8/9/2015 1 A Discussion On Back Pain TotalSolution Pain & Rehab Center 1661 Hanover Road, Suite 227, City of Industry, CA 91748 626-384-3268 By: Hsiu-Hsien.

04/19/231

A Discussion On Back Pain

TotalSolution Pain & Rehab Center1661 Hanover Road, Suite 227,

City of Industry, CA 91748626-384-3268

By: Hsiu-Hsien (Tom) Ling, M.D.

04/19/232

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?

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Pain is Undesirable

It negatively impacts your Quality of life Daily functions Mood Sleep Social Interaction Work Play

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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

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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!

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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, stenosis, pinched nerves, slipped vertebrae)

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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

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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

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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

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What can we do to prevent back pain? Slow down the aging phenomenon

Maximize spine health Preserve function Minimize pain

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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

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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

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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

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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

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Lumbar stenosis / sciatica

Generally speaking – Pain medications Flexion based lumbar stretching and

strengthening; Physical therapy Steroid injection Surgery

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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

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Osteoporotic Compression Fracture Usually thoracic, esp near

thoracolumbar junction Dowager’s hump / progressive

kyphosis +/- scoliosis

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Osteoporotic Compression Fracture Treatment:

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

Unilateral Trauma Leg-length discrepancy, causing

asymmetric stress Bilateral

Weakness of stabilizers of the SI joints Rule out autoimmune disease in younger

pts

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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.

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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

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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.

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Q & A