UNDERSTANDING

I.
M. Doctor,
BACK
PAINM.D.
My Office
My City, State

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 to
A. Herbert Alexander, MD
for his significant contributions to the
content of this presentation.

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?

Understanding Back Pain

Seeking help
Therapies to help back pain
sufferers
Medications

Surgery
Nonsurgical treatments
Complementary approaches

What is an orthopaedic surgeon?

MD who specializes in treatment and

health maintenance of musculoskeletal
system (bones, joints, ligaments,
muscles, tendons, cartilage and spine)

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 nonoperative treatment options

Educating an Orthopaedic Surgeon

College
Medical School
Internship
Orthopaedic Residency
Fellowship (optional)
2 Years Practice

TOTAL
7

4
4
1
4
(1)
2
16 years!

What do orthopaedic surgeons do?

Diagnose
Treat

Medication
Physical Therapy
Exercise
Brace
Surgery

Prevent

Back Pain

Your Orthopaedic Surgeon

Getting You Back In The Game

Back Pain

Structural Issues:

Psychological Issues:

Emotional stress

Medical Issues:

10

Muscular
Arthritic
Disk

Infections
Inflammatory conditions

Symptoms

11

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

Symptoms

12

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

General Treatment

13

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

General Treatment

14

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

Healthy Spine Function

Cervical

Spinal Column

Thoracic

Lumbar
Sacrum
15

Coccyx

Healthy Spine Function

Facet joint

Vertebra
Disc

Spinal canal
Vertebra

16

Healthy Spine Function

17

Healthy Spine Function

Trapezius

Latissimus
Obliques

Erector
spinae
muscles
Psoas

Gluteals
18

Abdominal
wall
muscles

Burden of Disease

19

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

Burden of Disease

58 million ambulatory care

visits for back and neck pain
82 million work days lost

20

Getting You Back In the Game

Robert Dover
Olympic equestrian
Age: 44
Condition/Injury: Low Back
Pain

21

Diagnosis

22

Herniated
disc/sciatica
Sprain/Strain
Stress-related
back pain

Diagnosis

23

Arthritis of spine
Symptomatic
disc
degeneration
Facet Syndrome
Spondylolisthesis
& Spondylolysis

Diagnosis

24

Spinal fractures
Lumbar spinal
stenosis
Chronic back pain
syndrome

Actual Clinical Case Example:

Conchita Espinosa Chediak

Age: 41
Condition/Injury: Large
herniated lumbar disc, severe
back pain, and foot drop

25

Large Disc Herniation

26

Are You At Risk?

27

Job requires frequent bending and

lifting
Twisting body when lifting & carrying
an object
Lifting and carrying in a hurry

Are You At Risk?

28

Overweight
Do not exercise regularly
Do not engage in recreational physical
activity
Smoker

Plan ahead,
dont hurry

Move in
close
when
placing
object on
high shelf
Lift with leg
muscles
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Tighten
stomach
muscles
Bend knees

Dont twist
Spread feet shoulder
distance apart

Seeking Help
Primary Care
Physicians
Orthopaedic
Surgeons
Spine Surgeons
30

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
31

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?
32

Active Therapies

33

Exercise is key
Aerobic conditioning program
Special back exercises

Active Therapies: Exercise

34

Active Therapies: Stretching

35

Active Therapies

Pain Programs

36

Involve multiple healthcare

professionals
Different treatments at different times
Goal is to decrease pain, increase
functioning
Patient must be highly motivated

Passive Therapies
Ultrasound and massage
Water therapy
Transcutaneous Electrical
Nerve Stimulation (TENS)

37

Passive Therapies
Traction
Corsets and braces

38

Medication
8 Important Questions to Ask Your
Orthopaedic Surgeon
1.

2.

3.

39

Why are you

recommending this
medication?
How will this medication
help me to feel better?
What are the benefits
and when will we know
if it works?

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?
40

Medication
7. Can I take this
medication with
others Im currently
taking?
8. How do I stop taking
it safely?

41

Medication
Analgesics
Antiinflammatories
Muscle relaxants

42

Sedatives
Anti-anxiety
agents
Antidepressants

Invasive Conservative
Treatments
Trigger point
injections
Facet injection
Spinal epidural
steroid injections
Selective nerve
root blocks

43

What to show here?

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

44

Surgery

45

Finding a Surgeon

Asking Questions About Surgery

46

Why?
Alternatives?
Benefits and for how long?

Asking Questions About

Surgery

47

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

Asking Questions About

Surgery
Duration of recovery?
Assistance at home and how
long?
Disability after surgery?
Physical therapy?
Return to normal activity?

48

Back Pain
Therapies
Medication
Surgery
Complementa
ry
Approaches
49

Resources

American Academy of Orthopaedic

Surgeons
6300 N. River Road
Rosemont, IL 60018
www.orthoinfo.org

50

Back Pain
What are your questions and
concerns?

51

Back Pain

Thank you for participating today

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

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