Back Pain. The Truth, The Whole Truth and Nothing But The Truth

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June McDaniel
5 years ago
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1 Back Pain The Truth, The Whole Truth and Nothing But The Truth

The Serious Causes of Back Pain Cancer Infection Discitis Osteomyelitis Epidural Abscess Red Flags Severe pain even when supine Acute spinal tenderness Onset

2 The Serious Causes of Back Pain Cancer Infection Discitis Osteomyelitis Epidural Abscess Red Flags Severe pain even when supine Acute spinal tenderness Onset > 50 or < 20 years Nocturnal pain that disturbs sleep Bilateral Neurological deficits in lower limbs Bladder/Bowel dysfunction Saddle anaesthesia/paraesthesia

3 Incidence & Prevalence Back pain is extremely common most people will experience it in their lifetime Incidence is highest in the 3 rd decade Point prevalence = 18%; I year prevalence = 38% Prevalence increases with age up to 60-65, then decreases The lifetime prevalence of non-specific back pain in the industrialised world = 60 70% Recurrence is common after one episode of activity-limiting back pain

4 Global Burden of Disease Study Largest most comprehensive worldwide observational epidemiological study to date ( ) 310 Diseases & Injuries; 195 countries and 519 geographical areas Low back pain prevalence = 540 million in 2015; increased by 17% since 2005 As common as dental caries, more common than diabetes, asthma, neck pain, COPD or Ischaemic heart disease. Disability Adjusted Life Years (DALYs) in 2015 = 60 million Among the top 10 conditions and injuries that account for the highest number of DALYs worldwide In the UK, most common cause of disability in young adults 100 million workdays lost/year In the US, economic burden is estimated at $ Billion/year

5 Anatomy 3 curves Cervical and Lumbar lordosis Thoracic kyphosis Why is it in 3 curves? Cervical v Lumbar vertebrae

7 Muscles

8 Multifidus

9 Muscle Atrophy PS = Psoas Major IT = Intertransversarius QL = Quadratus Lumborum IL = Iliocostalis Lumborum LO = Longissimus MU = Multifidus

10 Nerve Supply

11 Levers & Biomechanics

12 More Biomechanics In this position, to lift a weight of 25 kg creates a force through the spine that can be up to 12 times greater (300 kg)

13 What causes back pain? Origin Muscles Pulled/torn muscle Ligaments Torn ligament Joints Facet joint arthropathy Bones Collapse/end plate disruption Discs Degeneration Prolapse Osteoarthritis Ostoearthropathy Spondylitis All Wear and Tear Pathogenesis Genetic Finnish Twin Study Congenital Spondylolysis/Spondylolisthesis Trauma or Injury Occupation Heavy v Light Active v Sedentary Repetitive Strain Lifestyle Sport Activity Levels Obesity Smoking

14 What causes back pain? Ligaments Facet Joints

15 What causes back pain? Origin Muscles Pulled/torn muscle Ligaments Torn ligament Joints Facet joint arthropathy Bones Collapse/end plate disruption Discs Degeneration Prolapse Osteoarthritis Ostoearthropathy Spondylitis All Wear and Tear Pathogenesis Genetic Finnish Twin Study Congenital Spondylolysis/Spondylolisthesis Trauma or Injury Occupation Heavy v Light Active v Sedentary Repetitive Strain Lifestyle Sport Activity Levels Obesity Smoking

16 Prolapsed Disc

17 What causes back pain? Origin Muscles Pulled/torn muscle Ligaments Torn ligament Joints Facet joint arthropathy Bones Collapse/end plate disruption Discs Degeneration Prolapse Osteoarthritis Osteoarthropathy Spondylosis All Wear and Tear Pathogenesis Genetic Finnish Twin Study Congenital Spondylolysis/Spondylolisthesis Trauma or Injury Occupation Heavy v Light Active v Sedentary Repetitive Strain Lifestyle Sport Activity Levels Obesity Smoking

18 Spondylolysis Spondylolisthesis

19 What causes back pain? Origin Muscles Pulled/torn muscle Ligaments Torn ligament Joints Facet joint arthropathy Bones Collapse/end plate disruption Discs Degeneration Prolapse Osteoarthritis Ostoearthropathy Spondylitis All Wear and Tear Pathogenesis Genetic Finnish Twin Study Congenital Spondylolysis/Spondylolisthesis Trauma or Injury Occupation Heavy v Light Active v Sedentary Repetitive Strain Lifestyle Sport Activity Levels Obesity Smoking

20 Spinal Stenosis Spinal Claudication Pain/Numbness/Weakness on walking Limping

21 Treatment? Rest Early mobilisation Analgesia Over the Counter/Combination Exercise Physiotherapy Osteopathy/Chiropractic/Acupuncture Injections Surgery Neuromodulation

22 Myths I m worried when I get back pain, I m causing more damage I don t like taking painkillers because they mask the pain and I might not know I m doing more damage The Osteopath manipulated my spine and put the disc back in. Traction puts the disc back Wearing a corset or support belt helps to support the back and reduce pain Movement is bad for my back, so I have to be so careful I been told that if I m not careful I ll end up in a wheel chair

23 ? Back Pain Mostly the Truth, Not Entirely the Whole Truth and Maybe Almost the Truth (but not quite)

Common Thoraco- Lumbar Problems in the Mature Athlete

Common Thoraco- Lumbar Problems in the Mature Athlete Diana Heiman, MD Associate Professor, Family Medicine Residency Director East Tennessee State University Objectives Review the pathophysiology of the