A Discussion On Back Pain

1. 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

2. 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?

3. Pain is Undesirable • It negatively impacts your • Quality of life • Daily functions • Mood • Sleep • Social Interaction • Work • Play

4. 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

5. 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!

6. 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)

7. 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

8. 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

9. 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

10. What can we do to prevent back pain? • Slow down the aging phenomenon • Maximize spine health • Preserve function • Minimize pain

11. 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

12. 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

13. 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

14. 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

15. Lumbar stenosis / sciatica • Generally speaking – • Pain medications • Flexion based lumbar stretching and strengthening; Physical therapy • Steroid injection • Surgery

16. 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

17. Osteoporotic Compression Fracture • Usually thoracic, esp near thoracolumbar junction • Dowager’s hump / progressive kyphosis +/- scoliosis

18. Osteoporotic Compression Fracture • Treatment: • Opioids / pain medications • Thoracic extension exercises (superman) • TLSO brace or body shell • Kyphoplasty / vertebroplasty • Surgery • Tx underlying osteoporosis

19. 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

20. 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.

21. 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

22. 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.

23. Q & A