Break the cycle of back pain

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Break the cycle of back pain

• Steven B. Kirshner, MD
• Heather Eble, PT

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Back Pain

• Over 90 of the people in the USA will experience
  back pain at some time in their lives.

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Why?

• Injuries and accidents account for a small
  percentage of back pain.
• Normal daily activities
• Its not what you do, its how you do it that
  matters.
• Our society is too rushed.

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• The United States of America is number one in the
  world

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• For being-
• Overweight and out of shape

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• During pregnancy and motherhood,
• women are at greater risk
• of developing back pain.

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Pregnancy

• Weight distribution
• Hormonal changes
• Loose ligaments
• Delivery

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Motherhood

• Inadequate rest
• Exhaustion
• Lack of proper exercise
• Awkward positioning

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Menopause

• Hormonal changes
• Loss of calcium
• Inadequate conditioning
• Normal natural aging
• Osteoporosis

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Advanced Spinal Treatments
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Diagnosis

• Degenerative disc disease
• Herniated discs
• Spinal stenosis
• Osteoporosis
• Compression fractures
• Metastatic disease

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Treatments

• Physical therapy
• Medications
• Spinal injections
• Surgery

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Surgical Options

• Laminectomy
• Discectomy
• Spinal Fusion
• Kyphoplasty
• Motion-Sparing Devices

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Motion-Sparing Devices

• DYNESYS- flexible screw/rod system
• TDR- total/artificial disc replacement

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Kyphoplasty

• Relieves pain
• Restores vertebral height
• Helps patients regain normal
• function faster
• Reduces risk of pneumonia, blood clots, physical
  deterioration, etc.
• Prevents future fractures

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Vertebral Fracture Associated Conditions
Postmenopausal women age 55
Prominent thoracic kyphosis
Loss of 2 or more inches in height
Low BMD
Diagnosis of osteoporosis
Glucocorticoid therapy( 7.5 mg prednisolone)
Ismail AA et al. Osteoporos Int. 19999206213.
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Radiologic Assessment

• First week post fracture

8 weeks post fracture
MRI T2 Image
Courtesy of B. Boszczyk R. Bierschnieder, BG
Unfallklinik, Dept. of Neurosurgery, Murnau,
Germany
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Balloon Kyphoplasty

• Stabilizes the Fracture and Corrects Spinal
  Deformity caused by one or more VCFs

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Example Percent Lost Height Restored
Lost Height Restored (24 20) / (30 - 20) or
4/10 40
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Low Back Pain

• Are YOU at Risk?

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Why are women at risk?

• Pregnancy
• Motherhood
• Osteoporosis

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Pregnancy

• Center of gravity changes
• Altered sleeping positions
• Altered walking pattern
• Increased curve of the lumbar spine
• (low back)
• Stress on ligaments in the low back and pelvic
  area

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Preventive Measures

• Exercises
• Counteract the increased curve of
• the low back
• Improve leg strength for proper
• lifting ability
• Promote flexibility
• Decrease pain

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Preventive Measures

• Postural Awareness
• Lumbar roll to support the curve
• of the back
• Shoulder blades pulled slightly backwards
• Head tucked back so that center of ear is aligned
  with shoulders
• Pregnancy belts for support

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Physical Therapy Treatment

• If low back pain does develop during
• pregnancy, Physical Therapists can assist
• in designing a program that is right for you.

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Physical Therapy Treatment

• Application of moist heat or ice pack for pain
  relief
• Hands-on soft tissue mobilization as needed for
  muscle spasms or tightness
• Therapeutic massage
• Therapeutic exercise program to reduce pain
  (strength, flexibility, endurance, posture,
  education, home exercise program)

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Motherhood

• Restlessness during sleep times
• Fatigue / poor posture
• Lifting infants and children
• Carrying car seats, strollers and accessories
• Stress

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Preventive Measures

• Learning proper lifting techniques
• Strengthening of legs to decrease stress on low
  back
• Postural awareness
• General exercise to increase endurance
• Stretching and flexibility
• Rest periods throughout the day

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Physical Therapy Treatment

• Exercises
• Lumbar stabilization exercises improve
  coordinated contraction of muscles in the abdomen
  and low back to decrease stress on the spine and
  ligaments

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Physical Therapy Treatment

• Exercises
• Flexibility program will help improve motion of
  the back and hips to decrease pain when bending.
• Postural retraining to reduce stress on the
  spine, muscles and other structures in the low
  back.

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Physical Therapy Treatment

• Application of moist heat or ice pack
• Application of electrical stimulation
• Hands-on techniques to stretch tight muscles,
  reduce muscle spasms, mobilize joints or
  strengthen muscles

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Physical Therapy Treatment

• Education
• Proper lifting techniques
• Proper sitting and standing posture
• Gait training (improving walking pattern)
• Preventive exercises including a home exercise
  program

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Osteoporosis

• Characterized by a loss of calcium and
• bone tissue
• Susceptible to fractures, especially of
• the spine
• Hormonal changes that occur with
• menopause can worsen bone loss

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Risk Factors

• Family history
• Small / petite women
• Early menopause
• Lack of calcium intake
• Alcohol / smoking
• Immobility / lack of exercise

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Preventive Measures

• Calcium-rich diet
• Weight training
• Weight-bearing exercises
• Alteration of lifestyle

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Preventive Measures

• Exercise
• - Reduces bone loss
• - Conserves bone tissue
• - Decreases pain
• - Increases strength and fitness
• - Increases balance and coordination
• - Increases mobility

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Preventive Measures

• NOTE Exercise not only helps prevent
  osteoporosis, but can also reduce the rate of
  bone loss in women who already have osteoporosis.

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Physical Therapy

• Postural awareness training
• Balance exercise program to reduce risk for falls
  and subsequent fractures
• Home exercise program (may include walking,
  dancing, or gardening)
• Exercises in weight-bearing to improve bone and
  muscle strength

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Physical Therapy

• Pain relief modalities as needed including moist
  heat, soft tissue mobilization / massage, or
  electrical stimulation
• Education on preventive measures, including fall
  reduction and proper method for bending or lifting

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Summary

• Pregnancy, motherhood, and osteoporosis can place
  a woman at risk for low back pain
• There are many preventive measures for women to
  reduce the risk of experiencing pain.
• If pain does occur, physical therapists may be
  able to assist in reducing or eliminating low
  back pain.

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• For more information about Virtua Health, call
  1-888-Virtua-3 or go to www.virtua.org.