Lower back pain

Lower back pain-
--Lower back pain is very common among adults and is often caused by overuse and muscle strain or injury. Treatment can help you stay as active as possible. And it will help you understand that some continued or repeated back pain is not surprising or dangerous.
--Most low back pain can get better if you stay active, avoid positions and activities that may increase or cause back pain, use ice, and take nonprescription pain relievers when you need them.
--When you no longer have acute pain, you may be ready for gentle strengthening exercises for your stomach, back, and legs, and perhaps for some stretching exercises. Exercise may not only help decrease low back pain, but it may also help you recover faster, prevent reinjury to your back, and reduce the risk of disability from back pain.
--Exercises to reduce low back pain are not complicated and can be done at home without any special equipment.
--It's important that you don't let fear of pain keep you from trying gentle activity. You should try to be active soon after noticing pain, and gradually increase your activity level. Too little activity can lead to loss of flexibility, strength, and endurance, and then to more pain.

Spine Diseases

Spinal disease is any pathology which affects the spinal column and/or the spinal cord and spinal nerves which are contained therein. Spine disease is a large area of study because of the large number of diseases which can affect the spinal system, from purely skeletal disorders to primary nervous system disorders. All types of spine disease can present with either or both spinal symptoms or neurological symptoms associated with injury or compression of the spinal cord or spinal nerves. Spine disease is very common, with many people undergoing spinal surgery every day.

Degenerative spine disease is a general term for any pathology of the spine that occurs over time due to both normal aging and wear and tear of the vertebral column. This includes many pathologies, such as herniated disc disease, spinal stenosis, and spinal instability.

Traumatic spine disease refers to any disease of the spine which occurs as the result of a traumatic injury such as a fall or motor vehicle accident. It can include spinal fractures, traumatic disc herniation and spinal instability.

Spinal Tumors are tumors that involve the spinal cord or vertebral column. They can either be primary, originating in the spinal column, or secondary, spreading to the spine from other sites in the body, such as in the case of a metastatic cancer.

Spinal Dysraphisms are abnormalities in the the spinal cord, mostly due to abnormalities in the development of the spinal cord and/or vertebral column.

Treatment of spondylosis

Treatment of spondylosis:

Doctors usually recommend muscle relaxants and non-steroidal anti-inflammatory medications such as ibuprofen and naproxen to relieve the pain and stiffness. This is often combined with physiotherapy to stretch and strengthen the spine and lower back and neck muscles.

Surgery to remove bone spurs or affected discs is recommended for patients experiencing severe neurological problems such as weakness, pain and numbness in the arms and legs.

“Spinal problems caused by cervical and lumbar spondylosis are not life-threatening, but if left untreated, can lead to increased pain and decreased flexibility and mobility,” says A/Prof Tan. When nerves are pinched, damage to them often occurs, resulting in permanent pain, numbness, weakness or poor coordination.

Advances in medical technology have made minimally invasive spinal surgeries possible even for patients with severe spondylosis. These patients can expect less post-operative pain and faster recovery, A/Prof Tan adds.

Cutting-edge medical technology – including minimally-invasive surgery – and the expertise of its specialists make the Department of Orthopaedic Surgery at Singapore General Hospital a premier referral centre for spinal surgery, joint replacement and ankle and foot surgery, and the treatment of musculoskeletal tumours, trauma and sports-related injuries.

Spinal Cord Diseases

Spinal Cord Diseases

Your spinal cord is a bundle of nerves that runs down the middle of your back. It carries signals back and forth between your body and your brain. It is protected by your vertebrae, which are the bone disks that make up your spine. If you have an accident that damages the vertebrae or other parts of the spine, this can also injure the spinal cord.

Other spinal cord problems include
-Tumors
-Infections such as meningitis and polio
-Inflammatory diseases
-Autoimmune diseases
-Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy

Symptoms vary but might include pain, numbness, loss of sensation and muscle weakness. These symptoms can occur around the spinal cord, and also in other areas such as your arms and legs. Treatments often include medicines and surgery

Tips for a Healthy Spine

1) Sleeping - Never on your belly! Side is acceptable but on your back is the best. Use one pillow and don't prop your head up.

2) Pillows - Cervical (contour) pillows are the best to support your neck properly

3) Mattresses - Firm mattresses are better than soft - no pillow tops.

4) Sitting - Avoid sitting for more than 45 minutes. Get up frequently. Sit with your legs underneath your chair and not with your legs crossed.

5) Computers - Your screen should be eye level. If it's too low, you will hunch over too much

6) Lifting - Lift with your back straight and bend your knees.

