Understanding back pain
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I. M. Doctor, M.D. My Office My City, State. UNDERSTANDING BACK PAIN. The information in this presentation was provided to the presenter by the American Academy of Orthopaedic Surgeons and may be modified. Endorsement of this presentation by the AAOS is not implied or inferred. Thank you to

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Understanding back pain

I. M. Doctor, M.D.

My Office

My City, State

UNDERSTANDING BACK PAIN


Understanding back pain 1283073

The information in this presentation was provided to the presenter by the American Academy of Orthopaedic Surgeons and may be modified.

Endorsement of this presentation by the AAOS is not implied or inferred.

Thank you to

A. Herbert Alexander, MD

for his significant contributions to the

content of this presentation.


Understanding back pain1

Understanding Back Pain

Orthopaedics and The Bone and Joint Decade

Types of back pain

Diagnosing the causes of back pain

Who is at risk for back pain?


Understanding back pain2

Understanding Back Pain

  • Seeking help

    • Therapies to help back pain sufferers

      • Medications

      • Surgery

      • Nonsurgical treatments

      • Complementary approaches


What is an orthopaedic surgeon

What is an orthopaedic surgeon?

MD who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine)


What is an orthopaedic surgeon1

What is an orthopaedic surgeon?

The expert in treating the musculoskeletal system

The expert in maintaining musculoskeletal health

The expert in understanding both operative and non-operative treatment options


Educating an orthopaedic surgeon

Educating an Orthopaedic Surgeon

  • College

  • Medical School

  • Internship

  • Orthopaedic Residency

  • Fellowship (optional)

  • 2 Years Practice

    TOTAL

4

4

1

4

(1)

2

16 years!


What do orthopaedic surgeons do

What do orthopaedic surgeons do?

  • Diagnose

  • Treat

    • Medication

    • Physical Therapy

    • Exercise

    • Brace

    • Surgery

  • Prevent


Understanding back pain 1283073

Back Pain

Your Orthopaedic Surgeon—

Getting You Back In The Game


Back pain

Back Pain

  • Structural Issues:

    • Muscular

    • Arthritic

    • Disk

  • Psychological Issues:

    • Emotional stress

  • Medical Issues:

    • Infections

    • Inflammatory conditions


Symptoms

Throbbing, aching, shooting, stabbing, dull or sharp pain

Pain down one or both legs with very little pain in the lower back

Numbness or weakness in the legs

Symptoms


Symptoms1

Pain down in the lower back & legs in certain positions such as standing or walking

Sleep problems, decreased energy, depression, and anxiety

Pain that stress and emotional issues causes or makes worse

Symptoms


General treatment

Examination by an orthopaedic surgeon

Period of activity modification

Perhaps medication to decrease pain and inflammation

Complete inactivity is not advised for more than a couple of days

General Treatment


General treatment1

Rehabilitation Goals

Increased muscle strength

Increased endurance

Increased flexibility

Improve aerobic fitness

General Treatment


Healthy spine function

Healthy Spine Function

Spinal Column

Cervical

Thoracic

Lumbar

Sacrum

Coccyx


Healthy spine function1

Healthy Spine Function

Facet joint

Vertebra

Disc

Spinal canal

Vertebra


Healthy spine function2

Healthy Spine Function


Healthy spine function3

Healthy Spine Function

Trapezius

Latissimus

Erector

spinae

muscles

Abdominal wall muscles

Obliques

Psoas

Gluteals


Burden of disease

Lower back pain is the one of the most commons common causes of missed work

Eight out of ten adults will experience back pain at some time

Burden of Disease


Burden of disease1

58 million ambulatory care visits for back and neck pain

82 million work days lost

Burden of Disease


Getting you back in the game

Getting You Back In the Game

Robert Dover

Olympic equestrian

Age: 44

Condition/Injury: Low Back Pain


Diagnosis

Herniated disc/sciatica

Sprain/Strain

Stress-related back pain

Diagnosis


Diagnosis1

Arthritis of spine

Symptomatic disc degeneration

Facet Syndrome

Spondylolisthesis & Spondylolysis

Diagnosis


Diagnosis2

Spinal fractures

Lumbar spinal stenosis

Chronic back pain syndrome

Diagnosis


Actual clinical case example

Actual Clinical Case Example:

