Non-surgical Care Of The Neck And Back

Non-Surgical Care of the Neck and Back

Nath an D. Prah low, M. D. Progr am Direct or an d I nte ri m Ch ai rma n De pa rtme nt of Ph ysi cal Med ici ne & Reh abi li tat io n Sep temb er 24 , 2 009

My back h urt s…

My back h urt s… It sh oul d be pret ty easy to fi x i t…

Causes of Low Back Pain •Sp ra in /st rai n •Myofa scial •Degenera tion/ di sc di sea se •Ra di culop at hy •Sa croil ila c d ysfu nc tion •Pir if ormis s ynd rome •Fa cet joi nt art hr opat hy •Ann ula r t ear •Fra ctur es/D is loca ti ons

•Connecti ve ti ssue di sea se •Vi ce rogenic •Va scul ogeni c •St enosis •Ost eoporosi s •Psychoge nic •Fai led b ack synd rome •Infecti ous •Neo pla sti c •Decondi ti oni ng

My bac k and legs hurt …

My bac k and legs hurt … Thi s mi ght b e a bit easier to fi gure out …

Causes of Low Back & Radiating Leg Pain •Herni at ed Lumba r D is c •Cent ra l Ca na l St enosi s •La tera l Stenosi s •Fa cet Join t Art hrop at hy •Sa croil iac Joi nt D ysf uncti on •Pir if ormis S yndr ome

Intervertebral Disc

Also known as… • • • • • •

Herni at ed Nuc leus Pulpo sis Dis c Hernia tio n Dis c Pro trus io n Dis c Ex tr usi on Sli ppe d Di sc Pi nched Nerve

Also known as… • • • • • •

Herni at ed Nuc leus Pulpo sis Dis c Hernia tio n Dis c Pro trus io n Dis c Ex tr usi on Sli ppe d Di sc Pi nched Nerve

• Ann ula r Te ar

Also known as… • • • • • •

Herni at ed Nuc leus Pulpo sis Dis c Hernia tio n Dis c Pro trus io n Dis c Ex tr usi on Sli ppe d Di sc Pi nched Nerve

• Ann ula r Te ar __________ • Bul ging Di sc

Stenosis

Facet Joint Arthropathy

o

My hip hurts …

My hip hurts … Le t’s send yo u to t alk wi th th e surgeon …

The Hip Bone’s Connected to the ?!? • Where is your hip?

Sacroiliitis

X

o

Piriformis Syndrome

Also known as… • Pi rif orm is Syndro me • Pyr if or mis Syn dr om e • Sc ia tic a

Physical Examination • Inspec ti on/Pal pat ion/R ange of Mo ti on • Refle xes/Mus cle Strengt h/Se ns at io n • Spe cial Test s – Sp url ing’ s Ma ne uver ( Ce rvica l Ra dicul opathy) – St andi ng Gi ll ette Test – St rai gh t L eg R ai se (Lumba r Ra dicul opathy) – FAB ER Test – Pir if ormi s Str etch T est

I don’t know the diagnosis, so what do I do? • Get as ac cur at e a dia gnos is as pos sibl e • Begin tre atment earl y, even be for e di agno si s is fi nal ize d • Phys ic al Thera py, Phys ical T he ra py, Phys ic al Thera py!! ! • Hom e exerc is es!!!

Diagnostic Testing •Im aging St udie s – Pla in fil ms —ca n wa it 4-6 weeks i f no ‘ red fla gs ’ • Fr act ure ris k, ne uro lo gica l def ici t, ble ed in g, inf ect io n, cancer ris k

– CT /MRI— gi ve s g reat an atomi c inf orma tion, bu t abnor mal iti es ma y not be caus ing symptoms – Bone sca n – Dis co gra m

More Diagnostics •Ele ctr odi agno sti c Studi es (EMG ) ~2 wee ks befo re ab norm al – May gi ve in fo a bout a cute vs. chr oni c – Cor rela te wi th M RI – Ca n tell peri ph eral vs. cent ra l

Treatment •Act ivi ty Modi fi cations & R est rict ions –Avo id be d res t

•Medi cations –NSAID s –Oral st ero ids –Mus cle relax er s –Pai n med icat ion

•Heat/cold

• Sp ec ial tr eatmen ts – Tr acti on – TEN S (tr ans cutan eous el ect ri cal neu rost imu lat ion) – Ul traso und – Ph onophoresi s – Io ntophoresi s

More Aggressive Treatments •Injec tion s –Sacr oili ac jo int , face t jo int, ep idu ral , and se lect ive ner ve r oot blocks aid in dia gn osis

•Sur gery –Bac k su rge ry may be ver y help ful for leg sy mpt oms; may be hel pf ul for back sy mpt oms wh en done for the rig ht re as ons –New su rgi cal tre at men t optio ns are beco mi ng av ai labl e— ”minimal ly in va si ve ”

•Int erve nt ional Pr ocedur es –Kyph oplast y— co mp ressi on fract ure –RF Ab la ti on— face t joint

What is a Physiatrist? • Not a Ps yc hia tris t • Not a Phys ic al The ra pis t • Not a Phys io lo gis t • Not a Phys ic ist

So, what exactly does a Physiatrist do? Phys ical Medici ne •Gene rall y out pat ient •Common di ag noses inc lud e muscul oskeleta l injuri es (sp ort s, ove ruse, in dus tri al) , con genit al co ndi ti ons, etc. •El ectr omyo gra ph y

Reha bi li tat ion •Inpa tient & out pa ti ent •Common d iag noses in clud e sp ina l cord in jury, tr auma ti c br ain injury, amput ati on, s tr oke , pos t-MI, etc.

• The mai n goa l of the Ph ysi at rist is t o ma ke the p ati ent as f unct iona ll y in de pendent a s

Thank You!

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