7) Wallets - You should not sit with wallet in your back pocket. It can cause pelvic misalignment as well as pressure on the sciatic nerve.

8) Purses/Handbags - Avoid carrying them on one shoulder. Slinging them with the strap on the opposite should can help. The best is to go light and carry them in your hand alternating sides often.

9) Footware - Purchase good supportive footware with adequate arch support

10) Orthotics - Most people have faulty foot posture that will eventually cause back problems. If you have fallen arches you should consider getting orthotics. Ask one of the GRC doctors.

Back extensions-

Back extensions-

Stretches and mobilises the spine backwards

Start position:
Lie on your stomach, and prop yourself on your elbows, lengthening your spine. Keep your shoulders back and neck long.

Action:
Keeping your neck long, arch your back up by pushing down on your hands. You should feel a gentle stretch in the stomach muscles as you arch backwards. Breathe and hold for five to 10 seconds. Return to the starting position.
Repeat eight to 10 times.

Tips:
Don't bend your neck backwards.
Keep your hips grounded.

KNEE ROLLS

Knee rolls

Start position:
Lie on your back. Place a small flat cushion or book under your head. Keep your knees bent and together. Keep your upper body relaxed and your chin gently tucked in.

Action: 
Roll your knees to one side, followed by your pelvis, keeping both shoulders on the floor. Hold the stretch for one deep breath and return to the starting position
Repeat eight to 10 times, alternating sides.

Tips:
Only move as far as feels comfortable.
Place a pillow between your knees for comfort.

SPINE EXERCISES: Bottom to heels stretch

SPINE EXERCISES: Bottom to heels stretch

Stretches and mobilises the spine

Start position: 
Kneel on all fours, with your knees under hips and hands under shoulders. Don't over-arch your lower back. Keep your neck long, your shoulders back and don't lock your elbows.

Action: Slowly take your bottom backwards, maintaining the natural curve in the spine. Hold the stretch for one deep breath and return to the starting position.
Repeat eight to 10 times.

Tips:
Avoid sitting back on your heels if you have a knee problem.
Ensure correct positioning with the help of a mirror.
Only stretch as far as feels comfortable.

Break Up Tension with the Cat-Cow Stretch-

Come to a four pointed kneeling position. Stack your shoulders directly above your wrists, and place your knees on the floor slightly behind your hips. Exhale and round your spine. As you do this press outward through your hands and roll your tailbone under (toward your forehead) to lengthen your lower back. Inhale, arch your spine in the other direction by lifting your tailbone upward as you curl your chin backward. Repeat for 30 full rounds of breath.

Exercise : Chest Raises from Prone

Exercise : Chest Raises from Prone

-This is a more advanced exercise. Not everyone will be able to do this one. If you can lie on your stomach without difficulty, you can safely try this one.
-Lie on stomach on bed or floor.
-Putting a pillow under stomach is optional and makes it easier to get on stomach and lift head.
-Pinch shoulders back, smoothly lift head and chest and continue to look straight down.
-Hold for a slow 5 count.
-Rest for 2 seconds and repeat until tired.
-Do once every day.

Suggestion: If you can get on your stomach but can’t lift your head up, keep trying it. You might eventually start getting your head and chest up, and then you’ll know your exercises are helping!

EXERCISE: Strengthning Extensor muscles

EXERCISE: Strengthning Extensor muscles 

-Stand straight in good posture.
-Place ball behind upper back.
-Keep feet apart and away from wall for good balance.
-Push hard with feet and legs to press back against ball.
-Keep spine, hips and knees in the same position. Only the ankle joints pivot where shown by dot.
-Hold for a slow 5 count and follow with a 2 second rest.
-Repeat until you feel your leg or back muscles tire.
-Slowly increase up to 15–20 repetitions.
Do once every day.
-As strength increases move feet further away from the wall to push harder. Remember don’t let your spine bend.

Spine transplant:A boon to mankind

We have all heard about Heart and Liver transplant which in their own way have revolutionised medical treatment.Equally revolutionary is Spine Transplant on which not much has been talked in the public sphere.Earlier Disc transplant used to be a fusion surgery which definitely used to remove the pain but the patients mobility was greatly reduced.Now a days, an artificial instrument is transplanted into the spine which not just removes the pain but continues to do the actual disc job like carrying load ,providing flexibility.
It has come as a big relief for young patients who suffer damage in spine in some serious accident.Also it greatly helps those suffering from paralysis of spine.All in all its a great boon for those suffering from serious spinal problem

EXERCISE: neck press against resistance

EXERCISE TIME:

Neck Press Against Resistance-

--Lie on back with pillow under head to support in neutral position.
--Push head down firmly to straighten and lengthen spine as shown.
--Keep chin tucked and head facing upward.
--Hold for a slow 5 count.
--Relax for a couple of seconds.
--Repeat 10 times or until neck muscles tire.
--Do once in the morning and once in the evening every day—perhaps before getting up and going to bed at night.

