Transcript of Spine Pain What You Need to Know What You Need to Know Joseph H. Fillmore, MD Joseph H. Fillmore,...
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- Spine Pain What You Need to Know What You Need to Know Joseph
H. Fillmore, MD Joseph H. Fillmore, MD
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- What We Will Talk About Facts and Fiction Facts and Fiction
Anatomy Anatomy Causes of Back Pain Causes of Back Pain Who is at
Risk? Who is at Risk? When to Get Help When to Get Help Available
Treatment Available Treatment
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- Fact or Fiction Most new back pain is caused by a slipped disc
Most new back pain is caused by a slipped disc No, only a small
percentage is due to disc problems No, only a small percentage is
due to disc problems
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- Fact or Fiction Most back pain requires surgery No, only 2 to
5% of patients actually require surgery
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- Fact or Fiction Since everyone has back pain, I should just
live with it Since everyone has back pain, I should just live with
it No. Getting help and treatment early can prevent recurrence and
further problems later on. No. Getting help and treatment early can
prevent recurrence and further problems later on.
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- Fact or Fiction Proper nutrition can reduce back pain Proper
nutrition can reduce back pain Yes, a good balanced diet including
fruits and vegetables Yes, a good balanced diet including fruits
and vegetables
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- Fact or Fiction All patients with low back pain need to have an
MRI All patients with low back pain need to have an MRI No. Only in
certain cases. Most back pain resolves on its own. No. Only in
certain cases. Most back pain resolves on its own.
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- Anatomy The spine has three major components: The spine has
three major components: the spinal column (i.e., bones and discs)
neural elements (i.e., the spinal cord and nerve roots) supporting
structures (e.g., muscles and ligaments)
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- Anatomy
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- Anatomy
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- Anatomy 80% of weight is supported by the spinal vertebral
bodies 80% of weight is supported by the spinal vertebral
bodies
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- Anatomy A cutaway drawing of the spine illustrates the location
of the spinal cord and nerve roots A cutaway drawing of the spine
illustrates the location of the spinal cord and nerve roots
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- Anatomy Ligaments and muscles help to support the spine and
prevent excessive movement that could lead to injury Ligaments and
muscles help to support the spine and prevent excessive movement
that could lead to injury
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- Anatomy These curves allow the head to position over the pelvis
in a sitting and standing position, while allowing for load bearing
and shock absorption in the spine These curves allow the head to
position over the pelvis in a sitting and standing position, while
allowing for load bearing and shock absorption in the spine
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- Who is at Risk For Back Pain? 90% of people experience back
pain 90% of people experience back pain Most is from activity Most
is from activity Most pain resolves without significant treatment
Most pain resolves without significant treatment Heavy lifting,
twisting, smoking, poor posture and obesity all contribute to low
back pain Heavy lifting, twisting, smoking, poor posture and
obesity all contribute to low back pain
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- ERGONOMICS
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- AGE FACTORS Increased degenerative joint disease Increased
degenerative joint disease decreased articular cartilage content
decreased proteoglycans chondrocyte failure decreased blood
supply
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- AGE FACTORS Loss of muscle mass Loss of muscle mass Decrease in
Type II muscle fibers Strength decreases 15%/decade ages 50- 80
muscles shorten Decreased collagen Decreased collagen increased
stiffness and overload failure
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- AGE FACTORS Degenerative disc disease Degenerative disc disease
Boden et al 20% 60 years with Disc Herniation 20% 60 years with
Disc Herniation 36% 60 years with Disc Herniation 36% 60 years with
Disc Herniation 21% 60 years with spinal stenosis 21% 60 years with
spinal stenosis
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- Causes of Spine Pain Strains Disc herniations, tears Facet
Joint Problems (arthritis, strains) Sacroiliac dysfunction
Fractures Spinal stenosis Cancer/metastatic disease Post surgical
Spinal infections Medical Illness Certain rheumatological
conditions (ie ankylosing spondolytis
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- Sprains Ligaments and muscles are subject to stress overload
causing tears, inflammation Ligaments and muscles are subject to
stress overload causing tears, inflammation
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- Disc Herniations
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- Joint Structures
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- Spondylolisthesis
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- Spinal Stenosis Spinal Stenosis is narrowing where the nerve
