Transcript LOW BACK PAIN - Stelmack Pinpoint Health Care

LOW BACK PAIN
Dr. Zachary Stelmack
ANATOMY OF THE LUMBAR SPINE/PELVIS
5 lumbar vertebrae (bones of that make up your spine)
L1, L2, L3, L4, L5
1 Sacrum (not part of the lumbar spine exactly, but goes right along with it)
5 lumbar/Sacral Intervertebral discs
L1(L1/L2), L2(L2/L3), L3(L3/L4), L4(L4/L5), L5(L5/S1)
Curve of the lumbar spine is set in extension, or convex
Sacrum and iliac bones make up the Sacroiliac (SI) Joints
ANATOMY OF THE LUMBAR SPINE
Many ligaments
- ligaments attach bone to bone
- they are there to prevent excessive, damaging motion
Muscles
common muscles found in the lumbar spine/associated with low back pain:
quadratus lumborum
trapezius
multifidi
lumbar paraspinal muscles/erector spine muscles
piriformis (a part of pelvis musculature)
latissimus dorsi
gluteus maximus and medius
psoas
hamstrings
quads
ANATOMY OF THE LUMBAR SPINE
Range of Motion (ROM)
flexion
extension
lateral flexion
very slight rotation
the pelvis performs flexion and extension
ANATOMY OF THE LUMBAR SPINE
The spinal cord is protected as it sits in the canal made up of the vertebrae
- this is called the vertebral canal
Nerves exit the spinal cord through openings between the vertebrae
Most common nerves:
femoral nerve
supplies front of thigh
sciatic nerve
supplies back of thigh/leg
ANATOMY OF THE LUMBAR SPINE
Intervertebral Discs (IVD)
provides cushioning in between the vertebrae
protects against compression
2 parts
an outer annulus fibrosis (more fibrous)
an inner nucleus pulposus (gelatinous-like)
ANATOMY OF THE LUMBAR SPINE
Joints of the Spine
Facet Joints
found in the back part of the vertebrae
this is where movement occurs
WHAT CAN GO WRONG?
Degeneration
of the bones/joints/discs
Growths
Impingement
-disc
-nerve
-ligament
-spinal cord
WHAT CAN GO WRONG?
Sprains/Strains
-ligaments
-tendons
-muscles
Breaks/Fractures
Infection/Inflammation
WHAT CAN GO WRONG?
*REMEMBER* - The nerves travel in between the vertebrae and it is the discs that keep
the space open so they are not impinged
Muscles and ligaments ensure proper range of motion and function
- and most importantly: STABILITY and PROTECTION
WHAT CAN GO WRONG?
Bone spurs (growths)
Tumors
Bone degeneration
Disc tears
Disc bulge
Facet joint degeneration
Muscle/ligament sprains
Inflammation
WHAT CAN GO WRONG?
Most causes of pain all come down to inflammation, muscle tightness, and nerve
impingement
MOST COMMON CONDITIONS ASSOCIATED WITH LBP
Muscle Hypertonicity/Spasm, sprains/strains
Lumbar Disc Degeneration/Disc Bulges
Sciatica
Arthritis
Spinal Stenosis
Muscle Hypertonicity/Spasm, Sprains/Strains
Overuse
Improper movements
Improper sleep
injury
Muscle Hypertonicity/Spasm, Sprains/Strains
Muscles tighten
Decreases normal range of motion
Causes mostly local pain or diffuse pain
Most common muscles involved: lumbar paraspinals/erector spinae, quadratus lumborum,
and piriformis, hamstrings, quads
PAIN: usually dull/achy, stays local or slightly diffuse
- Stiffness, tightness
Muscle Hypertonicity/Spasm, Sprains/Strains
Prognosis: good, if taken care of
Treatments consist of muscle therapy, stretches, therapeutic exercises, adjustments
If left untreated:
can heal inappropriately
muscle tightness causes decreased range of motion and eventually degeneration
of the joint
more likely to frequently have re-injury
muscle imbalance and eventually involvement of other muscles
Muscle Hypertonicity/Spasm, Sprains/Strains
NOTE: almost every issue of the spine involves muscle hypertonicity
Lumbar Disc Degeneration/Disc Bulge
Degeneration is more common after the age of 30
Disc Bulge/Herniation are more common under the age of 30
Outer disc can tear
Disc can bulge
Disc can degenerate
Lumbar Disc Degeneration/Disc Bulge
All of these things cause impingement
Compress tissue
Compress nerves
PAIN:
usually diffuse, sharp at times, dull achy
pain can be positional based
pain can be radiating
Lumbar Disc Degeneration/Disc Bulge
Improper movements
Lifting heavy objects often
Injury/falls
Age
Obesity
TOO MUCH FLEXION
Lumbar Disc Degeneration/Disc Bulge
Prognosis: good if caught early on, if left alone can develop into chronic condition
Treatment:
muscle therapy
exercises/positional exercises
distraction/traction
If left untreated:
chronic, travel, arthritis
RADIATING PAIN
When pain “radiates”, or MOVES some distance away from the initial site of site of what is
causing the pain. It travels down a nerve(s) being effected/impinged/encroached upon.
