Joint PainsJoint Pains

Mediplex Health Care Mediplex Health Care

The Story of …..The Story of …..

Alok Sharma & Rahul Gupta….Alok Sharma & Rahul Gupta…. Class matesClass mates Age: early 20’s :Bright Computer Age: early 20’s :Bright Computer

Professionals.Professionals. Recruited in Good Software company. Recruited in Good Software company. Long stressful working hours.Long stressful working hours. Sometimes working late in nights.Sometimes working late in nights.

Story of Alok…Story of Alok…

He never had time for himself or he never He never had time for himself or he never tried to find some time.tried to find some time.

He was advised to do some exercise, relax He was advised to do some exercise, relax and adopt right posture while working.and adopt right posture while working.

He is always saying “ Once I complete this He is always saying “ Once I complete this project then only I will start taking care of project then only I will start taking care of myself”.myself”.

Now he is in late 20’s …married ….Now he is in late 20’s …married ….

The story goes on …The story goes on …

Now he is getting tired easily, he has put on Now he is getting tired easily, he has put on weight and becoming irritated easily. He has weight and becoming irritated easily. He has started experiencing pain & stiffness in started experiencing pain & stiffness in neck.neck.

He is advised that its high time …..take care He is advised that its high time …..take care of body…ready made excuse ….No time. of body…ready made excuse ….No time.

No time ?No time ?

Time to think !Time to think ! Drive your car to different places and Drive your car to different places and

important meetings. Don’t get it refueled as important meetings. Don’t get it refueled as there is no time to do that ……there is no time to do that ……

What is going to happen ?What is going to happen ? You are ultimately going to stuck in the You are ultimately going to stuck in the

middle of road ….loosing all your clients …..middle of road ….loosing all your clients ….. What about your body ?What about your body ?

Now his body crashed !Now his body crashed !

He is in early 30’s He is in early 30’s Suffering from cervical spondylosis….Suffering from cervical spondylosis…. Can’t even work on computers for 15 Can’t even work on computers for 15

minutes. minutes. Feels giddy whenever he turns his head.Feels giddy whenever he turns his head. Lost strength in hands & can’t lift even 1-2 Lost strength in hands & can’t lift even 1-2

Kg of weights.Kg of weights.

Story still continues !Story still continues !

Bed ridden !Bed ridden ! On sick leaves !On sick leaves ! Promotions are stopped & job is at stake !Promotions are stopped & job is at stake ! Rising medical bills !Rising medical bills ! Financial insecurity as he is sole bread Financial insecurity as he is sole bread

winner !winner ! Emotional and social problem ! Emotional and social problem !

Whereas Mr. Gupta !Whereas Mr. Gupta !

Mr. Gupta …his class mate, has been Mr. Gupta …his class mate, has been promoted to senior position….promoted to senior position….

Energetic and enthusiastic.Energetic and enthusiastic. Challenging assignments.Challenging assignments. Financially very well off.Financially very well off. Almost nil medical bills.Almost nil medical bills. Enjoys vacations, work and family life.Enjoys vacations, work and family life.

AnalysisAnalysis

You have to invest time on yourself.You have to invest time on yourself. Time or money are just excuses. You have Time or money are just excuses. You have

to steal 40 minutes per day, 3-4 times in a to steal 40 minutes per day, 3-4 times in a week.week.

Healthy body and mind is just what counts in Healthy body and mind is just what counts in long run !long run !

What will you do with rest of things and if What will you do with rest of things and if you are not well !you are not well !

DefinitionDefinition

Pain affecting joints !Pain affecting joints ! Joint pain can be caused by many types of Joint pain can be caused by many types of

injuries or conditions. No matter what injuries or conditions. No matter what causes it, joint pain can be very causes it, joint pain can be very bothersome.bothersome.

Lets understand about jointsLets understand about joints

Skeleton SystemSkeleton System JointsJoints Parts of jointsParts of joints

Lets understand about joints !Lets understand about joints !

Causes of Joint painsCauses of Joint painsJoint injury : Strain, Sprain & previous joint injury

Infections - many infections cause aching joints and aching muscles

Viral infection, Common cold, Flu etc

Arthritis – Osteoarthritis, Rheumatoid arthritis , Psoriatic arthritis , & Gout

Joint infection : Tendinitis, Bursitis etc

Common Joint ProblemsCommon Joint Problems

Osteoarthritis (OA)Osteoarthritis (OA) Rheumatoid ArthritisRheumatoid Arthritis

Based Upon LocationsBased Upon Locations Lumbar SpondylosisLumbar Spondylosis Cervical SpondylosisCervical Spondylosis

OAOA Osteoarthritis is the most common form of arthritis. Osteoarthritis is the most common form of arthritis. This is the form that usually comes with age and This is the form that usually comes with age and

most often affects the fingers, knees, and hips. most often affects the fingers, knees, and hips. Sometimes osteoarthritis follows an injury to a Sometimes osteoarthritis follows an injury to a

joint. For example, a young person might hurt his joint. For example, a young person might hurt his knee badly playing cricket. Then, years after the knee badly playing cricket. Then, years after the knee has apparently healed, he might get arthritis knee has apparently healed, he might get arthritis in his knee joint. in his knee joint.

What Causes OA ?What Causes OA ?

Primary osteoarthritis is mostly related to Primary osteoarthritis is mostly related to aging. .

