BACKACHEPREVENTION AND CURE

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BACKACHE-PREVENTION AND CURE

• DR DEEPAK AGRAWAL
• All India Institute of Medical Sciences,
• New Delhi

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• Vertebrae
• In the neck there are seven cervical vertebrae
• Supporting the chest there are 12 thoracic
  vertebrae
• Next are five lumbar vertebrae
• Below them is the sacrum (which consists of 5
  sacral vertebrae)

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• Intervertebral Discs
• 23 narrow spongy shock absorbers which fit
  between the 24 separate bones of you
  spine.Without the discs these bones would grate
  and crunch every time you moved

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• Each disc has a strong fibrous outer casing -
  called the annulus fibrosus - and a soft,
  squashy, jelly-like interior called the nucleus
  pulposus - which is reinforced with strands of
  fibre.

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• Intervertebral discs have very little in the way
  of nerve supply and contain no blood. They are
  made up largely of water.
• As you get older the amount of fluid in your
  discs will diminish slightly - and as a result
  you will get shorter.

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• Although any disc in the entire spine can
  prolapse or burst, the most common ones to which
  this happens are the lowest two, that is between
  the fourth and fifth lumbar vertebrae and between
  the fifth lumbar and the top of the sacrum.

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Backache

• WHAT CAUSES BACK PAIN?
• Disc injury
• Degenerative disc disease.

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Backache

• RUPTURD DISC
• A ruptured disc is an injured or damaged disc
  that leaks out watery jelly (called nucleus
  pulposus) from the center of the disc.
• This leakage reduces the shock absorber effect
  and sometimes the jelly presses against a nerve
  and causes pain, primarily leg pain.

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• Prolapsed Disc
• The phrase "a slipped disc" is used very commonly
  and indeed at some time of other this diagnosis
  has been blamed for producing almost every form
  of acute back pain. There are two major errors in
  this.
• 1.All discs do not and cannot slip.
• 2.what does go wrong and may be called a "slipped
  disc" is much less frequent than previously
  thought

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Backache

• DEGENERATIVE DISC DISEASE
• As discs degenerate, they lose their water
  content and height, bringing vertebrae closer
  together.
• The nerve openings are consequently narrowed and
  the added pressure from the disk can pinch a
  nerve causing back or leg pain.

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Backache

• PROBLEMS
• The Neck
• The Mid Back
• The Lower Back
• Hips
• Base of the Spine

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Backache

• NECK
• A slipped or prolapsed disc in the cervical spine
  could result in a severe pain in your shoulder,
  arm or hand.
• Small movements may make the pain worse.
• accompanied by numbness or tingling in the fingers

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Backache(CHART)

• MID BACK
• Back pain that becomes worse after sitting in one
  position for a long time may be caused by poor
  posture or by a badly-designed chair.
• Stress, anxiety and emotional worries can lead to
  muscle tension which results in aches and pains
  in the back. This is one of the MOST COMMON
  causes of back pain - probably affecting as many
  as eight out of ten sufferers.

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Backache

• TYPES
• Sudden onset
• Continuous
• Exacerbated on 1. Exercise
• 2. Passing urine
• 3. Movement/ cold weather

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Backache

• SUDDEN ONSET PAIN
• If your pain started after a trivial movement -
  such as tying up your shoe laces or turning over
  in bed - it may be a result of a slipped disc or
  a joint problem in your spine.
• Pain going down one or both legs, or numbness or
  tingling in one or both legs, then you may be
  suffering from sciatica

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Backache

• CONSTANT PAIN
• Radiates round the chest - a fracture caused by
  osteoporosis of thin bones.
• Accompanied by discomfort when passing urine
  and/or blood in your urine - kidney
  infection/Stone.
• In the middle of the back that is made worse by
  eating and accompanied by indigestion - stomach
  ulcer.

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Backache

• CONSTANT PAIN (Contd.)
• Low back pains that are accompanied by
  gynecological symptoms (discharge, bleeding etc.)
  may suggest a gynecological cause - such as
  period pain.

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• INVESTIGATIONS
• MRI (Magnetic Resonance Imaging) scan is the
  most common test used to look at the spine. This
  allows us to view not only the bones of the
  spine, but also the nerves and disks.
• Slices can also be taken across the spine, giving
  a cross sectional view.
• The MRI scanner allows us to see the nerves and
  disk quite clearly.
• No special dyes or needles are necessary.

