You and your back TAKE CARE OF YOUR BACK BACK CONDITIONS OVERVIEW

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1 Take care f yur back Back cnditins verview Anatmy f yur back What is Sclisis? What is Osteprsis? Acute lw back pain TAKE CARE OF YOUR BACK Yu and yur back Intrductin: Back pain is a very cmmn health prblem. Apprximately 90% f the ppulatin suffers frm back pain at smetime in their lives that requires treatment. Back pain and injuries related t lifting and material handling are sme f the mst frequent type f injuries, bth n and ff the jb. Sme back pain is due t misuse f yur back. Yu can prevent back pain by yurself. Cmmn causes f Lwer Back Pain: Sitting fr a lng time in a pr wrking psture. Prlnged bending. Heavy lifting. Pr standing, sitting r lying psture. Prly arranged wrking envirnment. Gd psture: Psture refers t the psitin f a persn in lying, sitting, standing r while ding any type f activity. In all these psitins yur spine shuld resemble an S shape curve which is the best psture fr yur spine. Gd psture places minimal stress n yur spinal, muscles and jints. BACK CONDITIONS OVERVIEW Back Strains and Sprains - A strain is a muscle r tendn injury; a sprain is a ligament injury Back strain is a cmmn cause f back pain, especially lwer back pain. Back muscle strain can be caused by verlading f the back muscles (e.g. lifting a heavy bject) r veruse f the back muscles (e.g. repetitive bending r lifting r hlding the back in ne psitin fr t lng). Back strain frm veruse may ccur quickly r may take weeks r mnths t develp (chrnic veruse injuries). Back sprain may ccur frm a fall. Back muscles may nt react quickly enugh during a fall r accident and fail t keep the spine within its nrmal range f mtin, which may result in verstretched r trn ligaments. Sciatica is pain r numbness alng the sciatic nerve that radiates frm the lwer back t the buttcks and back f the thigh. The pain may be caused by cmpressin, inflammatin, r reflex mechanisms (muscle spasms). The mst cmmn cause f Sciatica is a herniated disk f the lumbar regin f the spine (lwer back). The pain can vary frm a dull ache t a burning sensatin. It can be slightly annying r intensely painful. It usually ccurs n ne side nly. The pain ften cmes n gradually thrughut the days and it at its wrst at night. The pain intensifies after prlnged sitting r standing. Mst cases reslve within 6 weeks.

2 Herniated Disc (als knwn as 'Slipped Disc) is a rupture f the uter casing f the disc. When a disc is ruptured sme f the inner substance may prtrude and tuch spinal nerves, causing pain dwn the leg (sciatica) as well as back pain. The majrity f herniated discs imprve withut surgery. Spinal Stensis is cmpressin f the spinal crd r spinal nerve rts. This cmpressin may be caused by a bne spur r bulging disc and is related t degeneratin f the spine. Spinal stensis is mre cmmn in the elderly. Symptms are pain, tingling, numbness. Mst cases ccur in the lwer back - the sciatic nerve is cmpressed which causes pain t radiate dwn the buttcks and leg. The pain is usually relieved by sitting, and made wrse with activity. Spndyllisthesis is a cnditin in which a vertebra slips ver the vertebra belw it, mst cmmnly a vertebra in the lwer back. The degree f the slippage varies. There may be n symptms at all r there may be back pain, smetimes accmpanied by pain radiating dwn the buttcks and leg. Surgery is rarely needed. Isthmic Spndyllisthesis starts with a crack in a vertebra, usually the lwest lumbar vertebra, causing it t discnnect frm the facet jints. This results in the vertebra slipping frward ver the vertebra belw it - resulting in misalignment and narrwing in the spinal canal. The fracture mst ften ccurs in early childhd but the slippage ften ccurs later. Smetimes the slippage ccurs in childhd, is present fr years withut symptms, but ften accelerates disc degeneratin later in life. Degenerative Spndyllisthesis starts with degeneratin f the disks that result in a vertebra slipping ver the vertebra belw. Ostearthritis f the Spine (Spndylsis) is a degenerative disease affecting the facet jints (spinal jints) and the intervertebral discs. Ostearthritis usually desn't begin until after the age f 45 and is the mst cmmn after the age f 60, but may ccur at any age. Ankylsing Spndylitis belngs t a grup f chrnic inflammatry diseases f the spine called Spndylitis. Ankylsing Spndylitis is a type f arthritis causing inflammatin f the spine. It is mst cmmn in teens and yung adults althugh it can als affect children and lder peple. Osteprsis is a cnditin in which the bnes gradually becme prus, brittle, and fragile. The risk f steprsis increases with age. Osteprsis is mst cmmn in wmen ver the age f 50. clisis is an abnrmal lateral (side-t-side) curvature f the spine with rtatin f the vertebrae within the curve. Adlescent Sclisis is the mst cmmn frm. Sclisis des nt usually cause any pain when it ccurs in children. In grwing children, rthpedic braces usually prevent the curve frm getting wrse but d nt crrect the curve that is already present; therefre, it is imprtant t catch sclisis early. Surgery can be perfrmed if the curve is severe. Fibrmyalgia is a cnditin that causes widespread pain and fatigue. Althugh any area f the bdy may be affected, the lwer back, neck, shulders, are cmmn prblem areas. Whiplash is usually the result f a car accident, but can als ccur in a fall. It is an injury t the neck caused by sudden backward and frward mvements f the neck in which the muscles dn t have time t react t keep the neck within a safe range f mtin. (Or the frce may t great fr the muscles t hld the spine within a safe range f mtin). This results in verstretching r tearing the ligaments and muscles that supprt the cervical spine and pssible injuries t the discs and facet jints. The main symptms are neck pain and stiffness.

