spine care after spinal trauma final.pptx

Best care for spine after accident

1. Gp Capt MS Sridhar Sr Adv Surgery & Neurosurgery Command Hospital Air Force Bangalore CARE FOR YOUR SPINE

2. Introduction Preventing disease is always preferable to treating disease.

3. Back pain is like tooth decay and the common cold, affects all of us, at some point in our lives. Nobody is immune to this condition or its potential disability which does not discriminate by gender, age, race or culture.

4. At any given time 20% of the population will be suffering from back ache 75% of population will suffer from back ache at some time in their lives .

5. Natural history of back ache – It gets better! – 40 to 50% of patients improve within one week. – 85 to 90% patients improve in 6-12 wks. – 75% of patients recover within 6 mo. – 90% improve with conservative treatment only.

6. Natural History of back ache – it usually comes back! – 40% of patients with acute back pain report recurrence at 6 mo follow-up. – 44% of patients - chronic phase by 2 yrs. – No definitive diagnosis found in 85% of LBP cases.

7. Medical research supports return to work programs as a best practice during the recovery phase from back ache. Return to work combined with therapy often results in faster recovery Absolute bed rest is NOT necessary for a quick recovery

8. Oh…My poor back! 3 types of back problems Acute Chronic Recurrent

9. “I bent forward to pick up……” Acute problems Usually can pinpoint a time and/or incident Usually localized in low back Pain may vary from mild to extreme Examples Muscle spasm Locked facet (joint) “Crick in my neck” “Catch in my back” Impinged facet “I drove 8 hours straight” Uh, Oh!

10. “I’m sorry, I can’t go _____ because of my bad back” Chronic problems Problem that lasts longer than 14 days Usually from “wear and tear” May stem from an acute problem Examples Arthritis Degenerative disc Nerve inflammation

11. Same story...different day Recurrent Problems Acute “flair ups” of chronic condition Made worse by certain activities Examples Sacroiliac Joint Problems (SI) Where pelvis joins the spine Can cause shooting pain

12. anatomy

13. 36% of load transmission is through the anterior columns 64% is through the posterior columns 64 36

14. Facet Joints 24 pair = 48 joints! Allow movement of spine Made of same “stuff” as all other joints The facet joints ensure that your back doesn’t bend of twist further than it should The Links

15. Ligaments Ligaments help to keep the vertebrae in position Help to prevent injury by stabilizing the spine and limiting its movement. Bands of tough tissue Encase the spinal column Connect vertebrae to one another

16. Inter vertebral discs “ SHOCK ABSORBERS “ of spine. ANNULUS FIBROSIS NUCLEUS PULPOSIS Hygroscopic, Water content 80-90%(diurnal variation) 70-76%(adults) Always under tension - transmitted to annulus as tensile force.

17. Sagittal anatomic section through a normal intervertebral disc Annulus fibrosis Nucleus pulposis

18. Normal disc Mild disc degeneration Moderate disc degeneration Severe disc degeneration

19. What makes them all go 'round... Spenius capitis Splenius cervicis Serratus posterior superior Serratus posterior inferior Iliocostalis lumborum Iliocostalis thoracis Iliocostalis cervicis Longissimus thoacis Longissimus cervicis Longissimus capitis Spinalis thoracis Spinalis Cervicis Spinalis Capitis Semispinalis thoracis Semispinalis cervicis Semispinalis capitis Multifidus Rotatores Interspinalis Intertransversarii Obliquus capitis inferior Obliquus capitis superior Rectus capitis posterior minor Rectus capitis posterior major Longus colli Longus capitis Rectus capitis anterior Rectus capitis lateralis Trapezius Rhombois Serratus anterior Levator scapula

20. “ The more there is to mess up the more likely something will mess up .” 33 vertebra + 23 discs + 48 joints (24 pair) + 64 muscles (32 pair) + 54 nerves (27 pair) 222 different things to break! Murphy’s Law?!

21. Motion occurs in all the structures holding the two vertebrae together BEWEGUNGGSSEGMENT Junghans -1932 ALL, PLL, I/V Disc, Facet joints, Inter laminar lig , Lig flavum , Inter spinous lig

22. Anatomical section showing a normal facet and a hypertrophied facet causing canal stenosis Normal facet joint Hypertrophied facet joint

23. Bio mechanically disc degeneration is divided into 3 stages Dys functional stage ( traumatic tears of annulus, degen. of nucleus ) Unstable stage ( disc, facet facet degeneration, ligament laxity ) Restabilisation stage ( disc collapse, fibrosis, osteophyte formation ) – “ SPONDYLOSIS”

24. What is a disc prolapse ?

25. If a disc is strained beyond its’ limit, causing the outer casing to tear, the inner substance can seep out. If this substance presses on or irritates a spinal nerve, you feel pain or tingling in the leg. The leg pain is known as “sciatica”.