Protein makeup of cartilage degenerates.Protein makeup of cartilage degenerates. Repetitive use of the joints over the years Repetitive use of the joints over the years

irritates and inflames the cartilage, causing irritates and inflames the cartilage, causing joint pain and swelling. joint pain and swelling.

PathologyPathology

Eventually, cartilage begins to degenerate Eventually, cartilage begins to degenerate by flaking or forming tiny crevasses. by flaking or forming tiny crevasses.

Loss of cartilage cushion causes friction Loss of cartilage cushion causes friction between the bones, leading to pain and between the bones, leading to pain and limitation of joint mobility. limitation of joint mobility.

Osteoarthritis occasionally can be found in Osteoarthritis occasionally can be found in multiple members of the same family, multiple members of the same family, implying an implying an heredity (genetic) basis for this (genetic) basis for this condition. condition.

PathologyPathology

Inflammation of the cartilage can also of the cartilage can also stimulate new bone outgrowths (spurs) to stimulate new bone outgrowths (spurs) to form around the joints. form around the joints.

Comparison of Normal Vs Diseased Comparison of Normal Vs Diseased Joints Joints

Secondary osteoarthritisSecondary osteoarthritis

Secondary osteoarthritis is caused by Secondary osteoarthritis is caused by another disease or condition. another disease or condition.

Conditions that can lead to secondary Conditions that can lead to secondary osteoarthritis include osteoarthritis include obesity, repeated , repeated trauma or or surgery to the joint structures, to the joint structures, abnormal joints at birth (congenital abnormal joints at birth (congenital abnormalities), abnormalities), gout, , diabetes and other and other hormone disorders.hormone disorders.

Risk FactorsRisk Factors

Obesity causes osteoarthritis by increasing causes osteoarthritis by increasing the mechanical the mechanical stress on the cartilage. on the cartilage.

In fact, next to aging, obesity is the most In fact, next to aging, obesity is the most powerful powerful risk factor for osteoarthritis of the for osteoarthritis of the knees. knees.

The early development of osteoarthritis of The early development of osteoarthritis of the knees among weight lifters is believed to the knees among weight lifters is believed to be in part due to their high body weight. be in part due to their high body weight.

Risk FactorsRisk Factors

Crystal deposits in the cartilage can cause Crystal deposits in the cartilage can cause cartilage degeneration, and osteoarthritis. cartilage degeneration, and osteoarthritis. Uric acid crystals cause arthritis in gout, crystals cause arthritis in gout, while calcium pyrophosphate crystals cause while calcium pyrophosphate crystals cause arthritis in pseudogout.arthritis in pseudogout.

Hormone disturbances, such as diabetes Hormone disturbances, such as diabetes and growth hormone disorders, are also and growth hormone disorders, are also associated with early cartilage wear and associated with early cartilage wear and secondary osteoarthritis. secondary osteoarthritis.

SymptomsSymptoms

Joint pain is usually worse later in the day. There Joint pain is usually worse later in the day. There can be swelling, warmth, and creaking of the can be swelling, warmth, and creaking of the affected joints.affected joints.

Pain and stiffness of the joints can also occur Pain and stiffness of the joints can also occur after long periods of inactivity, for example, sitting after long periods of inactivity, for example, sitting in a theater. in a theater.

In severe osteoarthritis, complete loss of cartilage In severe osteoarthritis, complete loss of cartilage cushion causes friction between bones, causing cushion causes friction between bones, causing pain at rest or pain with limited motion. pain at rest or pain with limited motion.

DiagnosisDiagnosis X-rays : loss of joint cartilage, narrowing of the joint space X-rays : loss of joint cartilage, narrowing of the joint space

between adjacent bones, and bone spur formation. between adjacent bones, and bone spur formation. Arthrocentesis often performed in the doctor's office: a Arthrocentesis often performed in the doctor's office: a

sterile needle is used to remove joint fluid for analysis. sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding gout, infection, Joint fluid analysis is useful in excluding gout, infection,

and other causes of arthritis. and other causes of arthritis. Arthroscopy is a surgical technique whereby a doctor Arthroscopy is a surgical technique whereby a doctor

inserts a viewing tube into the joint space. Abnormalities of inserts a viewing tube into the joint space. Abnormalities of and damage to the cartilage and ligaments can be detected and damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope. and sometimes repaired through the arthroscope.

Cervical spondylosis Cervical spondylosis

Cervical spondylosis is a chronic Cervical spondylosis is a chronic degeneration of the bones (vertebrae) of the degeneration of the bones (vertebrae) of the neck (cervical spine) and the cushions neck (cervical spine) and the cushions between the vertebrae (disks). between the vertebrae (disks).

Cause (Same as OA)Cause (Same as OA)

As you age, the disks of your spine become drier and less As you age, the disks of your spine become drier and less elastic. Degeneration can cause some of the disks to bulge elastic. Degeneration can cause some of the disks to bulge and, in some cases, cause the central cartilage of the disks and, in some cases, cause the central cartilage of the disks to protrude through a crack in the ring that surrounds the to protrude through a crack in the ring that surrounds the disk (herniate). The surrounding ligaments become less disk (herniate). The surrounding ligaments become less flexible, and the vertebrae may develop bone spurs.flexible, and the vertebrae may develop bone spurs.