3 The Spinal Clumn: The spinal clumn (als called the vertebral clumn) cntains and prtects the spinal crd and supprts the bdy and head. The spinal clumn is flexible t allw mvement f the bdy. The spinal clumn is cmprised f a clumn f small bnes called vertebrae. Shck absrbing discs separate the vertebrae. Vertebrae: The 24 vertebrae are named accrding t their lcatin alng the spine. We start ut with 33 vertebrae but the lwest nine fuse tgether t frm single bnes 5 fused vertebrae frm the sacrum and 4 tiny fused vertebrae frm the cccyx (tailbne). The 24 True r Mvable Vertebrae: Cervical spine (neck area) with 7 vertebrae (labelled C1 C7) Thracic spine (chest area) with 12 vertebrae (labelled T1 T12) Lumbar spine (lwer back) with 5 vertebrae (labelled L1 L5) Fused Vertebrae (belw the lumbar spine) Sacrum: a triangular shaped slid base with 5 fused vertebrae cnnects with the pelvis Cccyx: (the tailbne) with 4 very small fused vertebrae Main Parts f a Vertebra: The tw main parts f the vertebra are the vertebral bdy and the vertebral arch. Vertebral Bdy: The anterir segment and largest part f a vertebra, basically cylindrical in shape. Vertebral Arch: The psterir part f a vertebra; the vertebral arch has several prcesses (bny prjectins).

4 Prcesses (bny prjectins) f the Vertebral Arch: The spinus prcess (prjecting frm the centre f the vertebral arch) and the transverse prcesses (prjecting frm either side f the vertebral arch) serve as attachments fr the muscles and ligaments. Intervertebral Framen (plural: intervertebral framina): The pening frmed between adjacent vertebrae frm which the spinal nerves exit. There is an pening n each side. Facet Jints: Facet jints (cmmnly called spinal jints) jin adjacent vertebrae. Facet jints are hinge-like and allw adjacent vertebrae t mve n ne anther t allw bending and twisting and als keep the spine within a nrmal range f mtin. The surfaces f the bnes that make up the facet jints are cated with smth cartilage that allws the bnes t glide smthly against each ther. Muscles, ligaments and discs supprt the jints f the spine. Spinal Crd: A part f the central nervus system, the spinal crd transmits messages frm the brain t ther parts f the bdy and vice versa. The spinal crd begins at the brain and runs dwn t the level f the secnd lumbar vertebrae. Three meninges (membranes) cver the spinal crd. Spinal nerves branch ut frm the spinal crd. Cauda Equina: The spinal nerve rts cntinue beynd the lwer end f the spinal crd, within the spinal canal. This cllectin f nerves resembles a hrse's tail and is called the cauda equina. Meninges: The three membranes enclsing the spinal crd and brain - the pia mater, arachnid, and dura mater. The dura mater is the utermst and tughest f the three meninges. Sciatic nerve: A sensry and mtr nerve, the sciatic nerve riginates in the lumbar and sacral areas f the spinal clumn. The sciatic nerve is frmed by several nerve rts that extend beynd the lwer end f the spinal crd and cnverge. (The spinal crd at the secnd lumbar vertebrae). Its tw branches run thrugh the pelvis, deep int each side f the buttcks, thrugh the hip, the backside f the upper leg dwn t the ft.. The sciatic nerve is the largest nerve in the human bdy - the diameter f a finger. Spinal Canal: Spinal Canal (als called vertebral canal) is the large canal in the centre f the spinal clumn that cntains the spinal crd and its membranes. x Dn ts Dn t bend ver t lift anything Dn t d repetitive mvements e.g. bending frward Dn t lift with a rtated r lateral flexed spine D s Assess the lad Plan the lift Maintain crrect psture Keep spinal curves intact Place the feet crrectly Hld the lad with the hands nt the fingers Brace the abdminals Lift with leg and buttck muscles and use mmentum Hld the lad clse t the bdy Keep fit fr lifting

