department of physiology skrp gujrati homoeopathic medical college, indore

Department of Physiology SKRP Gujrati Homoeopathic Medical College, Indore

H.O D DIRECTOR

• Backache is the most commonest complaints of patients coming to clinics for Homoeopathic Treatments.

• Back pain strikes 4 out of 5 people at any time

in their lives.

• 75 to 80 % OF ALL THE PEOPLE WILL EXPERIENCE

SOME FORM OF BACKACHE DURING

THEIR LIFETIME

• It is difficult for the physician to point out the exact causes of

patient back pain ,because of complex composition of

human spine, disc, muscle, ligaments, tendons, nerves &

various other tissues which are arranged like ----

three dimensional puzzle to make up the spine.

• Anatomy of the back region is complex.

Many structures have the potential to cause pain. Only by having a sound knowledge of the anatomy and

the pathologic process involving the area

we can identify the cause and start treatment.

Basic anatomy• Man mostly lies on his back. • Back is an inherent weakness of human body therefore the skin, fascia & muscles of the back are adapted to sustain pressure of the body weight.

 • The back, which extends from the skull to the tip of the coccyx, can be defined as the posterior surface of the trunk.

The Vertebral column• The vertebral column is the central bony pillar of the body. It supports the skull, pectoral girdle, upper limbs and thoracic cage and by way of the pelvic girdle transmits body weight to the lower limbs.• Within its cavity lie the spinal cord, the roots of the spinal nerves and the covering meninges, to which the vertebral column gives great protection

Composition of the vertebral column

The vertebral column is composed of 33 vertebrae-• 7 cervical, • 12 thoracic, • 5 lumber, • 5 sacral (fused to form the sacrum)• 4 coccygeal (the lower 5 are commonly fused)

1)    The Intervertebral discs are responsible for ¼ of the length of the spinal cord. 2)    They may be regarded as semi elastic disc which lies between the rigid bodies of adjacent vertebrae. 3)  Their physical characteristics permit them to serve as the shock absorber when the load on vertebral column is suddenly as when one is jumping from a height.

Joints and pads of fibro cartilage between vertebras called

INTERVERTEBRAL DISCS.

The curvature provide a flexible support ( shock absorbing resilience) for body The four curvature of the adult vertebral column

1)    Cervical 2)    Thoracic 3)    Lumbar 4) Sacral

In the fetus the vertical column has one continuous anterior concavity as development proceeds the lumbosacral angle appears. After birth when the child becomes able to raise her head and keep it poised on the vertebral column the cervical part of the vertebral column becomes concave posteriorly .

The following movement of vertebral column are possible :- 1)     Flexion 2)     Extension 3)     Lateral bending 4) Rotation

When we lift a weight, its effect on the lumbosacral disc is magnified because of very small cross sectional area of the disc.

In order to understand the importance of area, we can visualize ourselves standing on sand or lying down on sand. If we stand our feet sink in; if we lie down we hardly make a dent on the sand. Although the body weight is same in both cases the difference lies in the area through which it acts on sand, The area of the feet is much smaller than that of the back. Therefore when we stand on the sand the pressure (force per unit area) is much greater the when we lie down.

    Coming back to the back, the Intervertebral discs have a very small cross sectional area.

    Therefore when we lift a heavy weight, they can be subject to a pressure greater than they can withstand

The reason why our discs still generally escape Injury is that when we lift a heavy weight, the muscles of the back, the intercostals, The muscles of the abdominal wall, And The diaphragm undergo reflex contraction.

        Therefore if the load is shared by the large cylinders, the pressure on the discs is very much reduced.

        But we can understand that for effective sharing of load, the abdominal and back muscles should be strong.

That is why regular exercises aimed at strengthening these muscles are very useful in preventing backache

Back pain is one of the most common musculo skeletal disorders. The pain effects the lower lumbar spine, lumbo sacral area and sacro iliac. 

It may radiate down the legs in a reticular or sternal distribution. The source of pain can be vertebra, Intervertebral joints, muscles, ligaments, nerves and fascia.