These degenerative changes may be a result of wear and These degenerative changes may be a result of wear and tear throughout your life. An earlier injury to your neck may tear throughout your life. An earlier injury to your neck may predispose you to this degeneration. By age 60, most predispose you to this degeneration. By age 60, most people will show signs of cervical spondylosis on X-ray, people will show signs of cervical spondylosis on X-ray, although they may not have signs or symptoms.although they may not have signs or symptoms.

Cause (Same as OA)Cause (Same as OA) As you age, the disks of As you age, the disks of

your spine become drier your spine become drier and less elastic. and less elastic. Degeneration can cause Degeneration can cause some of the disks to bulge some of the disks to bulge and, in some cases, cause and, in some cases, cause the central cartilage of the the central cartilage of the disks to protrude through a disks to protrude through a crack in the ring that crack in the ring that surrounds the disk surrounds the disk (herniate). The surrounding (herniate). The surrounding ligaments become less ligaments become less flexible, and the vertebrae flexible, and the vertebrae may develop bone spurs. may develop bone spurs.

Signs and symptoms Signs and symptoms Neck pain and stiffness that gets progressively Neck pain and stiffness that gets progressively

worse worse Numbness or weakness in the arms, hands and Numbness or weakness in the arms, hands and

fingers fingers Headaches that radiate to the back of the head Headaches that radiate to the back of the head Loss of balance Loss of balance Numbness or weakness in the legs, if the spinal Numbness or weakness in the legs, if the spinal

cord is compressed cord is compressed Loss of bladder or bowel control, if the spinal cord Loss of bladder or bowel control, if the spinal cord

is compressed is compressed

BackacheBackache IntroductionIntroduction The back is a well-designed structure The back is a well-designed structure

made up of bone, muscles, nerves and made up of bone, muscles, nerves and other soft tissues. You rely on your back other soft tissues. You rely on your back to be the to be the workhorse workhorse of the body — its of the body — its function is essential for nearly every function is essential for nearly every move you make. Because of this, the move you make. Because of this, the back can be particularly vulnerable to back can be particularly vulnerable to injury and back pain can be disabling.injury and back pain can be disabling.

Four out of five adults have at least one Four out of five adults have at least one bout of back pain sometime during life. bout of back pain sometime during life. In fact, back pain is one of the most In fact, back pain is one of the most common reasons for health care visits common reasons for health care visits and missed work.and missed work.

On the bright side, you can prevent most On the bright side, you can prevent most back pain. Simple home treatment and back pain. Simple home treatment and proper body mechanics will often heal proper body mechanics will often heal your back within a few weeks and keep your back within a few weeks and keep it functional for the long haul. it functional for the long haul.

CausesCauses

Spondylosis.Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerative Spondylosis is a type of arthritis affecting the spine. It is due to the degenerative changes in the spine that often come with aging. changes in the spine that often come with aging.

Spinal stenosis.Spinal stenosis. This condition occurs when the space around the spinal cord and nerve roots This condition occurs when the space around the spinal cord and nerve roots narrows due to arthritis and bone overgrowth. This can press or pinch a nerve. narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.

Spondylolisthesis.Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward over This condition occurs when one vertebra in the spinal column slips forward over another. another.

These rare but far more serious causes of back pain also have specific treatment related to the These rare but far more serious causes of back pain also have specific treatment related to the underlying cause.underlying cause.

Cauda equina syndrome.Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs, This is a serious neurological problem causing weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control. numbness in the "saddle" or groin area, and loss of bowel or bladder control.

Cancer in the spine.Cancer in the spine. A tumor on the spine can press on a nerve causing back pain. A tumor on the spine can press on a nerve causing back pain. Infection of the spine.Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be If a fever and a tender, warm area accompany back pain, the cause could be

an infection. an infection. Injury.Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain. Damage to the bones, ligaments, or muscles of the back can cause severe pain. Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back

pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be difficult to treat.difficult to treat.

Screening and diagnosisScreening and diagnosis

X-ray.X-ray. These images show the alignment of your bones and whether you have These images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks. disks.

Magnetic resonance imaging (MRI) or computerized tomography (CT) Magnetic resonance imaging (MRI) or computerized tomography (CT) scans.scans. These scans can generate images that may reveal herniated disks or These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels. vessels.

Bone scan.Bone scan. In rare cases, your doctor may use a bone scan to look for bone In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera. doctor to detect bone problems using a special camera.

Nerve studies (electromyography, or EMG).Nerve studies (electromyography, or EMG). This test measures the This test measures the electrical impulses produced by the nerves and the responses of your muscles. electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis). caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Role of PhysiotherapyRole of Physiotherapy

Dr. Tarique AzamDr. Tarique AzamConsultant Physiotherapist, MIAPConsultant Physiotherapist, MIAP

Mediplex PhysiotherapyMediplex Physiotherapy

Physiotherapy RolePhysiotherapy Role

Physiotherapy is a non –Physiotherapy is a non –pharmacological ,Exercise oriented,natural pharmacological ,Exercise oriented,natural based approach which has assumed based approach which has assumed important role in management of joints and important role in management of joints and muscular problems. muscular problems. – Relieves pains & stiffness.Relieves pains & stiffness.– Increases strength of muscles.Increases strength of muscles.– Restores movements and function.Restores movements and function.

_ prevent joint problems._ prevent joint problems.

