Department of Physiology SKRP Gujrati Homoeopathic Medical College, Indore

1. BACKACHE THE BURNING PROBLEM NOW A DAYS Dr.A.K.Dwivedi BHMS (Gold Medallist),M.D. H.O D DIRECTOR Department of Physiology SKRP Gujrati Homoeopathic Medical College, Indore Advanced Homoeo-Health Center INDORE Ph. :- 09424083040

2. Backache is the most commonest complaints of patients coming to clinics for Homoeopathic Treatments. • Back pain strikes 4 out of 5 people at any time • in their lives. • 75 to 80 % OF ALL THE PEOPLE WILL EXPERIENCE • SOME FORM OF BACKACHE DURING • THEIR LIFETIME • It is difficult for the physician to point out the exact causes of • patient back pain ,because of complex composition of • human spine, disc, muscle, ligaments, tendons, nerves & • various other tissues which are arranged like ---- • three dimensional puzzle to make up the spine. • Anatomy of the back region is complex.

3. Many structures have the potential to cause pain. Only by having a sound knowledge of the anatomy and the pathologic process involving the area we can identify the cause and start treatment.

4. Basic anatomy • Man mostly lies on his back. • Back is an inherent weakness of human body • therefore the skin, fascia & muscles of the • back are adapted to sustain pressure • of the body weight. • The back, which extends from the skull • to the tip of the coccyx, can be defined • as the posterior surface of the trunk. WHAT IS BACK

5. The Vertebral column • The vertebral column is the central bony pillar of the • body. It supports the skull, pectoral girdle, upper • limbs and thoracic cage and by way of the pelvic • girdle transmits body weight to the lower limbs. • Within its cavity lie the spinal cord, the roots of the • spinal nerves and the covering meninges, to which • the vertebral column gives great protection WHAT IS BACK

6. Composition of the vertebral column • The vertebral column is composed of 33 vertebrae- • 7 cervical, • 12 thoracic, • 5 lumber, • 5 sacral (fused to form • the sacrum) • 4 coccygeal (the lower • 5 are commonly fused) WHAT IS BACK

7. 1)    The Intervertebral discs are responsible for ¼ of the length of the spinal cord. 2)    They may be regarded as semi elastic disc which lies between the rigid bodies of adjacent vertebrae. 3)  Their physical characteristics permit them to serve as the shock absorber when the load on vertebral column is suddenly as when one is jumping from a height. INTERVERTBRAL DISCS

8. Joints and pads of fibro cartilage between vertebras called • INTERVERTEBRAL DISCS.

9. MUSCLES OF BACK

10. The curvature provide a flexible support ( shock absorbing resilience) for body • The four curvature of the adult vertebral column • 1)    Cervical • 2)    Thoracic • 3)    Lumbar • 4) Sacral CURVATURE OF VERTERBRAL COLUMN

11. CURVATURE OF VERTERBRAL COLUMN In the fetus the vertical column has one continuous anterior concavity as development proceeds the lumbosacral angle appears. After birth when the child becomes able to raise her head and keep it poised on the vertebral column the cervical part of the vertebral column becomes concave posteriorly .

12. The following movement of vertebral column are possible :- 1)     Flexion 2)     Extension 3)     Lateral bending 4) Rotation MOVEMENTS OF VERTEBRAL COLUMN

13. When we lift a weight, its effect on the lumbosacral • disc is magnified because of very small cross • sectional area of the disc. • In order to understand the importance of area, we can visualize ourselves standing on sand or lying down on sand. • If we stand our feet sink in; if we lie down we hardly make a dent on the sand. Although the body weight is same in both cases the difference lies in the area through which it acts on sand, The area of the feet is much smaller than that of the back. • Therefore when we stand on the sand the pressure (force per unit area) is much greater the whenwe lie down. PATHO-PHYSIOLOGY

