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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