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TAKING CARE OF OUR BACK AND KNEES

TAKING CARE OF OUR BACK AND KNEES. INTRODUCTION. Back and knee pain are very common complaints by patients in Orthopedic practice Every alternate patient in Orthopedic outdoor is of back and knee problem Especially more in females

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TAKING CARE OF OUR BACK AND KNEES

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  1. TAKING CARE OF OUR BACK AND KNEES

  2. INTRODUCTION • Back and knee pain are very common complaints by patients in Orthopedic practice • Every alternate patient in Orthopedic outdoor is of back and knee problem • Especially more in females • Incidence of both the problems is very high in today’s busy life • Both are life time partners like diabetes and hypertension • Every one of us suffers from this problem in life one or other time

  3. Back problems are painful as well as costly • Change in concept in approach towards treatment • Anatomy of spine must be thoroughly known to diagnose & treat the problem • Role of patients awareness is very important in both back and knee problems • Eyes do not see what the mind do not know

  4. ANATOMY OF SPINE AND KNEE

  5. Anatomy • Thorough knowledge is must • Spine consists of blocks(vertebrae)stacked one on top of the other • Total - 33 vertebrae • Cervical -7(C1-7) • Thoracic - 12(T1-12) • Lumbar-5(L1-5) • Sacral-5(S1-5 fused in to one ) • Coccygeal -4(Often fused into one)

  6. Anatomy • Vertebrae • Ligaments • Ant. Longtudinal • Post. Longtudinal • ligamentum flavum • Supra Spinal • intra Spinal • Alienment of facets & nerve roots Needs special mention • Facets- • Nerve roots • Arrangement of spinal nerve roots with vertebrae is of major importance clinically

  7. SPINE

  8. SPINE

  9. LOWER LIMB

  10. ALL JOINTS

  11. KNEE JOINT

  12. details NORMAL Knee joint anatomy

  13. arthritis Understanding knee arthritis

  14. anatomy Understanding spine Normal spine

  15. Disc problems Understanding spine Normal& Degenerative spine

  16. Degenerative spine xrays Normal & osteoarthritis

  17. knee xrays spine

  18. Localizing Neurological Deficit

  19. Sciatica

  20. Clinical Evaluation • Challenging to physicians diagnostic skills • Diagnosis is more difficult due to • Spine is relatively inaccessible to complete physical examination • There is wide array of possible etiologies and underlying conditions

  21. Medical History • Age and Occupation • Onset of pain • Leisure and exercise activities • Pain characteristics and distribution • Temporal and mechanical features • Text neck syndrome

  22. Medical history • Use of computer and social media • Sitting arrangements • Work environment • Postural arrangements • Addictions • Psychological status of the patient

  23. Physical Examination • Tenderness • SLR • Neurological deficit • Peripheral pulsation • Diagnostic tests • X-ray • mylography • C.T. myelography • MRI- most recommendable • PET • Laboratory tests - depending upon cause

  24. Major Causes Of Low Back Pain • Varied etiology hence needs more attention to know the cause • Congenital • Spina bifida • Transitional vertebrae (Sacralization/ lumbarzation) • Tumors • Malignant • Benign

  25. Injury • Acute and chronic lumbar strain • Compression fractures • Facet syndromes • Spondylolysis/listhesis

  26. Metabolic Disorders • Osteoporosis • Inflammatory disease • Rheumatoid • Ankylosing Spondylitis

  27. Degenerative Disorder Spinal stenosis • Myofascial cycle • Spondylosis • Osteoarthritis • Disc herniation

  28. Psychosomatic Manifestations • Psychogenic pain syndrome • Functional Feigned pain • Malingering and compensatory behavior

  29. Clinical profile of knee pain • Pain, swelling, deformity • Inability to walk properly • Activities of daily living hampered • Clicking sound • Slowly progressive • Inability to squat • Inability to climb steps/staires

  30. Causes of knee pain • Trauma, especially repeated micro trauma • Life style related factors like obesity, sedentary life style • Addictions like smoking, alcohol, tobacco etc • Acute trauma • Degeneration. • Wear & tear of joint • More in knee as it is weight bearing joint • Rheumatoid arthritis • Drugs like steroids etc • Osteoporosis etc

  31. Investigations • X-ray • MRI • Blood investigations • CT SCAN • OTHER INVESTIGATIONS

  32. TREATMENT • Comprehensive approach is must • Drugs, diet, exercise are important • At times surgery is needed • Proper understanding of the problem • Team approach like Ortho. surgeon, dietician, physiotherapist, psychologist, councilors, and most important patient himself. • Concept of back school and knee club is important • 90% problems are addressed conservatively • Only 10% cases require surgical treatment

  33. Hamstring exercises Do’s & donot’s Do’s d 7

  34. Hamstring stretch Exercises Upper back exercises

  35. bones Bone and joint week back

  36. awareness Bone and joint week knee

  37. ROLE OF HEALTH EDUCATION & PUBLIC AWARENESS • VERY IMPORTANT ROLE • EYES DO NOT SEE WHAT MIND DO NOT KNOW

  38. Diet • Balanced diet • Satwik, santulit, sakas aahar • So many misunderstandings about diet • Proper dieticians advice is must • Calculated calorie conscious diet is needed • Important to keep weight in control

  39. Drugs or medical treatment • Useful • Proper drugs for proper disease • Opinion of expert is must • Basket of drugs is available like • Analgesics • Calcium • Dietary supplements • Steroids either orally or local/epidural injections • Various blocks

  40. Principals of Treatment • Conservative • Myofascial cycle dysfunction • Acute disc herniation • Chronic pain

  41. Surgical Management • Disc excision / Laminectomy • Spinal fusion • Chemonucleolysis • Minimally invasive procedures • New implant surgery • Endoscopic spinal surgery

  42. WHOLISTIC APPROACH • Wholistic approach is need of time • All possible remedies should be tried which are evidence based • Combination of therapies • Treat disease as well as patient as whole • Role of meditation, pranayam, yoga along with diet, exercise and drugs • At times surgical intervention must be done

  43. Comments • Many patients delay treatment because of fear and misbeliefs • This is unfortunate because competent surgeons & treatment methods are available • Gone are the days of fear & complications • Ultramodern Techniques available like Laser/Endoscopy • Newer implants • Experimental work like High pressure water streams, carbon dioxide & percutaneous techniques • lateral percutaneous discectomy

  44. Take home message • Back and knee problems are very common • Understanding the problem in scientific way is important • Only evidence based treatment should be taken • Team approach is important • Role of patient himself is very important • We can live happily with back and knee problems if we follow the advice of expert • Health education and public awareness is must • We are sure that change is possible with comprehensive approach • Prevention is always better than cure

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