14. Coming back to the back, the Intervertebral • discs have a very small cross sectional area. • ·    Therefore when we lift a heavy weight, they can • be subject to a pressure greater than they • can withstand PATHO-PHYSIOLOGY

15. The reason why our discs still generally escape Injury is that when we lift a heavy weight, the muscles of the back, the intercostals, The muscles of the abdominal wall, And The diaphragm undergo reflex contraction. PATHO-PHYSIOLOGY

16. ·        Therefore if the load is shared by the large cylinders, the pressure on the discs is very much reduced. ·        But we can understand that for effective sharing of load, the abdominal and back muscles should be strong. That is why regular exercises aimed at strengthening these muscles are very useful in preventing backache PATHO-PHYSIOLOGY

17. THE BURNING PROBLEM NOW A DAYS BACKACHE

18. Back pain is one of the most common musculo skeletal disorders. The pain effects the lower lumbar spine, lumbo sacral area and sacro iliac. It may radiate down the legs in a reticular or sternal distribution. The source of pain can be vertebra, Intervertebral joints, muscles, ligaments, nerves and fascia. BACKACHE

19. 1)Acute 2) Developmental defect 3) Inflammatory defects 4) Osteoarthritis 4) Mechanical trauma 5) Miscellaneous 6) Psychological cause 7) Gynecological 8) Surgical CAUSES OF BACKACHE

20. 1) Acute • a) Trauma to ligaments, muscle, vertebra. CAUSES OF BACKACHE

21. b) Muscle strain CAUSES OF BACKACHE Muscle strain of the lower back cause debilitating back pain Leads to inflammation causing pain and muscle spasm

22. c) Fracture of spine CAUSES OF BACKACHE

23. Developmental defects CAUSES OF BACKACHE kyphosis

24. Developmental defects CAUSES OF BACKACHE Lardosis

25. Developmental defects CAUSES OF BACKACHE Scolosis

26. 3)    Inflammatory defects ·       Ankylosing spondylitis (SSA) ·       Diskitis ·       Osteoporosis ·       Sarcoilitis Archnoiditis CAUSES OF BACKACHE

27. CAUSES OF BACKACHE DISKITIS

28. CAUSES OF BACKACHE OESTEOPOROSIS

29. 4) Osteoarthritis when arthritis effects the spine , vertebrae rub together, causing pain , stiffness, swelling and loss of motion. weakness or numbness of the arm or legs can also results CAUSES OF BACKACHE

30. Spinal Stenosis • when the spinal canal narrows and pinches the spinal cord and nerves causing pain and loss of sensation • Narrowing is a results of the degeneration wearing down, of the vertebral joints • Symptoms include pain while walking or standing CAUSES OF BACKACHE

31. Mechanical • a. Poor posture and conditioning often aggravated by obesity, pregnancy and overuse. • b.    Strain and sprain • c.     Failed back syndrome (FBS) • d.    Myelopathy • e.     Herniated disc • f. Degenerative diseases CAUSES OF BACKACHE

32. Herniated disc • Occurs due to • A fall or accident • Repeated straining of back • A sudden sternous action such as lifting a heavy weight or twisting voilently • Symptoms include • Back pain • Numbness tingling, pain , weakness in one or both legs ( this is called sciatica) • Changes in bladder and bowel habits CAUSES OF BACKACHE

33. Miscellaneous conditions a.  Osteitis b. Paget’s disease CAUSES OF BACKACHE

34. Psychological cause • ·        Anxiety • ·        depression • ·        frustration • ·       reinforcement • stress, anger and fear CAUSES OF BACKACHE

35. Gynecological cause • 1)     Fibroid • a)     Cervical fibroid • b)    Uterine fibroid • c)    Ovarian fibroid • 2)     Mennorhagia • 3)     Dysmennorhoea • 4)     Pelvic inflammatory disease • 5)     Prolapse of uterus • 6)     Retroverted uterus • 7)     Endometriosis • 8)     Leucorrhoea • 9)     Sexual excess CAUSES OF BACKACHE