26. LOADS ON INTERVERTEBRAL DISCS IN VARIOUS POSTURES

27. Lying supine-25%

28. Lying on side-75%

29. Standing -100%

30. Standing and bending forwards-150%

31. Bending forwards and lifting weights-220%

32. Sitting-150%

33. Slouching-185%

34. Sitting and bending forwards / lifting weights- =/>275%

35. COMMON CAUSES OF BACK ACHE

36. Common Causes of Low Back Pain Poor posture while standing e Improper lifting/bending Poor posture while standing

37. Poor posture while sitting Infrequent exercise Excessive weight and weak abdominal muscles may cause a spinal imbalance Common Causes of Low Back Pain

38. Dysfunctional sleep position

39. Dysfunctional sleep position Plays a role in 80% in causing - Pain … neck, shoulders, arms, hands, upper back, low back… Dysfunctional sleep positions - Stomach sleeping, Twisted / side arm(s ) overhead

40. Lying on your side, with knees bent, supports the natural curve of the back. Use a pillow to support the neck, especially if your shoulders are broad.

41. Sleeping on the stomach can increase the low back curve and stress the neck and shoulders. If you must sleep on your stomach, place a pillow under your hips to support the low back.

42. Sleeping on your back is restful and correct when the knees are properly supported.

43. BIODYNAMICS

44. The Forces Involved With the fulcrum in the center, it only takes ten pounds of pressure to lift a ten pound object . 10 kg 10 kg

45. The Forces Involved If you shift the fulcrum to one side, it takes much more force to lift the same object. Your waist acts like the fulcrum in a lever system, on a 10:1 ratio. Lifting a 10 kg object puts 100 kg of pressure on your lower back. 100 Kg 10 kg Fulcrum Lever distance Maximum load on lower back

46. The Forces Involved Lifting a ten pound object actually puts 1,150 pounds of pressure on the lower back!

47. It’s a Little Known Fact… The average human head weighs approximately 5-7 kgs. About as much as a bowling ball!

48. The head-neck support system can be likened to a 5-7 kg. ball on a flexible shaft stabilized by wires. The muscles pull down to stabilize , the stronger the muscles, the more force is transmitted through the spinal column

49. Every 2-3 cm forward the head is held requires 7 to 14 kg of extra muscle tension in the muscles of the neck

50. Bad Posture Predisposes to fatigue of muscles Leads to soreness and stiffness, exhaustion, stress and increased risk of injury Misalignment of bones cause abnormal wear and tear of joints

51. The Result…….

52. 50 Years Later

53. How do we injure our back?

54. Back injuries are second in number after injuries to the fingers and hands. Most lower back injuries come from: Common Causes of Back Injuries Lifting Lowering Pushing Pulling Carrying

55. Back injuries are second in number after injuries to the fingers and hands. Most lower back injuries come from: Common Causes of Back Injuries Lifting Lowering Pushing Pulling Carrying

56. Three main factors in manual lifting: Load Location - Where is the load? Task Repetition - Frequency of Exertion Load Weight -How heavy? Common Causes of Back Injuries

57. Twisting at the waist while lifting or holding a heavy load . . . This frequently happens when using a shovel. Common Causes of Back Injuries

58. Reaching and lifting . . . over your head, across a table, or out the back of a truck . . . Common Causes of Back Injuries

59. Lifting or carrying objects with awkward or odd shapes . . . Common Causes of Back Injuries

60. Working in awkward, uncomfortable positions . . . Common Causes of Back Injuries

61. Sitting or standing too long in one position . . . Sitting can be very hard on the lower back . . . Common Causes of Back Injuries

62. It is also possible to injure your back slipping on a wet floor or ice . . . Common Causes of Back Injuries

63. Prevention Of Back Injuries

64. Stacking / Retrieving Objects

65. Prevent Back Injuries Avoid lifting and bending whenever you can. Place objects up off the floor. Raise/lower shelves. Use carts and trollies.

66. Use cranes, hoists, lift tables, and other lift-assist devices whenever you can. Test the weight of an object before lifting by picking up a corner. Prevent Back Injuries Get help if it’s too heavy for you to lift it alone.

67. Bend with your knees not with your back. Lift with your legs. Hold the load close to your body. Contract your stomach muscles as you lift. Keep your back aligned and upright as you lift. Avoid twisting while lifting. Lifting NNMC Chiropractic NNMC Chiropractic

68. Lifting Straddle the load to keep it close to your center of gravity. NNMC Chiropractic

69. Lifting Never bend at the waist to lift. NNMC Chiropractic

70. When possible push your load. Do not pull heavy objects . Pushing versus Pulling NNMC Chiropractic NNMC Chiropractic

71. Getting In and Out of a Car Do not step into a car. Sit on the seat and then pull your legs into the car. Reverse the process for getting out.