1)Acute2) Developmental defect3) Inflammatory defects4) Osteoarthritis 4) Mechanical trauma5) Miscellaneous 6) Psychological cause7) Gynecological 8) Surgical

1) Acute Trauma to ligaments, muscle, vertebra.

b) Muscle strain

Muscle strain of the lower back cause debilitating back pain

Leads to inflammation causing pain and muscle spasm

c) Fracture of spine

3)    Inflammatory defects       Ankylosing spondylitis (SSA)       Diskitis        Osteoporosis        Sarcoilitis Archnoiditis

4) Osteoarthritis when arthritis effects the spine , vertebrae rub together, causing pain , stiffness, swelling and loss of motion. weakness or numbness of the arm or legs can also results

Spinal Stenosis• when the spinal canal narrows and pinches the spinal cord and nerves causing pain and loss of sensation

• Narrowing is a results of the degeneration wearing down, of the vertebral joints

• Symptoms include pain while walking or standing

Mechanicala. Poor posture and conditioning often aggravated by obesity, pregnancy and overuse.

b.    Strain and sprain c.     Failed back syndrome (FBS) d.    Myelopathy e.     Herniated disc f. Degenerative diseases

Herniated disc Occurs due to

• A fall or accident• Repeated straining of back• A sudden sternous action

such as lifting a heavy weight or twisting voilently

Symptoms include• Back pain • Numbness tingling, pain ,

weakness in one or both legs ( this is called sciatica)

• Changes in bladder and bowel habits

Miscellaneous conditions a.  Osteitis b. Paget’s disease

Psychological cause         Anxiety        depression        frustration       reinforcement stress, anger and fear

Gynecological cause 1)     Fibroid a)     Cervical fibroid b)    Uterine fibroid c)    Ovarian fibroid 2)     Mennorhagia 3)     Dysmennorhoea 4)     Pelvic inflammatory disease 5)     Prolapse of uterus 6)     Retroverted uterus 7)     Endometriosis 8)     Leucorrhoea 9)     Sexual excess

Surgical cause 1)     Surgical trauma 2) Surgical operation

1)     Children

Malignancy Infection Psychogenic Abnormal vertebral column 2)   Adolescents Ankylosing Spondylosis Osteochondritis 3)     Young adults Prolapsed inter vertebral disc Ligaments injury Sexual excess postural discomfort

3)     Young adults

Prolapsed inter vertebral disc

Ligaments injury

Sexual excess

postural discomfort

4)     Middle age

Degenerative disease

Spondylosis

5)     Aged

Osteoporosis

Malignancy

Paget”s Disease

If any patient complains backache the

problem may be of-

1)     Bone 2)     Muscle 3)     Ligaments 4)     Nerves 5)     Joints

We must find out whether it is any of this kind.

1)     Severe Backache 2)     Swelling 3)      Local inflammation 4)      Coldness 5)      Numbness in both limbs 6)      Redness 7)      Tenderness 8)      Stiffness 9)      Anemia 10) Fever 11) Weakness

12) Pain in back

a)     Aching

b)    Cramping

c)    Fatigueness

13) Pain & discomfort in the legs

14) Claudication with the middle

aged and older people

we can ask

If a Patient is coming with pain in BACK the pain can be of following things.

• Bone• Muscle• Tendons• Ligaments• Blood vessles• Nerve

Local Examination of – • Swelling /Edema• Tender• Redness• Any eruption• Tortuousness of veins• Hot/cold ( temperature )• Movement• Sound (cracking )

With the middle aged and older people, we can ask How far he /she can walk without doing rest. Problems in tissue around joints include

1)     Inflammation of bursa (BURSITIS) 2)     Tendons (TENDONITIS) 3)     On tendon sheath (TENOSYNOVITIS) 4) Stretching or tearing of ligament (SPRAIN)

InspectionInspection  Begin by observing the patient’s posture, including the position of both neck and trunk, when entering the room.

  Access the patient for the erect position of the head, smooth, coordinated neck movement and easy of gait.

  If possible the patient should be upright in the patient’s natural standing position with feet together and arms hanging at the sidesInspect the patient from the side, note any spinal curvatures

PalpationPalpation  From a sitting or standing position, Palpate the spinous process of each vertebra with your thumb. In the neck also palpate the facet joints that lie between the cervical vertebra.

Percuss the spine for tenderness by thumping with the ulnar surface of your fist.

Inspect and palpate the pre-vertebral muscles for tenderness and spasm.

       Ask the patient to bent forward to touch the toes (flexion). Note the smoothness and symmetry of movement. The range of motion and the curve in the lumbar area.

As flexion proceed the lumbar concavity should flatten out.

Place your hands on the posterior, superior iliac spine with your fingers Pointing towards the midline and ask the patient to bend backward as far as possible.

       Stabilize the pelvis by placing one hand on the patient’s hip and other on the opposite shoulder. Then rotate the trunk by pulling both the shoulder and the hip posteriorly.