structures live Spinal Stenosis is narrowing where the nerve
structures live
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- Sacroiliac Joint
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- Piriformis Syndrome
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- When to See the Doctor Pain is getting significantly worse Pain
is getting significantly worse Severe symptoms Severe symptoms
Groin or leg weakness or numbness Groin or leg weakness or numbness
Arm or hand weakness, tingling, or numbness Arm or hand weakness,
tingling, or numbness Loss of bowel or bladder control Loss of
bowel or bladder control Night pain Night pain
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- Non Operative Treatment Options Education Education Medications
Medications Ice Ice Bed Rest (2 days) Bed Rest (2 days)
Rehabilitation Rehabilitation Psychological Treatment Psychological
Treatment Interventional Pain Procedures Interventional Pain
Procedures
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- Medications NSAIDS Muscle Relaxants Oral Steroids Narcotics
TCAs Antiepileptics
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- Rehabilitation Pain Pain Flexibility Flexibility Proper Posture
Proper Posture Range of Motion Range of Motion Relaxation/Stress
Relief Relaxation/Stress Relief Balance Balance Coordination
Coordination Education Education
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- Rehabilitation/PT Focus on muscle groups affecting spine: Focus
on muscle groups affecting spine: Low back Abdomen Pelvis
Thighs
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- Progressive Health Center Treatments
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- Acupuncture- Improves circulation and enhances the bodys own
ability to deal with low back pain without the side effects that
can come with pain medication Acupuncture- Improves circulation and
enhances the bodys own ability to deal with low back pain without
the side effects that can come with pain medication Craniosacral
Therapy- Can increase relaxation and improve circulation with
gentle detection and correction Craniosacral Therapy- Can increase
relaxation and improve circulation with gentle detection and
correction Life Flow Energy Tai Yi- When stagnant energies are
dissipated or removed, your health can be restored which can
enhance your relaxed well-being Life Flow Energy Tai Yi- When
stagnant energies are dissipated or removed, your health can be
restored which can enhance your relaxed well-being Therapeutic
Massage- Reduces swelling, improved circulation, increased range of
motion and relieves muscular tension Therapeutic Massage- Reduces
swelling, improved circulation, increased range of motion and
relieves muscular tension Yoga Therapy- Releases tension, lengthens
the muscles and realigns the joints Yoga Therapy- Releases tension,
lengthens the muscles and realigns the joints
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- Interventional Pain Goals are to reduce pain and inflammation
Goals are to reduce pain and inflammation Epidurals Facet Joint
Injections Radiofrequency Neurotomies Sacroiliac Joint Injections
Intradiscal Procedures
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- Spine Pain Management Fluroscopic techniques Fluroscopic
techniques Epidurals Facet injections
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- Spine Pain Management Selective nerve root blocks Selective
nerve root blocks Lateral recess blocks Lateral recess blocks
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- Lumbar Medial Branch Rhizotomy
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- Spine Pain Management Provocative discography is required
Provocative discography is required Then, consider: Then, consider:
spinal intervention thermal annuloplasty other percutaneous proc
Discogenic pain:
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- Surgery
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- Prevention Sit and stand properly Exercise regularly (aerobic
exercise is especially good) Attain and maintain a healthy weight
Stop smoking Eat healthy (a well-balanced, low-fat diet rich in
fruits and vegetables) Lift safely Wear a seat belt Use proper
sports equipment
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- How to Lift Objects Stand close to the object, and if youll be
placing it on a high shelf, make sure youre also close enough to
the shelf. Stand close to the object, and if youll be placing it on
a high shelf, make sure youre also close enough to the shelf. Stand
with your feet shoulder-width apart and bend your kneesinstead of
bending from the waist to pick up the object. Stand with your feet
shoulder-width apart and bend your kneesinstead of bending from the
waist to pick up the object. As you lift, draw on your core
strength by tightening your stomach muscles. As you lift, draw on
your core strength by tightening your stomach muscles. Your leg
muscles (not your back muscles) should do most of the work, so do
not lock your knees as you lift. Your leg muscles (not your back
muscles) should do most of the work, so do not lock your knees as
you lift. To avoid twisting your body, especially while holding the
object, point your toes in the direction you want to move and pivot
in that direction. To avoid twisting your body, especially while
holding the object, point your toes in the direction you want to
move and pivot in that direction. For especially heavy objects, get
help. For especially heavy objects, get help.
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- Thank You!