Suggestions:
--While doing these exercises tighten and relax muscles smoothly—don’t jerk or apply sudden forces.
--This exercise may become easy after a while. If so, replace pillow(s) with a firm rolled towel. It should fit comfortably behind your upper neck and base of the head supporting your head in a comfortable neutral position.

Sitting Postures for office chairs:

Sitting Postures for office chairs:

--Be sure the back is aligned against the back of the office chair. Avoid slouching or leaning forward, especially when tired from sitting in the office chair for long periods

--For long term sitting, such as in an office chair, be sure the chair is ergonomically designed to properly support the back and that it is a custom fit

--When sitting on an office chair at a desk, arms should be flexed at a 75 to 90 degree angle at the elbows. If this is not the case, the office chair should be adjusted accordingly

--Knees should be even with the hips, or slightly higher when sitting in the office chair

--Keep both feet flat on the floor. If there's a problem with feet reaching the floor comfortably, a footrest can be used along with the office chair

--Sit in the office chair with shoulders straight

--Don't sit in one place for too long, even in ergonomic office chairs that have good back support. Get up and walk around and stretch as needed

Care for your spine

Care for your spine:

When you consider your body’s healthy habits (or not so healthy habits) start to think of a freshly ironed white shirt, with long sleeves. Take the same shirt and tie it up tight, in a knot. When you wake up tomorrow morning, which one do you want to wear to greet the day?

Now, think about how many activities during the day affect your back, neck, shoulders, arms, and your spine. How does crossing your legs or slumping in a chair hurt your back and add to the pain and discomfort you experience every day? These habits may restrict your body from receiving all the blood, oxygen, and nutrients it needs to function at its best level.

Most of us forget that daily activities impact our body and many of us have developed habits that, when identified and corrected, will be replaced with healthy alternatives. These tips will begin to help you understand how to maintain your healthy spine, to improve your neck and back, and to reduce these habits that impact your body.

These are habits that affect the direct relationship of your spine to your pain. When you become aware of what you are doing, you might want to write it down on paper. Place the note on your desktop or in your office as a reminder. When you are successful, cross a bad habit off this list and replace it with a new achievement:

--Walk ½ mile each morning
--Swim ten laps
--Have broccoli with dinner
--Replace each old bad habit with a healthy new habit.
--Take baby steps toward your healthier back, neck and spine.
--Avoid habits like crossing your legs while at your desk, bending your head down while at the computer, and avoid holding the desktop phone against your shoulder.
--Begin to practice these tips, one each day.
--Write down your old habit to be eliminated. Then write a healthy habit to replace it.
--Be specific. Instead of writing, “I’ll exercise.”
--Think about a specific exercise. “I’ll walk around my backyard for five minutes in the morning.”

Weight Loss for Back Pain Relief

Weight Loss for Back Pain Relief-

-Patients who are overweight or obese and suffer from back pain may not be aware that their excess weight is actually contributing to their back pain.

-While it has not been thoroughly studied exactly how excess weight can cause or contribute to back pain, it is known that people who are overweight often are at greater risk for back pain, joint pain and muscle strain than those who are not obese.

-In addition to back pain, symptoms exhibited by persons who are obese or severely overweight may include fatigue, as well as difficulty breathing and shortness of breath during short periods of exercise.

-If the fatigue and shortness of breath causes one to avoid activity and exercise, then this can indirectly lead to back pain as lack of exercise contributes to many common forms of back pain.

How Obesity Leads to Back Pain:
-According to the American Obesity Association, episodes of musculoskeletal pain, and specifically back pain, are prevalent among the nearly one-third of Americans who are classified as obese.

-Some of the most common obesity-related problems include musculoskeletal and joint related pain.1 For people who are overweight, attention to overall weight loss is important as every pound adds strain to the muscles and ligaments in the back.

-In order to compensate for extra weight, the spine can become tilted and stressed unevenly. As a result, over time, the back may lose its proper support and an unnatural curvature of the spine may develop.