Again stabilize the pelvis by placing your hand on the patient’s hip.

Ask the patient to lean to both side as far as possible.

  1) Plain X- ray 2) Ultra Sonography3) CT scan 4) MRI      5) Colour Doppler     6) Bone scan 7) If nerve root dysfunction Electromyography (EMG) & nerve root conduction studies

BLOOD INVESTIGATION Blood Picture ( Hb.,TLC and DLC, ESR ) Serum Blood Sugar RA factor Serum Electrolytes Uric Acid

MRI OF DISC HERNIATION

Laboratory findingLaboratory finding   High ESR     Infection    Inflammation    Malignancy   Low hemoglobin    Systemic disorder

    Elevated alkaline phosphates     Carcinoma of prostate

    ‘M’ bend on electrophoresis    Multiple myloma

• Urine test U.T.I

Causation : Mechanical injuries

Contusion

Hard work and anger

Pain : As if bruised, or beaten,

Sprained,

Soreness after over exercise

Cannot walk erect

Causation : Mechanical injuries

Bruises, Sprains,

Pain : in the left nape,

back and loins

Relived by pressure and lying on back, worse in morning before rising

Pain : Lameness in the neck

Aching between shoulder blades

Region of spine

Backache during PREGNANCY,

PROLAPUS and LEUCORRHOEA

Aggravation ; motion, stooping, walking, in the morning.

Pain : In the night in bed,and morning

before Rising.

Backache due to sexual excess,

sexual abuse,Onanism .

Backache great exhaustion, Lumbosacral region,

Feels weak, stiffness, and paralytic,

burning in the spine.

During pregnancy and after miscarriage

Aggravation ; after coition,in the morning

lying on painful side

Backache due to great exhaustion,

in Lumbosacral region,

burning in the spine.

Aggravation ; 4 to 8 pm , right side.

1) Alumina

2) Acid flour

3) Acid phos.

4) Bryonia Alb

5) Calcaria Carb.

6) Hypericum

7) Lachieces

8) Natrum mur

9) Medorrhinum

10) Rhus Tox.

11) Sepia

90 % OF THE PEOPLE WITH ACUTE BACK PAIN RECOVER WITHIN 4 – 6 WEEK

Acute back pain is treated with bed rest, with hips and knees held in flexed position.

Local heat and gentle massage are helpful.

Abdominal muscle strengthening exercises are advised.

weight reduction; exercise to improve abdominal

muscle tone and strength, correction of posture and working habits. Yoga, Physiotherapy & removal of cause and correction.

1) Regular exercise

2) Stretching before sport

3) Quit smoking

4) Lose weight

5) Maintain correct posture

6) Supportive seat while driving

7) Sleep on the back with pillow under bent knees

8) Avoiding standing too long

9) Reduce emotional stress

GOOD Posture Is Essential To Our Health And Safety

Standing• Keep your ears , shoulder and hips in one line

• Do not slouch• Maintain posture by keeping your stomach muscle tight as you walk

G O O D Posture Is Essential To Our Health And Safety

SITTING. Do not slump

• keep your knees lower than your hips to allow the small of your back to arch slightly

G O O D Posture Is Essential To Our Health And Safety

SITTING While working on desk

G O O D Posture Is Essential To Our Health And Safety

While driving

G O O D Posture Is Essential To Our Health And Safety

SLEEPING

G O O D Posture Is Essential To Our Health And Safety

BENDING

DO NOT BEND

YOUR WAIST

G O O D Posture Is Essential To Our Health And Safety LIFTING

Lifting loads in such a way that the center of gravity of the load is as close to the body as possible;

G O O D Posture Is Essential To Our Health And Safety

CARRYING

Avoiding jerky, twisting or turning motion during weight lifting because such motions do not allow time for reflex contraction of the abdominal and back muscles.

MR RAJEEV DUBEYAge : 35 yearsAddress : Bakhtawar ram nagar, INDOREOccupation : Pharmaceutical BusinessmanMr. Rajeev Dubey suffering from:

Severe Backache Numbness in both limb Inability to move Loss of sensation for micturation and defecation

Ist MRI L.S. SpineDone on 03.09.2005Technique : Axial T2, sagital T1 and T2, Coronal and sigital myelogramImpression : MRI findings reveal bulge with right Para central soft disc herniation at L5-S1, encroaching in right lateral recess, mildly impinging right S1 nerve root, subtle bulge is also seen at L4-5.

Orthopedic Doctors & Neurosurgeons advised him strict bed rest and spinal surgery, (but patients and their relatives are not agree for surgery).