Conchita Espinosa Chediak

Age: 41

Condition/Injury: Large herniated lumbar disc, severe back pain, and foot drop


Large disc herniation

Large Disc Herniation


Are you at risk

Job requires frequent bending and lifting

Twisting body when lifting & carrying an object

Lifting and carrying in a hurry

Are You At Risk?


Are you at risk1

Overweight

Do not exercise regularly

Do not engage in recreational physical activity

Smoker

Are You At Risk?


Understanding back pain 1283073

Plan ahead, don’t hurry

Tighten stomach muscles

Move in close when placing object on high shelf

Bend knees

Don’t twist

Lift with leg muscles

Spread feet shoulder distance apart

29


Seeking help

Seeking Help

Primary Care Physicians

Orthopaedic Surgeons

Spine Surgeons


Seeking help1

Before Your Appointment

Prepare to describe your symptoms

Gather medical history

Make list of medications

Write down concerns and questions and bring them

Seeking Help


Seeking help2

During Your Appointment

1. What should I expect from my treatment?

2. What effect will my treatment have on my daily activities?

3. What can I do to prevent further disability?

Seeking Help


Active therapies

Exercise is key

Aerobic conditioning program

Special back exercises

Active Therapies


Understanding back pain 1283073

Active Therapies: Exercise


Understanding back pain 1283073

Active Therapies: Stretching

35


Active therapies1

Pain Programs

Involve multiple healthcare professionals

Different treatments at different times

Goal is to decrease pain, increase functioning

Patient must be highly motivated

Active Therapies


Passive therapies

Passive Therapies

Ultrasound and massage

Water therapy

Transcutaneous Electrical Nerve Stimulation (TENS)


Passive therapies1

Passive Therapies

Traction

Corsets and braces


Medication

Why are you recommending this medication?

How will this medication help me to feel better?

What are the benefits and when will we know if it works?

Medication

8 Important Questions to Ask Your Orthopaedic Surgeon


Medication1

4. How do I take this medication?

5. What are the side effects? What to do if I have side effects? Are they temporary?

6. Is it okay to use generic?

Medication


Medication2

7.Can I take this medication with others I’m currently taking?

8.How do I stop taking it safely?

Medication


Medication3

Medication

Analgesics

Anti-inflammatories

Muscle relaxants

Sedatives

Anti-anxiety agents

Antidepressants


Invasive conservative treatments

Trigger point injections

Facet injection

Spinal epidural steroid injections

Selective nerve root blocks

Invasive Conservative Treatments

What to show here?


Surgery may be your choice when

Leg pain rather than back pain

Non-operative treatments are ineffective

Symptoms match test findings

Symptoms prevent daily living activities

Surgery May Be Your Choice When…


Surgery

Surgery

Finding a Surgeon


Asking questions about surgery

Why?

Alternatives?

Benefits and for how long?

Asking Questions About Surgery


Asking questions about surgery1

Risks?

What is procedure called?

How is it done?

Results?

Asking Questions About Surgery


Asking questions about surgery2

Duration of recovery?

Assistance at home and how long?

Disability after surgery?

Physical therapy?

Return to normal activity?

Asking Questions About Surgery


Back pain1

Back Pain

Therapies

Medication

Surgery

Complementary Approaches


Resources

Resources

American Academy of Orthopaedic Surgeons

6300 N. River Road

Rosemont, IL 60018

www.orthoinfo.org


What are your questions and concerns

What are your questions and concerns?

Back Pain


Understanding back pain 1283073

Back Pain

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  • Remember, your orthopaedic surgeon can help get you back in the game


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