2. TAKING CARE OF OUR BACK AND KNEES

3. INTRODUCTION
Back and knee pain are very common complaints by patients in Orthopedic practice
Every alternate patient in Orthopedic outdoor is of back and knee problem
Especially more in females
Incidence of both the problems is very high in today’s busy life
Both are life time partners like diabetes and hypertension
Every one of us suffers from this problem in life one or other time

4. Back problems are painful as well as costly
Change in concept in approach towards treatment
Anatomy of spine must be thoroughly known to diagnose & treat the problem
Role of patients awareness is very important in both back and knee problems
Eyes do not see what the mind do not know

5. ANATOMY OF SPINE AND KNEE

6. Anatomy Thorough knowledge is must
Spine consists of blocks(vertebrae)stacked one on top of the other
Total - 33 vertebrae
Cervical -7(C1-7)
Thoracic - 12(T1-12)
Lumbar-5(L1-5)
Sacral-5(S1-5 fused in to one )
Coccygeal -4(Often fused into one)

7. Anatomy
Vertebrae Ligaments Ant. Longtudinal Post. Longtudinal ligamentum flavum Supra Spinal intra Spinal Alienment of facets & nerve roots Needs special mention Facets- Nerve roots Arrangement of spinal nerve roots with vertebrae is of major importance clinically

8. SPINE

9. SPINE

10. LOWER LIMB

11. ALL JOINTS

12. KNEE JOINT

13. NORMAL Knee joint
anatomy
details

14. Understanding knee
arthritis
arthritis

15. Understanding spine
Normal spine
anatomy

16. Understanding spine
Normal& Degenerative spine
Disc problems

17. xrays
Normal & osteoarthritis
Degenerative spine

18. xrays
spine
knee

19. Localizing Neurological Deficit

20. Sciatica

21. Clinical Evaluation Challenging to physicians diagnostic skills
Diagnosis is more difficult due to
Spine is relatively inaccessible to complete physical examination
There is wide array of possible etiologies and underlying conditions

22. Medical History
Age and Occupation Onset of pain Leisure and exercise activities Pain characteristics and distribution Temporal and mechanical features Text neck syndrome

23. Medical history
Use of computer and social media Sitting arrangements Work environment Postural arrangements Addictions Psychological status of the patient

24. Physical Examination Tenderness SLR Neurological deficit
Peripheral pulsation
Diagnostic tests
X-ray
mylography
C.T. myelography
MRI- most recommendable
PET
Laboratory tests - depending upon cause

25. Major Causes Of Low Back Pain
Varied etiology hence needs more attention to know the cause
Congenital
Spina bifida
Transitional vertebrae (Sacralization/ lumbarzation)
Tumors
Malignant
Benign

26. Injury Acute and chronic lumbar strain Compression fractures
Facet syndromes
Spondylolysis/listhesis

27. Metabolic Disorders Osteoporosis Inflammatory disease Rheumatoid
Ankylosing Spondylitis

28. Degenerative Disorder
Spinal stenosis
Myofascial cycle
Spondylosis
Osteoarthritis
Disc herniation

29. Psychosomatic Manifestations
Psychogenic pain syndrome Functional Feigned pain Malingering and compensatory behavior

30. Clinical profile of knee pain
Pain, swelling, deformity
Inability to walk properly
Activities of daily living hampered
Clicking sound
Slowly progressive
Inability to squat
Inability to climb steps/staires

31. Causes of knee pain
Trauma, especially repeated micro trauma Life style related factors like obesity, sedentary life style Addictions like smoking, alcohol, tobacco etc Acute trauma Degeneration. Wear & tear of joint More in knee as it is weight bearing joint Rheumatoid arthritis Drugs like steroids etc Osteoporosis etc

32. Investigations X-ray MRI Blood investigations CT SCAN
OTHER INVESTIGATIONS

33. TREATMENT Comprehensive approach is must
Drugs, diet, exercise are important
At times surgery is needed
Proper understanding of the problem
Team approach like Ortho. surgeon, dietician, physiotherapist, psychologist, councilors, and most important patient himself.
Concept of back school and knee club is important
90% problems are addressed conservatively
Only 10% cases require surgical treatment

34. Do’s & donot’s
Hamstring exercises
Do’s d 7

35. Exercises
Upper back exercises
Hamstring stretch

36. Bone and joint week
back
bones

37. Bone and joint week
knee
awareness

38. ROLE OF HEALTH EDUCATION & PUBLIC AWARENESS
VERY IMPORTANT ROLE EYES DO NOT SEE WHAT MIND DO NOT KNOW

40. Diet
Balanced diet Satwik, santulit, sakas aahar So many misunderstandings about diet Proper dieticians advice is must Calculated calorie conscious diet is needed Important to keep weight in control

41. Drugs or medical treatment
Useful Proper drugs for proper disease Opinion of expert is must Basket of drugs is available like Analgesics Calcium Dietary supplements Steroids either orally or local/epidural injections Various blocks

42. Principals of Treatment
Conservative
Myofascial cycle dysfunction
Acute disc herniation
Chronic pain

43. Surgical Management Disc excision / Laminectomy Spinal fusion
Chemonucleolysis
Minimally invasive procedures
New implant surgery
Endoscopic spinal surgery

44. WHOLISTIC APPROACH Wholistic approach is need of time
All possible remedies should be tried which are evidence based
Combination of therapies
Treat disease as well as patient as whole
Role of meditation, pranayam, yoga along with diet, exercise and drugs
At times surgical intervention must be done

45. Comments Many patients delay treatment because of fear and misbeliefs
This is unfortunate because competent surgeons & treatment methods are available
Gone are the days of fear & complications
Ultramodern Techniques available like Laser/Endoscopy
Newer implants
Experimental work like High pressure water streams, carbon dioxide & percutaneous techniques
lateral percutaneous discectomy

46. Take home message Back and knee problems are very common
Understanding the problem in scientific way is important
Only evidence based treatment should be taken
Team approach is important
Role of patient himself is very important
We can live happily with back and knee problems if we follow the advice of expert
Health education and public awareness is must
We are sure that change is possible with comprehensive approach
Prevention is always better than cure