Specific Treatment depends
on actual pathology
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Disc herniation
Lumbar stenosis
Sciatica / lumbar radiculopathy
Lumbar spondylolisthesis (slippage)
Compression fracture(s) from
osteoporosis
Sacroiliac joint pain / facet joint pain
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Lumbar Disc Herniation
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Acute herniation –
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Bed rest x 2-3 days
Pain medications
Abdominal binder for stabilization
Gradual mobilization and strengthening
exercises for protection & healing; avoid
exacerbation
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Flexion based lumbar stretching and strengthening
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Lumbar stenosis / sciatica
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Generally speaking –
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Pain medications
Flexion based lumbar stretching and
strengthening; Physical therapy
Steroid injection
Surgery
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Lumbar spondylolisthesis
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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
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Osteoporotic Compression
Fracture
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Usually thoracic, esp near thoracolumbar
junction
Dowager’s hump / progressive kyphosis
+/- scoliosis
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Osteoporotic Compression
Fracture
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Treatment:
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Opioids / pain medications
Thoracic extension exercises (superman)
TLSO brace or body shell
Kyphoplasty / vertebroplasty
Surgery
Tx underlying osteoporosis
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Sacroiliac joint pain
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Unilateral
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Trauma
Leg-length discrepancy, causing asymmetric
stress
Bilateral
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Weakness of stabilizers of the SI joints
Rule out autoimmune disease in younger pts
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4/13/2015
Facet joint pain
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Axial pain worse with lumbar flexion, extension,
or rotation
Imaging correlation on MRI
Tx
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No treatment; exercise
Medication
Steroid injection
De-innervation of the joint
Surgical fusion, facectomy, etc.
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Prevention is the key!
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Proper posture and body mechanics
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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
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Yoga, swimming, marshal arts, for example
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Knowledge is power! Help
yourself and others
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Wise to enlist healthcare professional’s
help in the quest for health and wellness
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Thank you for your attention.
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Q&A
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