Modalities UsedModalities Used

A. ElectrotherapyA. Electrotherapy– LaserLaser– Long & Micro WaveLong & Micro Wave Short Wave Diathermy (SWD)Short Wave Diathermy (SWD)– Interferential Therapy (IFT)Interferential Therapy (IFT)– Trans Cutaneous Trans Cutaneous Electrical Stimulations (TENS)Electrical Stimulations (TENS)– Ultrasound, Muscle & Ultrasound, Muscle & Nerve Stimulation,Nerve Stimulation,– Wax and Hot Packs Wax and Hot Packs

Exercise TherapyExercise Therapy

Manual Manipulations: Manual Manipulations: Mulligan & Mackenzee TechniquesMulligan & Mackenzee Techniques

Shoulder wheel Shoulder wheel Traction Traction

Quadricep tableQuadricep table etcetc

Importance of Good PostureImportance of Good Posture Why is good posture important?Why is good posture important? When it comes to posture, your mother When it comes to posture, your mother

did know best. Her frequent reminders did know best. Her frequent reminders to "stand up straight" and "stop to "stand up straight" and "stop slouching" were good advice.slouching" were good advice.

Your spine is strong and stable when Your spine is strong and stable when you practice healthy posture. But you practice healthy posture. But when you stoop or slouch, your body's when you stoop or slouch, your body's center of gravity shifts. Your muscles center of gravity shifts. Your muscles and ligaments struggle to keep you and ligaments struggle to keep you balanced. This can lead to painful balanced. This can lead to painful strains and sprains of ligaments and strains and sprains of ligaments and muscles in your back. It can also muscles in your back. It can also cause neck pain, joint stiffness, fatigue cause neck pain, joint stiffness, fatigue and other health problems.and other health problems.

If you have chronic backaches, If you have chronic backaches, healthy posture will help relax your healthy posture will help relax your back muscles and may reduce your back muscles and may reduce your pain. Practicing good posture may also pain. Practicing good posture may also prevent backaches and other prevent backaches and other problems.problems.

Your spine's curvesYour spine's curves

A healthy back has three A healthy back has three natural curves: an inward or natural curves: an inward or forward curve at the neck forward curve at the neck (cervical curve), an outward (cervical curve), an outward or backward curve at the or backward curve at the upper back (thoracic curve), upper back (thoracic curve), and an inward curve at the and an inward curve at the lower back (lumbar curve). lower back (lumbar curve). Good posture doesn't mean Good posture doesn't mean balancing a book on your balancing a book on your head or standing at military-head or standing at military-style attention. It simply style attention. It simply aims to maintain these aims to maintain these natural curves. In contrast, natural curves. In contrast, poor posture actually leads poor posture actually leads to changes in natural spinal to changes in natural spinal curves, which can stress or curves, which can stress or pull muscles and cause pull muscles and cause pain.pain.

Good standing postureGood standing posture

When standing, keep your When standing, keep your chest held high and your chest held high and your shoulders back and shoulders back and relaxed. Try not to tilt your relaxed. Try not to tilt your head forward, backward or head forward, backward or sideways. Instead, tuck sideways. Instead, tuck your chin down slightly and your chin down slightly and pull your head back and up pull your head back and up as if to flatten your neck as if to flatten your neck against a wall.against a wall.

Pull in your abdomen and Pull in your abdomen and buttocks. Make sure your buttocks. Make sure your knees are relaxed, not knees are relaxed, not locked. Keep your feet locked. Keep your feet parallel and your weight parallel and your weight balanced evenly on both balanced evenly on both feet.feet.

Take the wall testTake the wall test

To test your standing posture, take the To test your standing posture, take the wall test. Stand with your head, shoulder wall test. Stand with your head, shoulder blades and buttocks touching a wall, blades and buttocks touching a wall, with your heels about two to four inches with your heels about two to four inches away from the wall. Reach back and away from the wall. Reach back and slide your hand behind the curve in your slide your hand behind the curve in your lower back, with your palm flat against lower back, with your palm flat against the wall.the wall.

There should be about one hand's There should be about one hand's thickness of space between your back thickness of space between your back and the wall. If there's too much space, and the wall. If there's too much space, tighten your abdominal muscles to tighten your abdominal muscles to flatten the curve in your back. If there's flatten the curve in your back. If there's too little space, arch your back so that too little space, arch your back so that your hand fits comfortably behind you. your hand fits comfortably behind you. Walk away from the wall while Walk away from the wall while maintaining this posture. Then return to maintaining this posture. Then return to the wall to check your success. Practice the wall to check your success. Practice maintaining healthy posture during your maintaining healthy posture during your daily activities.daily activities.

Good sitting postureGood sitting posture

Good sitting posture keeps your neck, Good sitting posture keeps your neck, shoulders and upper back muscles shoulders and upper back muscles relaxed. Choose a chair that allows you relaxed. Choose a chair that allows you to rest both feet flat on the floor, while to rest both feet flat on the floor, while keeping your knees level with your hips. keeping your knees level with your hips. If this doesn't feel comfortable, try If this doesn't feel comfortable, try placing a foot support under your feet to placing a foot support under your feet to find the best position for you.find the best position for you.

Stretch the top of your head toward the Stretch the top of your head toward the ceiling. Tuck your chin in slightly. Keep ceiling. Tuck your chin in slightly. Keep your upper back and neck comfortably your upper back and neck comfortably straight. Keep your shoulders relaxed, straight. Keep your shoulders relaxed, not elevated, rounded or pulled not elevated, rounded or pulled backward. Sit with your back firmly backward. Sit with your back firmly against the chair. Place a small cushion against the chair. Place a small cushion or rolled towel to support your lower or rolled towel to support your lower back curve if your chair doesn't provide back curve if your chair doesn't provide the support you need.the support you need.

