1. 8/9/2015 1 A Discussion On Back Pain TotalSolution Pain & Rehab Center 1661 Hanover Road, Suite 227, City of Industry, CA 91748 626-384-3268 By: Hsiu-Hsien (Tom) Ling, M.D.

2. 8/9/2015 2 The objective of today’s presentation is as follows: Let’s gain a better understanding of back pain Why we have it and how we can prevent it? If you already have back pain, let’s discuss what are some of the treatments out there?

3. 8/9/2015 3 Pain is Undesirable It negatively impacts your Quality of life Daily functions Mood Sleep Social Interaction Work Play

4. 8/9/2015 4 What is spine, anatomically? Bunch of joints (cushioned) Designed for mobility and movement Kinetic chain Provide structural support for the upper body Protection of the spinal cord Shock absorber for the brain

5. 8/9/2015 5 Kinetic Chain of the Spine The integrity of each individual vertebra will impact the overall function of spine Each link has a role in support, movement, stability, and shock reduction In fact, the joints of the appendages (arms/legs) are also linked, and act as shock absorbers for the spine during jumping, landing, or falling Every link in the kinetic chain matters over time!

6. 8/9/2015 6 Young vs. Old Spine Young Spine Strong bones Healthy, well-hydrated, elastic disks Flexible vertebral segments (ligaments/disks/muscles/tendons/joints) Load tolerant (intensity & duration) Able to repair damages Older Spine Weaker bone (osteopenia/osteoporosis) Less elasticity and water in disks Reduced mobility of vertebral segments Degenerative changes (bone spurs, loss of disc height, herniated/bulging disks, hypertrophy of ligaments, stenosis, pinched nerves, slipped vertebrae)

7. 8/9/2015 7 Who gets back pain? Although it’s more prevalent with the elderly, younger adults are getting back pain these days due to stress from work, inactivity, or obesity Back pain is unusual in kids

8. 8/9/2015 8 Causes of pain & impaired function Compression fractures of vertebrae (Osteoporosis) Sciatica (lumbar radiculopathy; pinched nerve) Neurogenic claudication (pain with walking) a/w spinal stenosis Arthritis of facet joints and tear of disc Reduced mobility in one segment of the spine will accelerate the use of adjacent segments, causing greater wear and tear

9. 8/9/2015 9 Other factors affecting spine Body weight / cross sectional area of abdomen Congenital factors (6 th lumbar vertebra; small spinal canal, gender) Systemic disease Posture & Body mechanics Occupation; Sedentary lifestyle, Stress

10. 8/9/2015 10 What can we do to prevent back pain? Slow down the aging phenomenon Maximize spine health Preserve function Minimize pain

11. 8/9/2015 11 The Key is to strengthen the muscle around the spine by lengthening it ! Exercises, such as Yoga, will add to the muscles that protect the (lumbar) spine Flexibility Strength Endurance Balance Superman stretch (in soccer) General principle Active stretch opposite direction of the natural curvature of the particular spine segment

12. 8/9/2015 12 Diagnosis and Treatment for back pain Getting an X-Ray and/or MRI will help your doctor diagnose the problem. Treatment: Exercise / Physical Therapy Modalities – ice/heat/TENS/ultrasound/massage/acupuncture Brace / Corset Medication Steroid injection Surgery

13. 8/9/2015 13 Specific Treatment depends on actual pathology Disc herniation Lumbar stenosis Sciatica / lumbar radiculopathy Lumbar spondylolisthesis (slippage) Compression fracture(s) from osteoporosis Sacroiliac joint pain / facet joint pain

14. 8/9/2015 14 Lumbar Disc Herniation Acute herniation – Bed rest x 2-3 days Pain medications Abdominal binder for stabilization Gradual mobilization and strengthening exercises for protection & healing; avoid exacerbation Flexion based lumbar stretching and strengthening

15. 8/9/2015 15 Lumbar stenosis / sciatica Generally speaking – Pain medications Flexion based lumbar stretching and strengthening; Physical therapy Steroid injection Surgery

16. 8/9/2015 16 Lumbar spondylolisthesis Avoid lumbar Hyperextension Flexion based lumbar lengthening and stretching to try to restore natural alignment and curvature If instability or neurologic deficit beyond numbness or tolerable pain, then surgical stabilization

17. 8/9/2015 17 Osteoporotic Compression Fracture Usually thoracic, esp near thoracolumbar junction Dowager’s hump / progressive kyphosis +/- scoliosis

18. 8/9/2015 18 Osteoporotic Compression Fracture Treatment: Opioids / pain medications Thoracic extension exercises (superman) TLSO brace or body shell Kyphoplasty / vertebroplasty Surgery Tx underlying osteoporosis

19. 8/9/2015 19 Sacroiliac joint pain Unilateral Trauma Leg-length discrepancy, causing asymmetric stress Bilateral Weakness of stabilizers of the SI joints Rule out autoimmune disease in younger pts

20. 8/9/2015 20 Facet joint pain Axial pain worse with lumbar flexion, extension, or rotation Imaging correlation on MRI Tx No treatment; exercise Medication Steroid injection De-innervation of the joint Surgical fusion, facectomy, etc.

21. 8/9/2015 21 Prevention is the key! Proper posture and body mechanics Lifting technique Activities modification Workplace ergonomics evaluation; occupational specific training Abdominal binder / corset (more than just the beauty of thin waist) Low impact exercises to strengthen the core Yoga, swimming, marshal arts, for example

22. 8/9/2015 22 Knowledge is power! Help yourself and others Wise to enlist healthcare professional’s help in the quest for health and wellness Thank you for your attention.

23. 8/9/2015 23 Q & A