Genetics/Lifespan Considerations
- bones and muscles adapt as you age
- some bones fuse during infancy while others grow as child develops
- growth is then turned off in adulthood (bones undergo remodeling)
- OA undergo physiologic changes: decrease strength and mobility
Alterations to Mobility
- back problems
- fractures
- multiple sclerosis
- OA
- Parkinson
- spinal cord injury
- amputations
Back pain
most common medical problem in America
-may result in: decreased quality of life, decreased mobility, increased pain and frustration, loss of work hours
Possible causes of back pain
- bas posture and sleeping habits
- low fitness level
- pregnancy
- obesity
- athletic injury
- degenerative disorders
- occupational risk factors
- referred pain from GI/GU/AAA
- backpack use
Prevention of back pain
- posture
- lifting
- body mechanics
- rest
- exercise
Herniated disc
- refers to a problem of the rubbery cushions between the individual bones that make up your spine
- occurs when nucleus pulpous ruptures and protrudes
- allowing fluids to leak out and irritate nerves
- compression of the nerve roots and cord shrinking the disc
- results in pain, numbness or weakness in arm or leg
- most people do not need surgery
Abrupt Disc Herniation
- nerve root compression
- severe pain
- muscle spasms
Gradual Disc Herniation
- slow onset pain
- associated with neurological symptoms (weakness/tingling)
Risk Factors for Back Pain
- most common between 30-50
- heavy lifting
- bending/twisting improperly
- overweight
- previous back problems
- smoking
- genetic factors
Clinical Manifestations of lumbar back pain
- low back pain
- radiating down the buttock and below the knee
- sciatic nerve pain
- weakness of the leg, foot, or toes
- bowel and bladder incontinence
- impotence
CES
Cauda Equina Syndrome
- latin for horse’s tail
- compression of the nerve roots of this part of the spine
- may be permanent neurological impairment
- urinary incontinence and paralysis
- caused by massive lumbar disc herniation, spinal stenosis and trauma
***Medical emergency
Straight Leg Test
-back or leg pain may be reproduced by raising the leg and flexing at 90 degrees
Diagnostic Studies
- L spine xray
- MRI
- CT
- EMG
- Myelogram
- Blood tests
Tx for Chronic Low Back Pain
- low back exercises/PT
- Rest
- Local heat/cold application
- pain relievers
- weight reduction
- surgery
Non-Pharm Tx for Back Pain
- brace
- massage
- traction
- PT
Pharm Tx
- Salicylates
- NSAIDs
- Skeletal muscle relaxants
- Neuropathic pain meds
- Corticosteroids
- Epidural Injections
Skeletal Muscle Relaxants
- baclofen
- methocarbamol
Neuropathic Pain Meds
- gabapentin
- pregabalin
- duloxetine
Intrathecal Morphine Pain Pump Implant
- risks for the intrathecal pain pump procedure are low
- method of giving medication directly to your spinal cord
- symptoms can be controlled with a much smaller dose than is needed with oral meds
- goal: better control your symptoms and to reduce oral meds; thus reducing their associated side effects
Laminoectomy
surgical removal of part of the posterior arch of the vertebrae to allow for removal of the disk
Disectomy
-micro surgical procedure that allows the surgeon to visualize the disk and disk space better for easier removal of the herniated portion
Laser Disectomy
- outpatient procedure
- laser is used on the herniated portion of the disk
Spinal Fusion
- used for unstable spinal areas by creating a connecting vertebrae with a bone graft
- fibula or iliac crest
- rods, plates, and screws
- infuse bone graft/cage (regeneration)
- TLSO while OOB
- Surgical and graft site if used
- Avoid sitting or standing for long periods of time
- encourage walking, lying down, and shifting weight
- no twisting the spine
Vertebroplasty
- outpatient
- used to stabilize vertebral bone fractures