72. Correct Postures

73. Posture - is the single most common cause of painful soft tissue syndromes affecting the body

74. A Better Core Equals a Better Back Your ”core” muscles—comprised of the abdominal and back muscles- act like that of a corset to hold everything in or support and stabilize your lumbar spine. The result is a slimmer shape , and more importantly, a spine that is supported against strain, pain and injury.

75. A Healthy Core Equals a Healthy Back

76. To build a functionally strong back— a better back for life you must first address posture

77. Dynamic Vs Static exercises Muscles are involved in two types of activity – Dynamic & Static Dynamic –muscle fibers contract and relax as a result fresh oxygenated blood flows into the muscle each time it relaxes.

78. Static Muscle fibers contract and remain contracted for a long time – results in a continuous deficit of oxygenated blood . Waste products accumulate produce feeling of pain, fatigue , tenderness resulting in cramps – sustained contraction of muscle which cannot relax on its own.

79. Sitting or standing for long periods produces static loads on the para spinal muscles

80. Poor Postures

81. Syndromes of LBA Myofascial syndrome Mechanical syndrome Neural compression syndrome Neuropathic pain syndrome Inflammatory syndrome Psychosocioeconomic syndrome

82. Myofascial syndrome Pain due to irritation/injury of musculo ligamentous structures Worse in mornings and evenings,relieved by walking. Frozen back syndrome

83. Mechanical syndrome Pain due to instability of lumbar spine motion segment. Worse in evenings and on bending relieved by lying down. Spondylolisthesis/ retrolisthesis/ vaccum disc/ facet arthropathy etc.

84. Inflammatory syndrome Caused by Discitis Osteoporosis Ankylosing spondylitis Reiters syndrome Rheumatoid arthritis Psoriatic arthropathy Fibromyositis etc. Mornings stiffness and pain, relieved by walking and as the day progresses.

85. Neural compression syndrome Caused by PIVD/ canal stenosis. Need to differentiate new symptoms from old ones.

86. “How successful is surgery?” We’re not perfect, but.. Greater than 85% of patients undergoing spine surgery have significant, dramatic, or complete relief of their pain arm/leg improves sooner and more completely than neck/back More than 75% patients have improvement in their function More than 90% of working patients return to work

87. “Wait a minute here, Mr. Crumbley ….Maybe it isn’t sciatica after all.”

88. Ergonomics

89. Ergonomics and Prevention Step # Key Word Description 1 Analyze Analyze the risks you may be exposed to on a particular job . 2 Minimize Minimize identified risks by finding ways to reduce repetitive motion and excessive force. 3 Neutralize Neutralize awkward postures that may cause strain and tension by placing your body in a natural, relaxed position. In a neutral position your shoulders and back are relaxed, your neck is straight and your arms and elbows are close to your body

90. Correct sitting posture

91. Ergonomically Correct Work Station

92. Chair – Low Back Support is Essential

93. Wrong Sitting Posture – Sitting on Front Edge of Chair

94. Chair Height Feet flat on floor May need a foot rest Thighs parallel to the ground Or knees slightly lower than hips

95. Chair Too High

96. Chair – Seat Pan Depth 1-2 inches from back of knees to front of seat

97. Seat Depth Too Long: can cut off circulation Too Short: does not provide enough support

98. Wrong Sitting Posture – Ankles Tucked

99. Wrong Sitting Posture – Leaning Forward 21/11/2010 111 CHAF Bangalore

100. Physiotherapy

101. Increasing abdominal pressure Decreases the load on the spine by 40%! One kg load in front of abdomen exerts a 5 kg load on the spine while standing. Back rest decreases stress on back.

102. All exercises to be done deliberately and slowly. There should not be any jerky movements. Rest in between exercises is as important as the exercises themselves. Do not over do the exercises do only 3 to 5 repetitions of each exercise. Exercise for 10 seconds rest for 20 seconds.

103. Low Back Exercises Avoid impact and twisting activities : Running, Tennis, Golf Exercise shouldn’t cause any pain or any dizziness. If it occurs, stop the exercise immediately.

104. Minimize problems of your back by exercises that tone the muscles in your Back, Abdomen, Hips and Thighs.

105. Exercise! Exercise regularly, every day. Warm up slowly . . . A brisk walk is a good way to warm up. Inhale deeply before each repetition of an exercise and exhale when performing each repetition.