Keep your shoulders straightKeep your shoulders straight

Pay attention to the position of Pay attention to the position of your shoulders when you're your shoulders when you're sitting or standing. Slouching or sitting or standing. Slouching or rolling your shoulders forward rolling your shoulders forward shortens your chest muscles shortens your chest muscles and reduces their flexibility and reduces their flexibility (kyphosis). But, if you pull your (kyphosis). But, if you pull your shoulders too far back, you can shoulders too far back, you can develop swayback (lordosis), in develop swayback (lordosis), in which your abdomen sticks out which your abdomen sticks out too far in front and your buttocks too far in front and your buttocks stick out too far in back.stick out too far in back.

Check out your reflectionCheck out your reflection

Stand in front of a mirror to Stand in front of a mirror to see if you're keeping your see if you're keeping your shoulders straight, or ask a shoulders straight, or ask a friend to evaluate your friend to evaluate your shoulder position. Your shoulder position. Your shoulders should be in the shoulders should be in the same position as the same position as the picture on the left. You picture on the left. You may find that this is difficult may find that this is difficult for you, especially if you for you, especially if you work at a computer or sit work at a computer or sit for long periods to read.for long periods to read.

It all adds upIt all adds up

Although good posture should be Although good posture should be natural, you may feel wooden or natural, you may feel wooden or stiff at first if you've forgotten what stiff at first if you've forgotten what good posture feels like. The key is good posture feels like. The key is to practice good posture all the to practice good posture all the time. You can make improvements time. You can make improvements at any age. Stretching and core at any age. Stretching and core strengthening exercises may help strengthening exercises may help because they strengthen the lower because they strengthen the lower abdominal muscles that support abdominal muscles that support your spine. Talk with your doctor if your spine. Talk with your doctor if you're concerned about your you're concerned about your posture or if you need help deciding posture or if you need help deciding if certain exercises are right for you.if certain exercises are right for you.

Proper lifting techniques Proper lifting techniques Start in the best positionStart in the best position Before you lift a load, think Before you lift a load, think

through your task. Decide through your task. Decide where you'll place the load and where you'll place the load and how you'll get it there. If an how you'll get it there. If an object is too heavy, get some object is too heavy, get some help.help.

When you're lifting an object When you're lifting an object from the floor, don't lift from a from the floor, don't lift from a standing position with your standing position with your waist bent and your legs locked. waist bent and your legs locked. Instead, plant your feet firmly on Instead, plant your feet firmly on the ground, standing as close to the ground, standing as close to the load as possible. Then the load as possible. Then kneel down, resting one knee kneel down, resting one knee on the ground. Lift the object on the ground. Lift the object from between your legs and from between your legs and hold it close to your body. hold it close to your body.

Let your leg muscles do the workLet your leg muscles do the work

Your leg muscles are Your leg muscles are some of the strongest some of the strongest muscles in your body. muscles in your body. Use them to lift the Use them to lift the load. Keep your back load. Keep your back as upright as possible. as upright as possible. As you lift, tighten your As you lift, tighten your abdominal muscles. abdominal muscles. This helps support This helps support your spine.your spine.

Carry the load close to your bodyCarry the load close to your body

When you're standing and When you're standing and ready to move, hold the ready to move, hold the load close to your body to load close to your body to lessen the strain on your lessen the strain on your lower back. Avoid turning lower back. Avoid turning or twisting while holding or twisting while holding the load. Turn by pivoting the load. Turn by pivoting your feet, not your back. your feet, not your back. Avoid lifting heavy loads Avoid lifting heavy loads above your waist.above your waist.

Squatting instead of kneelingSquatting instead of kneeling

You can follow the same procedure You can follow the same procedure from a squatting position instead of from a squatting position instead of a kneeling position, if that's more a kneeling position, if that's more comfortable for you. Stand as close comfortable for you. Stand as close to the load as possible. While to the load as possible. While maintaining your balance, squat maintaining your balance, squat down, with one foot slightly in front down, with one foot slightly in front of the other. Lift the object from of the other. Lift the object from between your legs, holding it close between your legs, holding it close to your body. Then stand up using to your body. Then stand up using your leg muscles to lift the load. your leg muscles to lift the load. Tighten the abdominal muscles that Tighten the abdominal muscles that support your spine, keeping your support your spine, keeping your back as straight as possible as you back as straight as possible as you rise from the floor.rise from the floor.

Lifting items out of the trunk of Lifting items out of the trunk of your caryour car

When you're lifting an item out When you're lifting an item out of your trunk, place one of your of your trunk, place one of your knees on your car's bumper for knees on your car's bumper for balance and support. Lift objects balance and support. Lift objects in two steps. First, lift the object in two steps. First, lift the object to rest on the car frame. Then to rest on the car frame. Then lift it from the car frame to carry lift it from the car frame to carry it. Keep your back as straight as it. Keep your back as straight as possible as you lift the load.possible as you lift the load.

Consider storing items in the Consider storing items in the trunk close to the bumper. It will trunk close to the bumper. It will be easier for you to lift them out be easier for you to lift them out correctly.correctly.

