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Oh my back!Low back pain and its management
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What structures make up the back?
The spine consists of four main areas
Cervical (C1-C7)
Thoracic (T1-T12) Lumbar (L1-L5)
Sacrum/coccyx
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Statistics
LBP ranked highest in terms of disability (YLDs) inthe Global Burden of Disease 2010 research
It ranked sixth in terms of overall burden,measured in disability adjusted life years (DALYs)
Globally, 1 in 10 people had LBP
Prevalence is almost equal among men andwomen (10.1 vs 8.7%) and is highest in WesternEurope.
Occurs most frequently between ages 30 and 50.
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Statistics
Back pain treatments cost the NHS around 1billionper year
Lost production as a result of LBP is estimated tocost at least 3.5 billion per year.
90% of acute back pain resolves in 6 weeks
More than 13,000 back pack-related injurieswere reported amongst US school children in2000.
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Symptoms
Depending on the cause, symptoms canvary
Dull, sharp or burning
Felt at a single point or over a broad area
Occurs suddenly or comes on gradually
Occurs with spasms or stiffness
Associated leg symptoms such as pain,
numbness or tingling
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Low Back Pain (Lumbago)
Back pain is a common problem thataffects most people at some point intheir life. It usually feels like an ache,tension or stiffness in your back.
Classifications:
Acuteless than 6 weeksSub-Acute6 to 12 weeks
Chronicmore than 12 weeks
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Red Flag Symptoms
History of cancer
Progressive motor or sensory deficit
Prolonged steroid use, IV drug use
Major trauma
Numbness in groin/saddle
Bilateral leg weakness
Fever and chills Unrelenting severe pain with rest
Loss of bowel or bladder function
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Cauda Equina
A serious problem that can occur if thenerves at the end of the spinal cord aresqueezed
Seek emergency treatment if youexperience any red flag Symptoms
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Causes of Back Injuries
Most back injuries can be attributed toone of these five causes
Poor posture Improper body mechanics/work habits
Stressful living
Loss of flexibility
Poor conditioning/overweight
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Your back went out because
your front went out.
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Obesity
World Health Organization (WHO)
Overweight: BMI 25-29
Obese: BMI 30 and above
By 2015: 700 million will be obese
Overweight and obesity lead to serioushealth consequence
Cardiovascular disease
Diabetes
Musculoskeletal disorders
Some cancers
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Diagnostic Testing
Physicians will not generally orderdiagnostic tests in the first six weeks of
low back painMost of the time, the causes for back
pain cannot be found by x-ray, CT scanor MRI
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The intensityof the pain
does not equal theseverityof the injury
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Potential Disk Problems
Degenerated disks
Thinning disks
Bulging disks
Herniated disks
Osteophyte (bone
spur) formation
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Why does back pain seem
to always come back?
The disks between our vertebrae act likeshock absorbers
When disks are injured from either wearand tear or a sudden force, they areunable to repair themselves very wellbecause they lack the rich blood supply
needed for healing
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Sciatica
Set of symptoms - not a disease in itself
When the sciatic nerve is irritated or
compressedCauses shock like or burning low back
pain that can extend down to the foot
Extreme cases can cause loss of motor
control
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Sciatica
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Sciatica Treatment
Self care under a doctors care
Chiropractic
Prescription medications
Epidural steroid injections
Physical therapy program
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Piriformis Syndrome
Muscle that runsabove the sciaticnerve.
When the musclebecomes tight,causes sciatica likepain down the leg
Prolonged sitting,car accidents, falls
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Piriformis Syndrome
Treatment Stretching- #1 treatment
Physical therapy
Massage therapy
Anti-inflammatory medications
Temperature treatments
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Spinal Stenosis
Congenital or age related narrowing of the spinalcanal
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Spinal Stenosis
Risk of developing increases after 50years of age, severity can increase with
age Treatments include
Pilates or yoga to stretch and strengthen thespine.
Physical therapy
Epidural steroid Injections
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Spondylosis
Spinal arthritis
Can allow for a forward
slippage of the vertebraeonto the vertebrae belowit
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Helping prevent spinal
osteoarthritis Stay ahead of the
game!
Get up and go!
Cut the fat!
Sit smart
Stand smart too!
Save those joints
Only eat the goodstuff
Kick the habit, dont
smoke!
No pain, all gain!
Be good to yourself
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Muscle Strains
The majority of back pain is caused by musclestrains
Usually heals with conservative treatments andtime
Muscles in the lower back have an excellentblood supply bringing it the necessary nutrientsfor healing to occur
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Medications
Over the counter
Acetaminophen, ibuprofen, aspirin
Narcotic pain relievers Not recommended for long term use
Tramadol, Oxycodone, Hydrocodone,Codeine
Muscle relaxants Treats muscle spasms
Tizanidine, Lorazepam, Baclofen, Dantrolene
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Treatment Options
Exercise
Temperature treatments
Physical therapy
Chiropractic
Acupuncture
Massage therapyWater therapy
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Did you notice surgery was not included?
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Exercise and Low Back Pain
The natural stimulus for healing process is activeexercise
The majority of people do not get enoughexercise from daily activities to support theirlower back muscles.
While some of these muscles are used ineveryday life, a complete exercise program foroptimal lower back health is needed
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The doctor said he needed moreactivity. So I hide his TV remote
three times a week
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Healthy Living
Exercise regularly
Maintain or achieve a healthy weight
Regular core strengthening exercises
Eat healthy, drink plenty of water
Practice good body mechanics
Good quality sleep
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Body Mechanics
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Sleeping Easier with Back
Pain No perfect position for everyoneListen
to your body
Pillow between your legs Firmer mattress
Egg crate or pillow top if it helps
Good sleep routine
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Easing back pain during
sleep
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Four things to take away
Chances are you will experience backpain at some point in your life
Expensive diagnostic tests cannotalways identify the cause of your pain
There is no quick fix
Establish a healthy lifestyle