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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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Presentation Transcript
slide2

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
slide9

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 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
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

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?
slide29

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
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
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

slide52

Back Pain

  • Thank you for participating today
  • Remember, your orthopaedic surgeon can help get you back in the game