Your daily back routine Your daily back routine Keep your back strongKeep your back strong You can stretch and strengthen You can stretch and strengthen

your back and supporting your back and supporting muscles with the basic muscles with the basic exercises shown here. Try to exercises shown here. Try to work at least 15 minutes of back work at least 15 minutes of back exercises into your daily routine. exercises into your daily routine. Remember to breathe fully and Remember to breathe fully and deeply as you do these deeply as you do these exercises. If you've hurt your exercises. If you've hurt your back before, or if you have other back before, or if you have other health problems such as health problems such as osteoporosis, talk to your doctor osteoporosis, talk to your doctor before you get started.before you get started.

Knee-to-chest stretchKnee-to-chest stretch

Lie on your back on a firm Lie on your back on a firm surface with your knees surface with your knees bent and feet flat. Pull your bent and feet flat. Pull your left knee toward your chest left knee toward your chest with both hands. Hold for with both hands. Hold for 15 to 30 seconds. Return 15 to 30 seconds. Return to the starting position. to the starting position. Repeat with opposite leg. Repeat with opposite leg. Repeat with each leg three Repeat with each leg three or four times.or four times.

Cat stretchCat stretch

Get down on your hands Get down on your hands and knees. Slowly let your and knees. Slowly let your back and abdomen sag back and abdomen sag toward the floor (A).toward the floor (A).

Slowly arch your back Slowly arch your back away from the floor. Pull away from the floor. Pull your abdomen up to the your abdomen up to the ceiling (B). Repeat several ceiling (B). Repeat several times.times.

Half sit-upHalf sit-up

Lie on your back on a firm Lie on your back on a firm surface with your knees surface with your knees bent and feet flat. With bent and feet flat. With your arms outstretched, your arms outstretched, reach toward your knees reach toward your knees until your shoulder blades until your shoulder blades no longer touch the no longer touch the ground. Don't grab your ground. Don't grab your knees. Hold for a few knees. Hold for a few seconds and slowly return seconds and slowly return to the starting position. to the starting position. Repeat several times.Repeat several times.

Leg lifts with bent kneeLeg lifts with bent knee

Lie on your stomach on a Lie on your stomach on a firm surface with your head firm surface with your head turned to the side. Bend turned to the side. Bend one knee back. Keeping one knee back. Keeping your knee bent, raise that your knee bent, raise that leg slightly off the surface leg slightly off the surface and hold for about five and hold for about five seconds. Return to the seconds. Return to the starting position. Repeat starting position. Repeat several times. Change several times. Change legs and repeat the legs and repeat the exercise.exercise.

Leg lifts with leg straightLeg lifts with leg straight

Lie on your stomach Lie on your stomach on a firm surface with on a firm surface with your head turned to your head turned to the side. Raise one leg the side. Raise one leg slightly off the surface slightly off the surface and hold for about five and hold for about five seconds. Return to the seconds. Return to the starting position. starting position. Repeat several times. Repeat several times. Change legs and Change legs and repeat the exercise.repeat the exercise.

Chair stretchChair stretch

Sit in a chair. Slowly bend Sit in a chair. Slowly bend forward toward the floor forward toward the floor until you feel a mild stretch until you feel a mild stretch in your back. Hold for 15 to in your back. Hold for 15 to 30 seconds. Return to the 30 seconds. Return to the starting position. Repeat starting position. Repeat three or four times. Don't three or four times. Don't do this exercise if you do this exercise if you have osteoporosis.have osteoporosis.

Shoulder blade squeezeShoulder blade squeeze

Sit upright in a chair. Keep Sit upright in a chair. Keep your chin tucked in and your chin tucked in and your shoulders down. Pull your shoulders down. Pull your shoulder blades your shoulder blades together, straighten your together, straighten your upper back and hold your upper back and hold your chest high. Hold a few chest high. Hold a few seconds. Return to the seconds. Return to the starting position. Repeat starting position. Repeat several times.several times.

Mediplex Arthritis Mediplex Arthritis Reversal/Prevention ProgramReversal/Prevention Program

Integrated Program (Yoga, Physiotherapy, Integrated Program (Yoga, Physiotherapy, Life Style Modifications and Super Specialty Life Style Modifications and Super Specialty Homeopathic Medicines)Homeopathic Medicines)

Scientific program (Formulated after 5 years Scientific program (Formulated after 5 years of Clinical & Research work).of Clinical & Research work).

Over 3000 clients.Over 3000 clients. Success Rate is over 90 %.Success Rate is over 90 %. On an average in 8 days relief starts in On an average in 8 days relief starts in

patients.patients.

Features…Features… Managed by highly qualified and Managed by highly qualified and

experienced team of doctors, experienced team of doctors, Physiotherapists, Yoga experts and Physiotherapists, Yoga experts and dieticians.dieticians.

Clients from NIIT, GE, GENPACT, WIPRO Clients from NIIT, GE, GENPACT, WIPRO etcetc

ComponentsComponents

MPX Arthritis Reversal/ Prevention Program

Power Yoga

Super Specialty Homeopathic

medicinesAdvanced Physiotherapy

Life Style Modifications

ProcessProcessEvaluation and

Assessment

Arthritis started

Reversal Program

Prevention Program

No

Yes

Reversal Program

Super Specialty Homeopathic Consultation

and Medicine

Advanced Physiotherapy

Sittings

Specially Designed Yoga Asans

• Diet• Exercise• Positive Thinking• Meditation

Life Style Modifications

Prevention Program

Super Specialty Homeopathic Consultation

and Preventive Medicine

Preventive Physiotherapy

Sittings

Preventive Yoga Asans

• Diet• Exercise• Positive Thinking• Meditation

Life Style Modifications

Where do you want to see yourself ?Where do you want to see yourself ?

