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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


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
  • 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
  • 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
  • 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
  • Generally speaking –
    • Pain medications
    • Flexion based lumbar stretching and strengthening; Physical therapy
    • Steroid injection
    • Surgery
lumbar spondylolisthesis
Lumbar spondylolisthesis
  • 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
  • Usually thoracic, esp near thoracolumbar junction
  • Dowager’s hump / progressive kyphosis +/- scoliosis
osteoporotic compression fracture1
Osteoporotic Compression Fracture
  • 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
  • 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
  • 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!
  • 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
  • Wise to enlist healthcare professional’s help in the quest for health and wellness
  • Thank you for your attention.