-In particular, pain and problems in the low back may be aggravated by obesity. This occurs for people with extra weight in their stomachs because the excess weight pulls the pelvis forward and strains the lower back, creating lower back pain. According to the American Obesity Association, women who are obese or who have a large waist size are particularly at risk for lower back pain.1

Identifying the Need for Weight Loss :
-Body Mass Index (BMI) is a measure commonly used by medical practitioners. BMI is a mathematical formula (BMI=kg/m2) that takes into account a person’s weight in kilograms and height in meters and calculates a number. The higher a person’s BMI falls on a pre-determined range of values, the higher the likelihood for obesity.

-Although there is some debate over the specific meaning of BMI measurements, a BMI of 30 or higher is typically considered to be obese, while a measure of 25 to 29.9 is typically considered to be overweight.

-It is also important to evaluate where excess fat is carried on the patient’s body. Patients who carry more weight around their midsection are at greater risk for obesity-related health problems, such as low back pain. Weight loss for health considerations is often advisable for women with a waist measurement of more than 35 inches or men with a waist measurement of more than 40 inches.

Degenerative Disc Disease-

Degenerative Disc Disease-

Normally, the spine and all its ligaments and muscular support are stable, only moving in certain ways. However, with severe degenerative disc disease, the normal stability of a spine can become lax and lead to abnormal weakness in certain areas. Instability can both lead to pain as well as injury to the spinal cord or spinal nerves, both of which can cause neurological symptoms. Instability can also occur as the result of a trauma which tears supportive soft tissues or breaks bones of the spine.

Symptoms-
-Lower back pain that is generally made worse with sitting
-Back pain intensified by bending, lifting and twisting
-Walking and running may feel better than prolonged sitting or standing
-Desire to change positions frequently so alleviate pain

Treatment-
Treatment for degenerative spine disease varies considerably depending on the specifics of each case. Some patients benefit from conservative therapy with rest and physical therapy and some cases call for spine surgery. The faculty of the Spine Institute will prescribe a path of treatment that is unique to each patient and their particular condition.

SPINAL FUSION

Spinal fusion is surgery to permanently join together two or more bones in the spine so there is no movement between them. These bones are called vertebrae.

ABOUT SPINAL FUSION:
-You will be asleep and feel no pain (general anesthesia).The doctor will make a surgical cut (incision) to view the spine. This may be done:

-On your back or neck over the spine. You will be lying face down. Muscles and tissue will be separated to expose the spine.
On one side of your belly, if you are having surgery on your lower back. The surgeon will use tools called retractors to gently separate, hold the soft tissues and blood vessels apart, and have room to work.

-With a cut on the front of the neck, toward the side.
Other surgery, such as a diskectomy, laminectomy, or a foraminotomy, is almost always done first.

-The surgeon will use a graft (such as bone) to hold (or fuse) the bones together permanently. There are several ways of fusing vertebrae together:

-Strips of bone graft material may be placed over the back part of the spine.

-Bone graft material may be placed between the vertebrae.
Special cages may be placed between the vertebrae. These cages are packed with bone graft material.
The surgeon may get the graft from different places:

-From another part of your body (usually around your pelvic bone). This is called an autograft. Your surgeon will make a small cut over your hip and remove some bone from the back of the rim of the pelvis.

-From a bone bank. This is called an allograft.

-A synthetic bone substitute can also be used.
The vertebrae may also fixed together with rods, screws, plates, or cages. They are used to keep the vertebrae from moving until the bone grafts are fully healed.

-Surgery can take 3 to 4 hours.

Artificial Disc Replacement :

A rapidly developing alternative to spinal fusion surgery, artificial disc replacement is a procedure that involves replacing a painful disc that is causing chronic back pain with an artificial disc that provides pain relief without compromising the spine's natural anatomical structure. Artificial disc replacement surgery may be performed on the lower back (lumbar spine) or the neck (cervical spine). Artificial discs are structurally similar to the damaged discs that are replaced and share similar functions, including acting as shock absorbers in the back or neck.

Non-surgical Treatment for Spinal Stenosis

1.Exercises:
Although a suitable program of spinal stenosis exercises may be helpful in the hands of a good physical therapist, it is not curative. Even though stenosis exercises are not a cure, however, it is very important for patients to remain active as tolerated and not additionally debilitated from inactivity; therefore, an appropriate spinal stenosis exercise program is a key part of any treatment program.


2.Activity modification.:
With this treatment for stenosis, patients are usually counseled to avoid activities that cause adverse spinal stenosis symptoms. Patients are typically more comfortable while flexed forward. Examples of activity modification for treatment of spinal stenosis might include: walking while bent over and leaning on a walker or shopping cart instead of walking upright; stationary biking (leaning forward on the handlebars) instead of walking for exercise; sitting in a recliner instead of on a straight-back chair.