Mr. Sharma or Mr. Gupta !Mr. Sharma or Mr. Gupta !

Choice is yours !Choice is yours !

Thank you !Thank you !

Mr. Ashfaq, Welfare Officer, NICMr. Ashfaq, Welfare Officer, NIC NIC staffNIC staff Mediplex TeamMediplex Team mediplex@gmail.com for booklet on “How to use computer mediplex@gmail.com for booklet on “How to use computer

for preventing backache ? “for preventing backache ? “ www.mediplex.inwww.mediplex.in P-15-A; Jangpura Extn New Delhi 14P-15-A; Jangpura Extn New Delhi 14 9313520295;9313520295;

TreatmentTreatment Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you

need to improve your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, need to improve your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.your doctor may suggest stronger medications or other therapy.

Medications and therapiesMedications and therapies Physical therapy and exercise.Physical therapy and exercise. A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release

techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurringstrengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurring

e techniques will help pain from recurring. e techniques will help pain from recurring. Prescription medications.Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back

pain that doesn't get better with over-the-counter pain relievers. pain that doesn't get better with over-the-counter pain relievers. Cortisone injections.Cortisone injections. If pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe If pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe

cortisone injections — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation cortisone injections — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots. around the nerve roots.

Electrical stimulation.Electrical stimulation. A procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points A procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points on the skin to nerve pathways. This is thought to interrupt pain signals, preventing them from reaching your brain. Although safe and painless, TENS doesn't work for on the skin to nerve pathways. This is thought to interrupt pain signals, preventing them from reaching your brain. Although safe and painless, TENS doesn't work for everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used with other treatments. TENS may be a good option everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used with other treatments. TENS may be a good option to try for people who can't take or don't get relief from medications. to try for people who can't take or don't get relief from medications.

Back schools.Back schools. These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves back anatomy and function, followed by practice sessions on how to protect your back at home and work. back anatomy and function, followed by practice sessions on how to protect your back at home and work.

Treating chronic back painTreating chronic back painTreatment for chronic back pain may also include using:Treatment for chronic back pain may also include using:

Antidepressant medications.Antidepressant medications. Low doses of certain types of antidepressants have been shown to relieve pain, independent of their effect on depression. Low doses of certain types of antidepressants have been shown to relieve pain, independent of their effect on depression. Narcotics (opioids).Narcotics (opioids). These medications, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor. These medications, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor. Other treatments.Other treatments. These may include anesthetic injections or self-administered pain medications that are sent directly to the spinal cord through a thin tube These may include anesthetic injections or self-administered pain medications that are sent directly to the spinal cord through a thin tube

(catheter) attached to a programmed pump. (catheter) attached to a programmed pump. Surgical and other proceduresSurgical and other procedures

Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types of back surgery include:of back surgery include:

Laminectomy and laminotomy.Laminectomy and laminotomy. These procedures involve removing part of your vertebra — the bony part of your spinal column. This procedure may relieve leg These procedures involve removing part of your vertebra — the bony part of your spinal column. This procedure may relieve leg pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine. pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine.

Fusion.Fusion. This surgery involves joining two vertebrae to eliminate painful movement. This surgery involves joining two vertebrae to eliminate painful movement. Intradiscal electrothermal therapy (IDET).Intradiscal electrothermal therapy (IDET). In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for

up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It's unclear whether this treatment is effective up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It's unclear whether this treatment is effective for back pain. for back pain.

BackacheBackache IntroductionIntroduction The back is a well-designed structure made The back is a well-designed structure made

up of bone, muscles, nerves and other soft up of bone, muscles, nerves and other soft tissues. You rely on your back to be the tissues. You rely on your back to be the workhorse of the body — its function is workhorse of the body — its function is essential for nearly every move you make. essential for nearly every move you make. Because of this, the back can be particularly Because of this, the back can be particularly vulnerable to injury and back pain can be vulnerable to injury and back pain can be disabling.disabling.

Four out of five adults have at least one bout Four out of five adults have at least one bout of back pain sometime during life. In fact, of back pain sometime during life. In fact, back pain is one of the most common reasons back pain is one of the most common reasons for health care visits and missed work.for health care visits and missed work.

On the bright side, you can prevent most back On the bright side, you can prevent most back pain. Simple home treatment and proper body pain. Simple home treatment and proper body mechanics will often heal your back within a mechanics will often heal your back within a few weeks and keep it functional for the long few weeks and keep it functional for the long haul. Surgery is rarely needed to treat back haul. Surgery is rarely needed to treat back pain.pain.

the buttocks and back of the leg. the buttocks and back of the leg. Spinal stenosis.Spinal stenosis. This condition occurs when the space around the spinal cord and nerve roots This condition occurs when the space around the spinal cord and nerve roots

narrows due to arthritis and bone overgrowth. This can press or pinch a nerve. narrows due to arthritis and bone overgrowth. This can press or pinch a nerve. Spondylosis.Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerative Spondylosis is a type of arthritis affecting the spine. It is due to the degenerative

changes in the spine that often come with aging. changes in the spine that often come with aging. Spondylolisthesis.Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward over This condition occurs when one vertebra in the spinal column slips forward over

another. another. These rare but far more serious causes of back pain also have specific treatment related to the These rare but far more serious causes of back pain also have specific treatment related to the

underlying cause.underlying cause. Cauda equina syndrome.Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs, This is a serious neurological problem causing weakness in the legs,

numbness in the "saddle" or groin area, and loss of bowel or bladder control. numbness in the "saddle" or groin area, and loss of bowel or bladder control. Cancer in the spine.Cancer in the spine. A tumor on the spine can press on a nerve causing back pain. A tumor on the spine can press on a nerve causing back pain. Infection of the spine.Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could be If a fever and a tender, warm area accompany back pain, the cause could be

an infection. an infection. Injury.Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain. Damage to the bones, ligaments, or muscles of the back can cause severe pain. Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back

pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be difficult to treat.difficult to treat.