5 WHAT IS SCOLIOSIS? Lateral r Sideways Curvature f the Spine Definitin: Sclisis is the term given t a lateral (away frm the middle) r sideways curvature f the spine. Wh gets Sclisis? Sclisis has a rate f 2:1 girls t bys. The statistics suggest a rate f abut 3-5 ut f 1,000 peple are affected. Sclisis usually ccurs in thse lder than 10 years, but the cnditin has been diagnsed in infants. Predispsing Factrs: In mst cases (85%), the cause f sclisis is unknwn (what dctrs call idipathic). The ther 15% f cases fall int 2 grups: Nn-structural (functinal): This type f sclisis is a temprary cnditin when the spine is therwise nrmal. The curvature ccurs as the result f anther prblem. Examples include 1 leg being shrter than anther, frm muscle spasm, r frm appendicitis. Als activities that require prlnged amunts f time sitting r standing can induce sclisis. Structural: In this type f sclisis, the spine is nt nrmal. The curvature is caused by anther disease prcess such as birth defect, muscular dystrphy, metablic diseases, cnnective tissue disrders r Marfan s syndrme. Prgressin: Pain will becme persistent if irritatin f ligaments results. The greater the initial curve f the spine, the greater the chance fr prgressin f the cnditin after grwth is cmplete. Severe sclisis (curves in the spine greater than 100 degrees) may cause breathing (respiratry) prblems. Prbable Outcmes: With early screening and detectin, mst children with sclisis can be treated t prevent mre curvature. They can lead nrmal lives and have the same life span as ther healthy peple. The prgnsis depends mre n why the sclisis ccurred. If the sclisis has ccurred as a result f an infectin by anther disease, then the prgnsis wuld be based upn this infectin, nt the sclisis. Hw is Sclisis diagnsed? The physical examinatin will include a frward bending test that will help the practitiner define the curve. There will als be a thrugh neurlgic exam t lk fr any change in strength, sensatin r reflexes. Hw is Sclisis treated? The treatment is determined by the cause f the sclisis, the size and lcatin f the curve, and the stage f bne grwth (hw clse t maturatin). Mst cases f adlescent idipathic sclisis require n treatment (less than 20 degrees) but shuld be checked by a dctr at regular intervals (ften every 6 mnths). As curves prgress abve 25 t 30 degrees in a child wh is still grwing, bracing is usually recmmended t help slw curve prgressin. There are many different kinds f braces used which have names such as the Bstn Brace, Wilmingtn Brace, Milwaukee Brace and Charlestn Brace, named after the centre which develped them. Each has a different appearance and there are different ways f using each type prperly. The selectin f brace and the manner in which it is used is determined by many factrs, including the specific characteristics f yur curve, and will be decided n fllwing cnsultatin between yu and yur dctr. A back brace will nt reverse the sclisis; rather the spine is straightened by the brace frm

6 asymmetric pressure, and can be adjusted as the patient grws. Bracing is nt effective in the cases f cngenital r neurmuscular sclisis and is less effective in infantile and juvenile idipathic sclisis. Curves f 40 degrees r greater usually require surgery because curves this large have a high risk f prgressing even after bne grwth stps. Surgical crrectin invlves crrecting the curve (althugh nt all the way) and fusing the bnes in the curve tgether. The bnes are hld in place with ne r tw metal rds held dwn with hks and screws until the bne heals tgether. Smetimes surgery is perfrmed thrugh an incisin in the back and smetimes thrugh an incisin n the abdmen r beneath the ribs. A brace may be required after surgery t stabilize the spine. The limitatins impsed by the treatments are ften emtinally difficult and may threaten self-image, especially f teenagers. Emtinal supprt is imprtant fr adjustment t the limitatins f treatment. Physitherapists and rthtists (rthpaedic appliance specialists) can be helpful in explaining the treatments and ensuring a cmfrtable fit f the brace t increase the cmpliance with the treatment plan. WHAT IS OSTEOPOROSIS? Osteprsis is the thinning f bne tissue and lss f bne density ver time. The leading causes f steprsis are a drp in estrgen in wmen at the time f menpause and a drp in teststerne in men. Wmen ver age 50 and men ver age 70 have a higher risk fr steprsis. Osteprsis ccurs when the bdy fails t frm enugh new bne; when t much ld bne is reabsrbed by the bdy, r bth. Calcium and phsphate are tw minerals that are essential fr nrmal bne frmatin. Thrughut yuth, yur bdy uses these minerals t prduce bnes. If yu d nt get enugh calcium, r if yur bdy des nt absrb enugh calcium frm the diet, bne prductin and bne tissues may suffer. As yu age, calcium and phsphate may be reabsrbed back int the bdy frm the bnes, which makes the bne tissue weaker. This can result in brittle, fragile bnes that are mre prne t fractures, even withut injury. A diet rich in calcium and regular weight based exercise thrughut life (especially childhd and adlescence) decreases the risk f steprsis in later years. Peple with existing steprsis can als benefit frm exercise. A sedentary lifestyle encurages lss f bne mass. Exercising regularly decreases the rate f bne lss, and cnserves remaining bne tissue, reducing the risk f fractures.