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MRI
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• MRI

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• The MRI scan is, perhaps, too good at showing
  the anatomic details of the spine.
• growing body of evidence suggests that not all
  abnormalities that show up on the MRI scan are
  really the cause of the individual patient's
  problem.
• Abnormalities, such as bulging disks, show up
  frequently in normal volunteers undergoing MRI
  scans-people who have never had any problem with
  their back.

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Backache

• MANAGEMENT
• Conservative
• Surgery

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Backache

• CONSERVATIVE MANAGEMENT
• Good posture
• Bed rest on hard bed
• Exercises
• Stress therapy

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• POSTURE
• The neck has a slight natural curve, which sits
  on top of the two curves in the middle and lower
  back.
• Correct posture maintains all three curves and
  prevents undue stress and strain by distributing
  body weight evenly

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• STANDING POSTURE
• In correct, fully erect posture, a line dropped
  from the ear will go through the tip of the
  shoulder, the middle of the hip, the back of the
  kneecap and the front of the anklebone.

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• SITTING POSTURE
• When sitting in any position, the three back
  curves need to be maintained.
• If you cannot sit without slouching forward or
  backward, you need to support yourself with hands
  and arms or lean against a wall or chair back.

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SITTING POSTURE
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SITTING POSTURE
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• LYING POSTURE
• Avoid propping head or upper body up on an arm
  and hand.
• Head should remain relaxed. Legs should be
  together.

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Backache

• EXERCISES
• Cat Back
• Fetal Position
• Arm exercises

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• Alternate Leg Slides
• Alternate Leg Raises

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• RELIEVE STRESS
• Yoga
• Meditation

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• SURGERY
• Only considered if
• Conservative management fails
• Patient develops neurological deficits (weakness,
  numbness, change in reflexes)

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• Diskectomy
• the removal of a herniated disk to relieve
  pressure on a nerve root
• Window in the lamina-retract nerve-removal of
  herniated disc material-healing by scar tissue

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• Laminectomy
• derived from lumber (lower spine), lamina (part
  of the spinal canal's bony structure) and -ectomy
  (removal).
• The operation is performed to relieve pressure on
  one or more spinal nerve roots

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• What To Expect After Surgery
• Pain
• It is normal to have pain after your operation.
  It will be most severe in the lower back area
  where the surgery was done. Residual leg pain is
  not unusual, this is caused by swelling of the
  previously compressed nerve as well as from
  surgery itself.

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• Activity
• Initially, you are permitted to get out of bed
  following surgery with the assistance from a
  nurse. Thereafter, you should be up walking as
  much as tolerated.

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• General Attitude
• It is normal to feel physically and emotionally
  let down and tired the second and third day after
  surgery.
• Natural reaction to the stress of surgery and the
  lingering effects of anesthesia.
• Must not be allowed to get in the way of your
  positive attitude that is essential for recovery
  to normal activity.

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• PREGNANCY BACKACHE
• Apply heat(try sitting in a warm tub or jacuzzi).
  
• Wear a support gadget (such as abdominal support
  straps).
• Do strengthening exercises. Pelvic-tilt exercises
  help strengthen the back, relieving pain.
• Take medications cautiously

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• Sex and the Back
• Sexuality is an integral part of normal and
  healthy relationships. It need not be the first
  thing abandoned when you are bothered by a
  flare-up of your neck or back pain. If you have
  chronic pain, it should not prevent you from
  enjoying this part of your relationship.

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• 3 components of sexual functioning
• emotional and psychological aspects of sexuality.
  
• physiological and anatomical ones. (These refer
  to your equipment and wiring).
• inability to get into a comfortable position due
  to neck or back pain.

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• The nerve connections, or wiring, must be intact
  from the brain to the sexual organs and they must
  get an adequate blood supply in order for things
  to proceed "normally".
• There are a very large number of medical
  conditions that can affect sexuality in this
  fashion. These include but are not limited to
  diabetes, heart disease, prostatism, vascular
  disease, and the pain from compression of a nerve.

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• Positions that are not comfortable in your
  day-to-day activities will not be comfortable
  during sex either.
• Do not be afraid to experiment, there is no right
  or wrong, normal or abnormal.
• Please do not try any sexual positions without
  your doctor present.

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• Just kidding - but Watch Your Back!!

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• THANK YOU