• Then on the basis of totality of symptoms, Staphys O/1, in Aquadistilla given for 1 week B.D. • After 1 week, patients say that he feels relieved from pain (backache) and in numbness 80%.

• That’s why, same medicine is repeated for 1 week again, which is followed by sac lac for next 15 days.

• After 1 month Staphys O/2, is given once a day followed by sac lac,

• Then after 2 months a dose of Medorrhinum 1M, followed by sac lac.

II nd MRIDone on 10.11.05Technique : Axial T2, sagital T1 and T21, coronal and sigital myelogramImpression ; MRI findings reveal bulge with right paracentral soft disc herniation at L5-S1, causing mild encroachment in right lateral recess. The extent of disc protrusion and nerve root impingement is decreased since previous study.

Aesc., Alum., Arn., Bell., Bar-c., Bry., Calc., Calc-p., Carb-s., Eup-per., Eup-per., Graph., Guaj., Ip., Kali-c.,Lac-c., Lyc., Mur-ac., Nat-m., Nat-s., Nux-m., Nux-v., Par., Phos., Psor., Puls., Rhus-t., Sep., Sil., Sulph.

PAIN,MORNING: WAKING ON : Aeth., Agar.,Arg-m., Berb., Calc-p., Cham., Chel., Grat., Kali-bi., Lac-c., Lach., Mag-m., Mag-s., Myric., Nat-m., Nit-ac.

BEFORE NOON : Ars., Cham., Nat-m., Nat-s.10 A.M. : Am-m.NOON : Dios., Eupi., Rhus-t.AFTERNOON : Abrot., Cham., Hyos., Mag-m., Rumex., Ruta., Sep.EVENING : Acon., Alumn., Ars., Cham., Gels., Kali-s., Nux-v.NIGHT : Acon., Apis., Merc-c., Sulph., Syph.MIDNIGHT : Nat-c.

CERVICAL : Alum., Nat-m., Sulph.DORSAL : Alum., Ruta.LUMBAR : Mag-m., Merc., Nat-m., Puls., Berb.SACRUM : Alum., Graph., Merc., Led.COCCYX : Alum., Bov., Graph., Spig.

COLDNESS : Medicines diffrentiate according to time :INCLUDING CHILL : Bol., Cact., Caps., Lach., Nat-m., Nat-s., Puls., Sil., Sulph.MORNING : Arn., Bry., Nux-v.8:30 – 9 A.M. : Asaf. 10 A.M. : Con11 A.M. : Cham.BEFORE NOON : Cam., Lyc. NOON : Rhus-t.AFTERNOON : Alum., Apis, Thuja.NIGHT : Ars., Nat-m. COLD WATER SPURTED ON, AS IF : Puls. DOWN BACK : Agar., Puls.MOTION ON : Puls.UP THE BACK : Gels.

According to region : Acon., Calc., Nux-v.

CERVICAL : Berb., Rhus-t. SCAPULAE : Anac. LUMBAR : Acon., Berb., Bry. SACRUM : Berb., Graph. COCCYX : Plate.

According to regionAccording to regionCERVICAL : Par., Rhus-t.DORSAL : Carb-s., Sil., Cimic.LUMBAR : Rhus-t.SACRAL : Chin., Rhus-t., Arg-n.COCCYX : Ant-c., Arg-n.

DUE TO SEXUAL EXCESS

Staph., Acid-flour.,

Picric acid., Colocynth

Caust., Cimic., Led., Nux-v., Rhus-t., Sep., Sil., Sulph.MORNING : Ang., Sep.NOON : Valer.EVENING : Dios.NIGHT : Lyc.MOVING : Rhus-t.RISING : Cham., Bry., Ambr., Rhus-t., Caust., Bell.SITTING : Ambr., Rhus-t.STANDING : Stry.PAINFUL : Caust., Rhus-t.WET WEATHER : Rhus-t.

According to time

Asaf., Hep., Lach., Sulph., Sil. CERVICAL : Lach., Sil., Lyc.LUMBAR : Calc-p.

PEDICULATED, BLUISH, AS LARGE AS CHERRY : Con., Thuj.FATTY, ON NECK : Bar-c., Calc., Thuj.MALIGNANT ON NECK : Calc-p.SARCOMA : Bar-c.

According to region :

Calc-c., Pul., Sul.CUTTING : Sep., Arg., Alu., Caus., Nat-m., Sep., Calc-p., Arn.DIGGING : Aco., Rho.