;. schematic cross-section of an inter-vertebral disc inter-vertebral disc herniated disc
TRANSCRIPT
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Schematic cross-section of Schematic cross-section of an an inter-vertebral discinter-vertebral disc
Herniated disc Herniated disc
Causal factors for back pain…
Spinal fracture
Herniated disc
TB spine
Mechanical low back pain - Diagnosis of exclusion – 75-80% of cases.
Spinal FractureSpinal Fracture
Herniated DiscHerniated Disc
TB SpineTB Spine
Trigger factors
Excessive load on normal back
Long / erratic hours
Poor workplace ergonomics
Stress: Physical, mental and emotional
Travel
Normal load on weak or unprepared back
Fatigue
Improper posture/ chronic malpositioning
Lack of exercise, poor physical conditioning
Weight control problems
Poor postureTrigger factors (contd)…
Three phases of management strategy…
Treatment of acute episodes.
Amelioration of chronic condition.
Prevention of exacerbation/ reinjury.
The case against protracted rest
Deconditioning: Loss of muscle strength and endurance
Chance of micro traumatic injury
Protracts recurrent episodes
Maintains chronic disability
Decreased flexibility Adversely modifies spinal biomechanics
Physiology of disc hydration affected
“Avoid pill popping”
Exercise - for which patients?
Central focus in 95% cases
“YES” in mechanical causes
“NO” in non-mechanical causes
Exercise types…
Back-specific exercises
Peri-pelvic and LL flexibility and strengthening
Aerobic conditioning
Double knee to chest stretch
Pelvic tilt
Some exercises for the back…
Lower trunk Lower trunk rotation stretch rotation stretch
Trunk Flexion Stretch
Trunk flexion stretchTrunk flexion stretch
Prone lumbar extensionProne lumbar extension
Some exercises for the back…
Alternate Prone Leg ExtensionAlternate prone leg extensionAlternate prone leg extension
Aerobic conditioningAerobic conditioning
Abdominal StrengtheningAbdominal strengtheningAbdominal strengthening
Lower Limb StretchesLower limb stretchesLower limb stretches
Complementary therapy
Back hygiene and back school
Correction of biomechanical factors
Posture
Weight control
Weight trainingWeight training
YogaYoga
YogaThe right chairThe right chair
Counter heightCounter height
Working PosturePosture at workPosture at work
The right posture…
Sitting PostureSitting posture
Forward bendingForward bending
Pulling an ObjectPulling an objectPulling an object
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