36. Surgical cause 1)     Surgical trauma 2) Surgical operation CAUSES OF BACKACHE

37. 1)     Children • Malignancy • Infection • Psychogenic • Abnormal vertebral column • 2)   Adolescents • Ankylosing • Spondylosis • Osteochondritis • 3)     Young adults • Prolapsed inter vertebral disc • Ligaments injury • Sexual excess • postural discomfort IN RELATION TO AGE CAUSES OF BACKACHE

38. 3)     Young adults Prolapsed inter vertebral disc Ligaments injury Sexual excess postural discomfort 4)     Middle age Degenerative disease Spondylosis 5)     Aged Osteoporosis Malignancy Paget”s Disease IN RELATION TO AGE CAUSES OF BACKACHE

39. If any patient complains backache the • problem may be of- • 1)     Bone • 2)     Muscle • 3)     Ligaments • 4)     Nerves • 5)     Joints • We must find out • whether it is any of this kind. CLINICAL SIGN & SYMPTOMS

40. 1)     Severe Backache • 2)     Swelling • 3)      Local inflammation • 4)      Coldness • 5)      Numbness in both limbs • 6)      Redness • 7)      Tenderness • 8)      Stiffness • 9)      Anemia • 10) Fever • 11) Weakness Symptoms OF Backche

41. 12) Pain in back a)     Aching b)    Cramping c)    Fatigueness 13) Pain & discomfort in the legs 14) Claudication with the middle aged and older people we can ask Symptoms OF Backche

42. CLINICAL EXAMINATON

43. If a Patient is coming with pain in BACK • the pain can be of following things. • Bone • Muscle • Tendons • Ligaments • Blood vessles • Nerve • Local Examination of – • Swelling /Edema • Tender • Redness • Any eruption • Tortuousness of veins • Hot/cold ( temperature ) • Movement • Sound (cracking ) CLINICAL EXAMINATION

44. With the middle aged and older people, • we can ask • How far he /she can walk without doing rest. • Problems in tissue around joints include • 1)     Inflammation of bursa (BURSITIS) • 2)     Tendons (TENDONITIS) • 3)     On tendon sheath (TENOSYNOVITIS) • 4) Stretching or tearing of ligament • (SPRAIN) CLINICAL EXAMINATION

45. Inspection • ·  Begin by observing the patient’s • posture, including the • position of both neck and trunk, • when entering the room. • ·  Access the patient for the erect position • of the head, smooth, • coordinated neck movement and easy of gait. • ·  If possible the patient should be upright in the • patient’s natural standing position • with feet together and arms hanging at the sides • Inspect the patient from the side, note any spinal • curvatures CLINICAL EXAMINATION

46. Palpation • ·  From a sitting or standing position, • Palpate the • spinous process of each vertebra • with your thumb. • In the neck also palpate the facet joints • that lie between the cervical vertebra. • ·Percuss the spine for tenderness • by thumping • with the ulnar surface of your fist. • Inspect and palpate the pre-vertebral muscles for • tenderness and spasm. CLINICAL EXAMINATION

47. ASSESS THE RANGE OF MOTION CLINICAL EXAMINATION IN THE SPINAL CLUMN

48. FLEXION • ·  Ask the patient to bent forward to touch the toes (flexion). • · Note the smoothness and symmetry of movement. • · The range of motion and the curve in the lumbar area. CLINICAL EXAMINATION As flexion proceed the lumbar concavity should flatten out.

49. EXTENSION Place your hands on the posterior, superior iliac spine with your fingers Pointing towards the midline and ask the patient to bend backward as far as possible. CLINICAL EXAMINATION

50. Rotation CLINICAL EXAMINATION ·       Stabilize the pelvis by placing one hand on the patient’s hip and other on the opposite shoulder. Then rotate the trunk by pulling both the shoulder and the hip posteriorly.