7 Exercise: Weight-bearing walking, jgging, playing tennis, dancing Resistance free weights, weight machines, stretch bands Balance tai chi, yga Riding a statinary bicycle Using rwing machines High Calcium Fds include: Cheese Ice Cream Leafy green vegetables Lw-fat milk Salmn Sardines (with the bnes) Tfu Yghurt Acute lw back pain Acute lw back pain refers t pain in the lwer back which has lasted fr less than 12 weeks. The lwer back is the regin f the bdy where the lumbar spine is lcated. The lumbar spine is the bttm sectin f the spine and cnsists f five bnes (vertebrae). Between these vertebrae are structures called discs which act as shck absrbers. There are cuntless muscles acting n the lumbar spine and a number f strng ligaments which prvide the spine with stability. Many f these structures can be invlved when yu experience acute lw back pain. Lwer back pain can unfrtunately happen t anyne at any time. Arund 70% f Australian adults will experience lwer back pain at sme pint during their life. What causes back pain? Acute lw back pain can be caused by many factrs such as: trauma (fall, car accident, lifting) muscle imbalances (pstural issues) existing medical cnditins rheumatlgical cnditins Injuries can happen when yu d smething new, different r strenuus, such as lifting heavy items r playing a new sprt. The pain may als ccur because f a build-up f stress n the back that gradually turns int an injury. Althugh serius causes f back pain are rare, it is imprtant that yu have yur cnditin assessed by a qualified health prfessinal such as a physitherapist. This is particularly imprtant if yur back pain is assciated with ther symptms like fever, unexplained weight lss, pins and needles r numbness, r if yur pain was caused by a high velcity trauma such as a car r sprting accident.

8 What shuld yu d? At the first sign f back pain, there are a few simple things yu can d t prvide shrt term relief and give yur back the best chance f healing quickly. Stay active: It may be tempting t stay in bed, it is imprtant t keep mving as much as yu cmfrtably can. By ding this, yu can prevent stiffness and relieve muscle spasms. Yur physitherapist can prescribe a gentle exercise prgram tailred t suit yur cnditin. They can als gradually prgress yur exercises t help yu return t nrmal functin as sn as pssible. Use heat: Heat has been shwn t imprve pain and functin during the first 48 hurs f back pain. A few easy ptins are heat wheat bags, gel heat packs and electric heat pads. Make sure yu test the heat befre yu apply it. Find cmfrtable psitins: Althugh yu shuld remain as active as pssible during the early stages f back pain, there are times when yu need t be lying r sitting dwn. Find psitins that allw yu the mst cmfrt, especially when sleeping. Using a pillw under the knees when lying n yur side can ffer supprt and relief frm pain. When sitting ensure yur lwer back is supprted. Yu can use a rlled up twel placed in the small arch f yur back. This will help prvide supprt and may relieve the pain. Stay psitive: Back pain is a distressing and disabling cnditin, but it is imprtant t remember that yu will get better. With prper treatment yu shuld regain nrmal pain-free mvement as well as imprving the strength f the key supprting muscles that surrund yur spine. Hw yur physi can help It is imprtant t cnsult a physitherapist as sn as pssible t assist with pain relief and imprve mvement. Physitherapists are experts in the assessment f musculskeletal injuries, especially back pain. They will prvide a thrugh examinatin t ascertain the structures respnsible fr yur pain. The physitherapist will als be able t give yu a better understanding f the cause f pain and further self-management techniques. Yur physitherapist will als discuss the treatment ptins with yu. Sme ptins may include: jint mbilisatin massage stretching strengthening exercises taping advice n recmmended psitins and pstures at hme and during wrk. Treatment f the underlying cause will nt nly reslve yur back pain, but prevent it frm cming back again. If yu re suffering frm back pain, dn t delay! The earlier yu see a physitherapist, the quicker they can help get yur back pain under cntrl. Cntact Burbng Street Physitherapy Centre t make an appintment with Elizabeth and she will get yu back t wrk, sprt and life.