BACKACHE-PREVENTION AND CURE DR DEEPAK AGRAWAL All India Institute of Medical Sciences, New Delhi
Vertebrae • In the neck there are seven cervical vertebrae • Supporting the chest there are 12 thoracic vertebrae • Next are five lumbar vertebrae • Below them is the sacrum (which consists of 5 sacral vertebrae)
Intervertebral Discs • 23 narrow spongy shock absorbers which fit between the 24 separate bones of you spine.Without the discs these bones would grate and crunch every time you moved
Each disc has a strong fibrous outer casing - called the annulus fibrosus - and a soft, squashy, jelly-like interior called the nucleus pulposus - which is reinforced with strands of fibre.
Intervertebral discs have very little in the way of nerve supply and contain no blood. They are made up largely of water. • As you get older the amount of fluid in your discs will diminish slightly - and as a result you will get shorter.
Although any disc in the entire spine can prolapse or burst, the most common ones to which this happens are the lowest two, that is between the fourth and fifth lumbar vertebrae and between the fifth lumbar and the top of the sacrum.
Backache WHAT CAUSES BACK PAIN? • Disc injury • Degenerative disc disease.
Backache RUPTURD DISC: • A ruptured disc is an injured or damaged disc that leaks out watery jelly (called nucleus pulposus) from the center of the disc. • This leakage reduces the shock absorber effect and sometimes the jelly presses against a nerve and causes pain, primarily leg pain.
Prolapsed Disc The phrase "a slipped disc" is used very commonly and indeed at some time of other this diagnosis has been blamed for producing almost every form of acute back pain. There are two major errors in this. • 1.All discs do not and cannot slip. • 2.what does go wrong and may be called a "slipped disc" is much less frequent than previously thought
Backache DEGENERATIVE DISC DISEASE • As discs degenerate, they lose their water content and height, bringing vertebrae closer together. • The nerve openings are consequently narrowed and the added pressure from the disk can pinch a nerve causing back or leg pain.
Backache PROBLEMS • The Neck • The Mid Back • The Lower Back • Hips • Base of the Spine
Backache NECK • A slipped or prolapsed disc in the cervical spine could result in a severe pain in your shoulder, arm or hand. • Small movements may make the pain worse. • accompanied by numbness or tingling in the fingers
Backache(CHART) MID BACK: Back pain that becomes worse after sitting in one position for a long time may be caused by poor posture or by a badly-designed chair. Stress, anxiety and emotional worries can lead to muscle tension which results in aches and pains in the back. This is one of the MOST COMMON causes of back pain - probably affecting as many as eight out of ten sufferers.
Backache TYPES: • Sudden onset • Continuous • Exacerbated on 1. Exercise 2. Passing urine 3. Movement/ cold weather
Backache SUDDEN ONSET PAIN: • If your pain started after a trivial movement - such as tying up your shoe laces or turning over in bed - it may be a result of a slipped disc or a joint problem in your spine. • Pain going down one or both legs, or numbness or tingling in one or both legs, then you may be suffering from sciatica
Backache CONSTANT PAIN: • Radiates round the chest - a fracture caused by osteoporosis of thin bones. • Accompanied by discomfort when passing urine and/or blood in your urine - kidney infection/Stone. • In the middle of the back that is made worse by eating and accompanied by indigestion - stomach ulcer.
Backache CONSTANT PAIN (Contd.): • Low back pains that are accompanied by gynecological symptoms (discharge, bleeding etc.) may suggest a gynecological cause - such as period pain.
INVESTIGATIONS: MRI (Magnetic Resonance Imaging) scan is the most common test used to look at the spine. This allows us to view not only the bones of the spine, but also the nerves and disks. • Slices can also be taken across the spine, giving a cross sectional view. • The MRI scanner allows us to see the nerves and disk quite clearly. • No special dyes or needles are necessary.
The MRI scan is, perhaps, too good at showing the anatomic details of the spine. • growing body of evidence suggests that not all abnormalities that show up on the MRI scan are really the cause of the individual patient's problem. • Abnormalities, such as bulging disks, show up frequently in normal volunteers undergoing MRI scans-people who have never had any problem with their back.
Backache MANAGEMENT • Conservative • Surgery
Backache CONSERVATIVE MANAGEMENT: • Good posture • Bed rest on hard bed • Exercises • Stress therapy
POSTURE: • The neck has a slight natural curve, which sits on top of the two curves in the middle and lower back. • Correct posture maintains all three curves and prevents undue stress and strain by distributing body weight evenly
STANDING POSTURE • In correct, fully erect posture, a line dropped from the ear will go through the tip of the shoulder, the middle of the hip, the back of the kneecap and the front of the anklebone.
SITTING POSTURE • When sitting in any position, the three back curves need to be maintained. • If you cannot sit without slouching forward or backward, you need to support yourself with hands and arms or lean against a wall or chair back.
LYING POSTURE: • Avoid propping head or upper body up on an arm and hand. • Head should remain relaxed. Legs should be together.
Backache EXERCISES: • Cat Back • Fetal Position • Arm exercises
Alternate Leg Slides • Alternate Leg Raises
RELIEVE STRESS • Yoga • Meditation
SURGERY Only considered if: • Conservative management fails • Patient develops neurological deficits (weakness, numbness, change in reflexes)
Diskectomy • the removal of a herniated disk to relieve pressure on a nerve root • Window in the lamina-retract nerve-removal of herniated disc material-healing by scar tissue
Laminectomy • derived from lumber (lower spine), lamina (part of the spinal canal's bony structure) and -ectomy (removal). • The operation is performed to relieve pressure on one or more spinal nerve roots
What To Expect After Surgery Pain: • It is normal to have pain after your operation. It will be most severe in the lower back area where the surgery was done. Residual leg pain is not unusual, this is caused by swelling of the previously compressed nerve as well as from surgery itself.
Activity: Initially, you are permitted to get out of bed following surgery with the assistance from a nurse. Thereafter, you should be up walking as much as tolerated.
General Attitude • It is normal to feel physically and emotionally let down and tired the second and third day after surgery. • Natural reaction to the stress of surgery and the lingering effects of anesthesia. • Must not be allowed to get in the way of your positive attitude that is essential for recovery to normal activity.
PREGNANCY& BACKACHE: • Apply heat(try sitting in a warm tub or jacuzzi). • Wear a support gadget (such as abdominal support straps). • Do strengthening exercises. Pelvic-tilt exercises help strengthen the back, relieving pain. • Take medications cautiously
Sex and the Back • Sexuality is an integral part of normal and healthy relationships. It need not be the first thing abandoned when you are bothered by a flare-up of your neck or back pain. If you have chronic pain, it should not prevent you from enjoying this part of your relationship.
3 components of sexual functioning: • emotional and psychological aspects of sexuality. • physiological and anatomical ones. (These refer to your equipment and wiring). • inability to get into a comfortable position due to neck or back pain.
The nerve connections, or wiring, must be intact from the brain to the sexual organs and they must get an adequate blood supply in order for things to proceed "normally". • There are a very large number of medical conditions that can affect sexuality in this fashion. These include but are not limited to diabetes, heart disease, prostatism, vascular disease, and the pain from compression of a nerve.
Positions that are not comfortable in your day-to-day activities will not be comfortable during sex either. Do not be afraid to experiment, there is no right or wrong, normal or abnormal. Please do not try any sexual positions without your doctor present.