106. Exercises to strengthen your back

107. Exercises for Abdomen Modified Sit-up . Slowly raise your shoulders off the ground while keeping your chin tucked. Touch your fingertips to your knee and hold for a count of 5. Do not arch your back. Repeat 5-10 times

108. Lie on your back with one knee bent so the foot is flat on the floor; keep the other leg straight and slowly raise it 8” off the floor. Hold for 5 seconds, lower and relax; repeat 3 - 5 times then change legs. Lift both the legs together and hold for 20 seconds Straight Leg Lift for Legs and Abdominal muscles

109. Lie prone on a firm flat surface keeping hands on hips or as shown. Lift legs one by one, keeping knee extended. Lift both together, keeping knee extended. Lift chest and both legs off the bed simultaneously Exercise for Back - Dorsal Raise

110. Back leg swing to strengthen hip and back muscles . . . Exercises To Help Your Back Stand behind chair, hands on chair. Lift one leg back and up, keeping the knee straight. Return slowly. Raise other leg and return. Repeat 5 time with each leg.

111. Exercises To Help Your Hips and Thighs Wall slides to strengthen your muscles . . . Stand with your back against a wall, feet shoulder-width apart. Slide down into a crouch with knees bent to 90 degrees. Hold for 5 – 10 seconds and slide back up the wall. Repeat 5 times.

112. Exercises to reduce strain on your back

113. Back Stretches Knees side to side Lie flat on the ground Bend the knees keeping them together Place the feet on floor Rotate knees side to side within the pain free range , l et your hips roll Repeat for 1-2 min.

114. Back Stretches Single Knee to chest Lie down flat on your back, Slowly bring one knee toward your chest and grasp it with your hands. Hold for 5 - 10 seconds, then relax Repeat with the other leg.

115. Back Stretches Double Knee to chest Lie flat on back Bend knees keeping the feet on the floor Grasp both the knees, pull them to the chest, don’t hold your breath Repeat 5 times

116. Back Stretches Pyriformis Stretch Lie down flat on your back, Cross left knee on the right Slowly bring right knee toward your chest and grasp it with your hands. Hold for 5 -10 seconds, then relax Repeat with the other leg.

117. Back Stretches (Hamstrings/Gluts)

118. Lie on stomach, hands under shoulders, elbows bent and push up. Raise top half of body as high as possible. Keep hips and legs on floor. Hold for 5 - 10 seconds. Repeat 10 times Stretch Your Back

119. Back Extension Stretch Place your hands on the back of your waist and stretch backward while looking at the ceiling. Hold for a second of five then slowly stand up.

120. Neck and Shoulder exercises

121. Shoulder Stretches 1 Fold your hands in the back of your neck and pull your shoulder blades together. Hold on for 10 seconds. Don’t pull your neck! Do this exercise 3 -5 times.

122. Shoulder Stretches 2 Fold your hands together and stretch your arms with the palm of your hands faced up. Hold on for 10 seconds. Do this exercise 3 times.

123. Shoulder rotations Make circling movements with your shoulders. First 15 seconds forward, then 15 seconds backward. Make slow movements. Try to feel stretch in your shoulders, neck and upper back when making forward movements. Try to feel stretch in your shoulders, the front of your neck and your chest muscles when making backward movements. .

124. Neck Glide Start with neck straight . Slowly slide your chin forward. Hold for 5 -10 seconds and return to starting position. Do ten times

125. Neck Extension Without arching your back, slowly move your head backward so you are looking upward. Hold for 5-10 seconds. Return to starting position

126. Acupressure Point The points shown here related to chronic pain. By pressing and holding for 5 - 10 seconds, a person can sense some relief of pain.

127. Neck Rotation Start by looking straight ahead. Slowly turn your head to the left. Hold for ten seconds, then return to starting position. Then, slowly turn you head to the other side. Hold for ten seconds, then return to starting position. Do ten times.

128. Neck Side Extension Start by looking straight ahead. Slowly lean your head to the left. Hold for 5-10 seconds, then return to starting position. Then, slowly lean your head to the other side. Hold for 5-10 seconds, then return to starting position. Do 10 repetitions

129. Neck Stretch Start by looking straight ahead. Slowly raise both shoulders up. Hold for 5-10 seconds, then return to starting position. Do 10 repetitions.

130. Neck Forward Flexion Start by looking straight ahead. Slowly lower your chin toward your chest. Hold for 5 - 10 seconds, then return to starting position. Do 10 repetitions

131. To Conclude…..

132. If you work at a desk, consider stretching throughout the day to keep your muscles flexible and avoid injury.

133. What should one do? Move! If you stand for a long time… Sit Down once an hour for a few minutes If you sit for a long time… Stand Up once an hour for a few minutes If your belly’s big… Lose Weight ! If your legs are tight… Stretch ! … Exercise !

134. Believe ½ of What You See, None of What you Hear … You Need a Firm Mattress You Need a Flat Pillow All Waterbeds are Bad Always Use Heat Back Braces Make Your Back Weak You Should Always Use a Lumbar Support When Sitting Sit-ups are Good for You

135. Take care of your back… and it will take care of YOU! “ Remember that an ounce of prevention is worth a pound of cure.”