For example: sciatica
This is called peripheralization
When a patient has radiating pain, one way we judge improvement is by how much pain is
centralizing (coming back to original sight of pain)
PAIN: sharp, diffuse, burning, numbness, tingling, pins and needles
Touching area of radiation won’t change the pain intensity.
SCIATICA
Radiation of pain down one or both legs due to irritation to the sciatic nerve.
Can radiate anywhere from buttocks to big toe.
Radiation will be continuous typically.
The further the radiating pain travels indicates the significance of the condition.
The sciatic nerve is the largest nerve in the body.
- it travels from the lumbar spinal cord region to the foot
- mostly in the back of the leg
SCIATICA
Causes:
impingement/irritation of the sciatic nerve
- bulging disc
- degeneration of spine
- nerve growth on sciatic nerve
- inflammation at the spine or spinal cord, or nerve
- very commonly  A TIGHT PIRIFORMIS MUSCLE
SCIATICA
Prognosis: great if treated right away
- the longer it has been chronic, the harder it is to dissipate
Treatment:
- tissue/muscle therapy to involved muscles
- distraction of the lumbar spine/traction
- positional exercises
- stretches
- therapeutic exercise
ARHRITIS
Inflammation and degeneration of bone and cartilage of any/many joints
Degeneration causes:
- pain
- bone spurs
- narrowing of spaces where nerves are
- weakness of bone
- stiffness of muscles/tendons/ligaments trying to stabilize effected joint
ARTHRITIS
Rheumatoid Arthritis
- systemic inflammatory disease/autoimmune
- occurs on both sides in same areas
- typically spreads
Osteoarthritis
- can occur in only one joint, one area, one sided
- typically occurs in places of high stress/usage
- common at areas of old injuries
Pain is very similar for both
- dull achy, sharp, stiffness
- radiating pain common
ARTHRITIS
Prognosis: moderate relief, chronic/intermittent reoccurrence
- pain brought down to manageable intensity and frequency
HOWEVER, PREVENTION IS KEY!
Treatment:
- tissue/muscle therapy to involved muscles
- distraction of the lumbar spine/traction
- stretches
- therapeutic exercise
- ultrasound therapy
-laser therapy
- anti-inflammatory diet, supplements (anti-inflammatory and support)
MOTION is LOTION
SPINAL STENOSIS
Encroachment or Narrowing of the vertebral canal onto the spinal cord.
Patient usually feels better/relief with flexion.
Extension increases symptoms significantly.
SPINAL STENOSIS
Causes:
bone spurs
arthritis
bulging disc
facet hypertrophy/inflammation/arthritis
spine degeneration
SPINAL STENOSIS
Prognosis: minimal to moderate, chronic typically
- early intervention is key
Treatment:
- muscle therapy
- flexion and distraction of spine
- therapeutic exercise
- bike riding/cycling
- correction of encroachment
- anti-inflammatory diet/supplements
WHAT CAN YOU DO NOW?
Insert some things from healthy daily living exercise
- Put one leg up when standing for long periods of time
-The “captain morgan” stance
WHAT CAN YOU DO NOW?
PILLOW AND POSITION
Pillow depends on position
Side Sleeper
pillow: thickness needs to be that of the length between the ear and the tip of
your shoulder
also, pillow between the legs (6 inches or so)
try to avoid hand under face or pillow
Back Sleeper
pillow: very flat, or can use neck pillow or rolled towel behind neck
Stomach Sleeper
try to avoid
very flat pillow
WHAT CAN YOU DO NOW?
WATER
increase water intake
dehydration can lead to poor joints
WHAT CAN YOU DO NOW?
30 minutes of activity daily (NOT JUST WORK ACTIVITY)
Walking, biking, swimming, dancing, jogging, sports, etc.
AVOID: sit-ups, crunches, equalized weight machines
ALWAYS stretch/warm up and cool down
WHAT CAN YOU DO NOW?
SITTING
no slouching
feet flat on the floor (do not keep legs crossed)
do not site for periods more than 20-30 minutes
- take breaks
make sure work station is straight forward and eye level
towel or lumbar roll behind lumbar spine
shoulders back and down
don’t “push off” to get out of chair, plant feet and drive through heels!
POSTURE BREAKS!
WHAT CAN YOU DO NOW?
Waking Up
DO NOT just jump out of bed in the morning
do some light stretches first
Upon getting out of bed, AVOID flexion (sitting, squatting, bending forward) for the first
30 mins-1 hour
WHAT CAN YOU DO NOW?
THROUGHOUT THE DAY
Avoid staying in the same position for long periods of time
Lift with your legs
Stretch often
No aprons/heavy necklaces/lanyards
Do not favor a side
example: purses, bags, etc.
NO luggage ladies!
WHAT CAN YOU DO NOW?
THROUGHOUT THE DAY
DO NOT self adjust!
Do not strain over heavy objects, ASK FOR HELP!
When something hurts, get it checked out. Yes, things heal with time but not usually properly!
QUESTIONS?