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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. The objective of today’s presentation is as follows:. Let’s gain a better understanding of back pain

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A discussion on back pain

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


The objective of today s presentation is as follows
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?


Pain is undesirable
Pain is Undesirable

  • It negatively impacts your

    • Quality of life

    • Daily functions

    • Mood

    • Sleep

    • Social Interaction

    • Work

    • Play


What is spine anatomically
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


Kinetic chain of the spine
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!


Young vs old spine
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)


Who gets back pain
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


Causes of pain impaired function
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


Other factors affecting spine
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


What can we do to prevent back pain
What can we do to prevent back pain?

  • Slow down the aging phenomenon

    • Maximize spine health

    • Preserve function

    • Minimize pain


The key is to strengthen the muscle around the spine by lengthening it
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


Diagnosis and treatment for back pain
Diagnosis and Treatment for back pain lengthening it !

  • 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


Specific treatment depends on actual pathology
Specific Treatment depends on actual pathology lengthening it !

  • Disc herniation

  • Lumbar stenosis

  • Sciatica / lumbar radiculopathy

  • Lumbar spondylolisthesis (slippage)

  • Compression fracture(s) from osteoporosis

  • Sacroiliac joint pain / facet joint pain


Lumbar disc herniation
Lumbar Disc Herniation lengthening it !

  • 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


Lumbar stenosis sciatica
Lumbar stenosis / sciatica lengthening it !

  • Generally speaking –

    • Pain medications

    • Flexion based lumbar stretching and strengthening; Physical therapy

    • Steroid injection

    • Surgery


Lumbar spondylolisthesis
Lumbar spondylolisthesis lengthening it !

  • 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


Osteoporotic compression fracture
Osteoporotic Compression Fracture lengthening it !

  • Usually thoracic, esp near thoracolumbar junction

  • Dowager’s hump / progressive kyphosis +/- scoliosis


Osteoporotic compression fracture1
Osteoporotic Compression Fracture lengthening it !

  • Treatment:

    • Opioids / pain medications

    • Thoracic extension exercises (superman)

    • TLSO brace or body shell

    • Kyphoplasty / vertebroplasty

    • Surgery

    • Tx underlying osteoporosis


Sacroiliac joint pain
Sacroiliac joint pain lengthening it !

  • Unilateral

    • Trauma

    • Leg-length discrepancy, causing asymmetric stress

  • Bilateral

    • Weakness of stabilizers of the SI joints

    • Rule out autoimmune disease in younger pts


Facet joint pain
Facet joint pain lengthening it !

  • 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.


Prevention is the key
Prevention is the key! lengthening it !

  • 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


Knowledge is power help yourself and others
Knowledge is power! Help yourself and others lengthening it !

  • Wise to enlist healthcare professional’s help in the quest for health and wellness

  • Thank you for your attention.


Q & A lengthening it !


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