UNDERSTANDING BACK PAINI. M. Doctor, M.D.

My Office

My City, State

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The information in this presentation was provided to the presenter by the American

Academy of Orthopaedic Surgeons and may be modified.

Endorsement of this presentation by the AAOS

is not implied or inferred.

Thank you toA. Herbert Alexander, MD

for his significant contributions to the content of this presentation.

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Understanding Back Pain

Orthopaedics and The Bone and Joint Decade

Types of back pain Diagnosing the causes of back pain Who is at risk for back pain?

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Understanding Back Pain

Seeking help

Therapies to help back pain sufferersMedicationsSurgeryNonsurgical treatmentsComplementary approaches

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What is an orthopaedic surgeon?

MD who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine)

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What is an orthopaedic surgeon?

The expert in treating the musculoskeletal system

The expert in maintaining musculoskeletal health

The expert in understanding both operative and non-operative treatment options

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Educating an Orthopaedic Surgeon

College Medical School Internship Orthopaedic

Residency Fellowship (optional) 2 Years Practice

TOTAL

4414(1)2

16 years!16 years!

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What do orthopaedic surgeons do?

Diagnose Treat

Medication Physical Therapy Exercise Brace Surgery

Prevent

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Back Pain

Your Orthopaedic Surgeon—

Getting You Back In The Game

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Back Pain

Structural Issues: Muscular Arthritic Disk

Psychological Issues: Emotional stress

Medical Issues: Infections Inflammatory conditions

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Symptoms

Throbbing, aching, shooting, stabbing, dull or sharp pain

Pain down one or both legs with very little pain in the lower back

Numbness or weakness in the legs

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Symptoms

Pain down in the lower back & legs in certain positions such as standing or walking

Sleep problems, decreased energy, depression, and anxiety

Pain that stress and emotional issues causes or makes worse

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General Treatment

Examination by an orthopaedic surgeon Period of activity

modification Perhaps medication to

decrease pain and inflammation

Complete inactivity is not advised for more than a couple of days

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General Treatment

Rehabilitation Goals Increased muscle strength Increased endurance Increased flexibility Improve aerobic fitness

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Sacrum

Coccyx

Cervical

Thoracic

Lumbar

Spinal Column

Healthy Spine Function

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VertebraFacet joint

Spinal canal

Disc

Healthy Spine Function

Vertebra

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Healthy Spine Function

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PsoasPsoas

TrapeziusTrapezius

ErectorErectorspinaespinae

musclesmuscles

LatissimusLatissimus

GlutealsGluteals

ObliquesObliques

Healthy Spine Function

Abdominal Abdominal wall wall musclesmuscles

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Burden of Disease

Lower back pain is the one of the most commons common causes of missed work

Eight out of ten adults will experience back pain at some time

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Burden of Disease

58 million ambulatory care visits for back and neck pain

82 million work days lost

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Robert DoverOlympic equestrian

Age: 44

Condition/Injury: Low Back Pain

Getting You Back In the Game

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Diagnosis

Herniated disc/sciatica

Sprain/Strain Stress-related

back pain

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Diagnosis

Arthritis of spine Symptomatic

disc degeneration

Facet Syndrome Spondylolisthesis

& Spondylolysis

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Diagnosis

Spinal fractures Lumbar spinal

stenosis Chronic back pain

syndrome

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Conchita Espinosa Chediak

Age: 41

Condition/Injury: Large herniated lumbar disc, severe

back pain, and foot drop

Actual Clinical Case Example:

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Large Disc Herniation

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Are You At Risk?

Job requires frequent bending and lifting

Twisting body when lifting & carrying an object

Lifting and carrying in a hurry

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Are You At Risk?

Overweight Do not exercise regularly Do not engage in recreational physical

activity Smoker

Plan ahead, don’t hurry

Spread feet shoulder distance apart

Bend knees

Lift with leg muscles

Tighten stomach musclesMove in

close when

placing object on high shelf

Don’t twist

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Primary Care Physicians

Orthopaedic Surgeons

Spine Surgeons

Seeking Help

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Seeking Help

Before Your Appointment Prepare to describe

your symptoms Gather medical

history Make list of

medications Write down concerns

and questions and bring them

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Seeking Help

During Your Appointment

1. What should I expect from my treatment?

2. What effect will my treatment have on my daily activities?

3. What can I do to prevent further disability?

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Active Therapies

Exercise is key Aerobic conditioning program Special back exercises

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Active Therapies: Exercise

Active Therapies: Stretching

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Active Therapies

Pain Programs Involve multiple healthcare

professionals Different treatments at different times Goal is to decrease pain, increase

functioning Patient must be highly motivated

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Passive Therapies

Ultrasound and massage Water therapy Transcutaneous Electrical

Nerve Stimulation (TENS)

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Passive Therapies

Traction Corsets and braces

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Medication

1. Why are you recommending this medication?

2. How will this medication help me to feel better?

3. What are the benefits and when will we know if it works?

8 Important Questions to Ask Your Orthopaedic Surgeon

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Medication

4. How do I take this medication?

5. What are the side effects? What to do if I have side effects? Are they temporary?

6. Is it okay to use generic?

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Medication

7. Can I take this medication with others I’m currently taking?

8. How do I stop taking it safely?

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Medication

Analgesics Anti-

inflammatories Muscle relaxants

Sedatives Anti-anxiety

agents Antidepressants

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What to show here?

Invasive Conservative Treatments

Trigger point injections

Facet injection Spinal epidural

steroid injections Selective nerve

root blocks

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Surgery May Be Your Choice When…

Leg pain rather than back pain Non-operative treatments are

ineffective Symptoms match test findings Symptoms prevent daily living

activities

45Finding a Surgeon

Surgery

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Asking Questions About Surgery

Why? Alternatives? Benefits and for how long?

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Asking Questions About Surgery

Risks? What is procedure called? How is it done? Results?

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Asking Questions About Surgery

Duration of recovery? Assistance at home and how

long? Disability after surgery? Physical therapy? Return to normal activity?

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Back Pain

Therapies

Medication

Surgery

Complementary Approaches

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American Academy of Orthopaedic Surgeons

6300 N. River RoadRosemont, IL 60018 www.orthoinfo.org

Resources

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What are your questions and concerns?

Back Pain

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Thank you for participating today

Remember, your orthopaedic surgeon can help get you back in the game

Back Pain