Screening and diagnosisScreening and diagnosis Diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you do Diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you do

see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand, see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rubber reflex- hammer. These walk and lift your legs. He or she may also test your reflexes with a rubber reflex- hammer. These assessments help determine where the pain is, what degree of motion you have without pain and assessments help determine where the pain is, what degree of motion you have without pain and whether you have muscle spasms. They will also help rule out more serious causes of back pain.whether you have muscle spasms. They will also help rule out more serious causes of back pain.

If there is reason to suspect that you have a tumor, fracture, infection or other condition that may be If there is reason to suspect that you have a tumor, fracture, infection or other condition that may be causing your back pain, your doctor may order one or more tests:causing your back pain, your doctor may order one or more tests:

X-ray.X-ray. These images show the alignment of your bones and whether you have degenerative joint These images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks. fibrous tissues (fascia), nerves or disks.

Magnetic resonance imaging (MRI) or computerized tomography (CT) scans.Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans can These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels. nerves, ligaments and blood vessels.

Bone scan.Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compression In rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera. allows your doctor to detect bone problems using a special camera.

Nerve studies (electromyography, or EMG).Nerve studies (electromyography, or EMG). This test measures the electrical impulses produced This test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis). stenosis).

TreatmentTreatment Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you

need to improve your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, need to improve your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.your doctor may suggest stronger medications or other therapy.

Medications and therapiesMedications and therapies Physical therapy and exercise.Physical therapy and exercise. A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release

techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurringstrengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurring

e techniques will help pain from recurring. e techniques will help pain from recurring. Prescription medications.Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back

pain that doesn't get better with over-the-counter pain relievers. pain that doesn't get better with over-the-counter pain relievers. Cortisone injections.Cortisone injections. If pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe If pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe

cortisone injections — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation cortisone injections — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots. around the nerve roots.

Electrical stimulation.Electrical stimulation. A procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points A procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points on the skin to nerve pathways. This is thought to interrupt pain signals, preventing them from reaching your brain. Although safe and painless, TENS doesn't work for on the skin to nerve pathways. This is thought to interrupt pain signals, preventing them from reaching your brain. Although safe and painless, TENS doesn't work for everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used with other treatments. TENS may be a good option everyone or for all types of pain. It's generally more effective for acute pain than for chronic pain and is often used with other treatments. TENS may be a good option to try for people who can't take or don't get relief from medications. to try for people who can't take or don't get relief from medications.

Back schools.Back schools. These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves These programs, available in many communities, focus on managing back pain and preventing its recurrence. Classroom study generally involves back anatomy and function, followed by practice sessions on how to protect your back at home and work. back anatomy and function, followed by practice sessions on how to protect your back at home and work.

Treating chronic back painTreating chronic back painTreatment for chronic back pain may also include using:Treatment for chronic back pain may also include using:

Antidepressant medications.Antidepressant medications. Low doses of certain types of antidepressants have been shown to relieve pain, independent of their effect on depression. Low doses of certain types of antidepressants have been shown to relieve pain, independent of their effect on depression. Narcotics (opioids).Narcotics (opioids). These medications, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor. These medications, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor. Other treatments.Other treatments. These may include anesthetic injections or self-administered pain medications that are sent directly to the spinal cord through a thin tube These may include anesthetic injections or self-administered pain medications that are sent directly to the spinal cord through a thin tube

(catheter) attached to a programmed pump. (catheter) attached to a programmed pump. Surgical and other proceduresSurgical and other procedures

Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types of back surgery include:of back surgery include:

Laminectomy and laminotomy.Laminectomy and laminotomy. These procedures involve removing part of your vertebra — the bony part of your spinal column. This procedure may relieve leg These procedures involve removing part of your vertebra — the bony part of your spinal column. This procedure may relieve leg pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine. pain caused by bone spurs or disk fragments that protrude into your spinal canal or press on nerve roots within your spine.

Fusion.Fusion. This surgery involves joining two vertebrae to eliminate painful movement. This surgery involves joining two vertebrae to eliminate painful movement. Intradiscal electrothermal therapy (IDET).Intradiscal electrothermal therapy (IDET). In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for

up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It's unclear whether this treatment is effective up to 20 minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation. It's unclear whether this treatment is effective for back pain. for back pain.

How your back is builtHow your back is built Your backbone (vertebral column) is Your backbone (vertebral column) is

actually a stack of more than 30 bones actually a stack of more than 30 bones called vertebrae. Together they create a called vertebrae. Together they create a bony canal that surrounds and protects bony canal that surrounds and protects your spinal cord. Small nerves enter and your spinal cord. