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BACKACHE-PREVENTION
AND CURE
DR DEEPAK AGRAWAL
All India Institute of Medical Sciences,
New Delhi
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Vertebrae
In the neck there are
seven cervical
vertebrae
Supporting the chest
there are 12 thoracic
vertebrae
Next are five lumbar
vertebrae
Below them is the
sacrum (which
consists of 5 sacral
vertebrae)
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Intervertebral Discs
23 narrow spongy
shock absorbers
which fit between the
24 separate bones of
you spine.Without the
discs these bones
would grate and
crunch every time you
moved
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Each disc has a
strong fibrous
outer casing called the annulus
fibrosus - and a
soft, squashy,
jelly-like interior
called the nucleus
pulposus - which is
reinforced with
strands of fibre.
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Intervertebral discs
have very little in the
way of nerve supply
and contain no blood.
They are made up
largely of water.
As you get older the
amount of fluid in
your discs will
diminish slightly - and
as a result you will get
shorter.
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Although any disc in
the entire spine can
prolapse or burst, the
most common ones to
which this happens
are the lowest two,
that is between the
fourth and fifth
lumbar vertebrae and
between the fifth
lumbar and the top of
the sacrum.
Backache
WHAT CAUSES BACK PAIN?
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Disc injury
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Degenerative disc disease.
Backache
RUPTURD DISC:
 A ruptured disc is an injured or damaged
disc that leaks out watery jelly (called
nucleus pulposus) from the center of the
disc.
 This leakage reduces the shock absorber
effect and sometimes the jelly presses
against a nerve and causes pain, primarily
leg pain.
Prolapsed Disc
The phrase "a slipped disc" is used very
commonly and indeed at some time of
other this diagnosis has been blamed for
producing almost every form of acute back
pain. There are two major errors in this.
 1.All discs do not and cannot slip.
 2.what does go wrong and may be called
a "slipped disc" is much less frequent than
previously thought
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DEGENERATIVE DISC DISEASE
 As discs degenerate, they lose their water
content and height, bringing vertebrae
closer together.
 The nerve openings are consequently
narrowed and the added pressure from
the disk can pinch a nerve causing back or
leg pain.
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PROBLEMS
The Neck
 The Mid Back
 The Lower Back
 Hips
 Base of the Spine
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NECK
 A slipped or prolapsed disc in the cervical
spine could result in a severe pain in your
shoulder, arm or hand.
 Small movements may make the pain
worse.
 accompanied by numbness or tingling in
the fingers
ackache(CHART)
MID BACK:
Back pain that becomes worse after sitting in one
position for a long time may be caused by poor
posture or by a badly-designed chair.
Stress, anxiety and emotional worries can lead to
muscle tension which results in aches and pains
in the back. This is one of the MOST COMMON
causes of back pain - probably affecting as many
as eight out of ten sufferers.
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TYPES:
 Sudden onset
 Continuous
 Exacerbated on
1. Exercise
2. Passing urine
3. Movement/ cold
weather
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SUDDEN ONSET PAIN:
 If your pain started after a trivial
movement - such as tying up your shoe
laces or turning over in bed - it may be a
result of a slipped disc or a joint problem
in your spine.
 Pain going down one or both legs, or
numbness or tingling in one or both legs,
then you may be suffering from sciatica
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CONSTANT PAIN:
 Radiates round the chest - a fracture
caused by osteoporosis of thin bones.
 Accompanied by discomfort when passing
urine and/or blood in your urine - kidney
infection/Stone.
 In the middle of the back that is made
worse by eating and accompanied by
indigestion - stomach ulcer.
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CONSTANT PAIN (Contd.):
 Low back pains that are accompanied by
gynecological symptoms (discharge,
bleeding etc.) may suggest a
gynecological cause - such as period pain.
INVESTIGATIONS:
MRI (Magnetic Resonance Imaging) scan
is the most common test used to look at
the spine. This allows us to view not only
the bones of the spine, but also the nerves
and disks.
 Slices can also be taken across the spine,
giving a cross sectional view.
 The MRI scanner allows us to see the
nerves and disk quite clearly.
 No special dyes or needles are necessary.
MRI
MRI
The MRI scan is, perhaps, too good at
showing the anatomic details of the spine.
 growing body of evidence suggests that
not all abnormalities that show up on the
MRI scan are really the cause of the
individual patient's problem.
 Abnormalities, such as bulging disks, show
up frequently in normal volunteers
undergoing MRI scans-people who have
never had any problem with their back.
Backache
MANAGEMENT
Conservative
 Surgery
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CONSERVATIVE MANAGEMENT:
 Good posture
 Bed rest on hard bed
 Exercises
 Stress therapy
POSTURE:
 The neck has a slight
natural curve, which sits
on top of the two curves in
the middle and lower back.
 Correct posture maintains
all three curves and
prevents undue stress and
strain by distributing body
weight evenly
STANDING POSTURE
 In correct, fully erect posture,
a line dropped from the ear
will go through the tip of the
shoulder, the middle of the
hip, the back of the kneecap
and the front of the
anklebone.
SITTING POSTURE
 When sitting in any
position, the three
back curves need to
be maintained.
 If you cannot sit
without slouching
forward or backward,
you need to support
yourself with hands
and arms or lean
against a wall or
chair back.
SITTING POSTURE
SITTING POSTURE:
LYING POSTURE:
 Avoid propping
head or upper body
up on an arm and
hand.
 Head should
remain relaxed.
Legs should be
together.
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EXERCISES:
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Cat Back
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Fetal Position
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Arm exercises
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Alternate Leg
Slides
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Alternate Leg
Raises
RELIEVE STRESS
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Yoga
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Meditation
SURGERY
Only considered if:
 Conservative management fails
 Patient develops neurological deficits
(weakness, numbness, change in reflexes)
Diskectomy
 the removal of a
herniated disk to
relieve pressure on a
nerve root
 Window in the laminaretract nerve-removal
of herniated disc
material-healing by
scar tissue
Laminectomy
 derived from
lumber (lower
spine), lamina (part
of the spinal canal's
bony structure) and
-ectomy (removal).
 The operation is
performed to
relieve pressure on
one or more spinal
nerve roots
What To Expect After Surgery
Pain:
 It is normal to have pain after your
operation. It will be most severe in the
lower back area where the surgery was
done. Residual leg pain is not unusual,
this is caused by swelling of the previously
compressed nerve as well as from surgery
itself.
Activity:
Initially, you are permitted to get out
of bed following surgery with the
assistance from a nurse. Thereafter,
you should be up walking as much as
tolerated.
General Attitude
 It is normal to feel physically and
emotionally let down and tired the second
and third day after surgery.
 Natural reaction to the stress of surgery
and the lingering effects of anesthesia.
 Must not be allowed to get in the way of
your positive attitude that is essential for
recovery to normal activity.
PREGNANCY& BACKACHE:
 Apply heat(try sitting in a warm tub
or jacuzzi).
 Wear a support gadget (such as
abdominal support straps).
 Do strengthening exercises. Pelvictilt exercises help strengthen the
back, relieving pain.
 Take medications cautiously
Sex and the Back
 Sexuality is an integral part of normal and
healthy relationships. It need not be the
first thing abandoned when you are
bothered by a flare-up of your neck or
back pain. If you have chronic pain, it
should not prevent you from enjoying this
part of your relationship.
3 components of sexual functioning:
 emotional and psychological aspects
of sexuality.
 physiological and anatomical ones.
(These refer to your equipment and
wiring).
 inability to get into a comfortable
position due to neck or back pain.
The nerve connections, or wiring, must be
intact from the brain to the sexual organs
and they must get an adequate blood
supply in order for things to proceed
"normally".
 There are a very large number of medical
conditions that can affect sexuality in this
fashion. These include but are not limited
to diabetes, heart disease, prostatism,
vascular disease, and the pain from
compression of a nerve.
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Positions that are not comfortable in
your day-to-day activities will not be
comfortable during sex either.
Do not be afraid to experiment, there
is no right or wrong, normal or
abnormal.
Please do not try any sexual
positions without your doctor
present.
Just kidding - but Watch Your
Back!!
THANK YOU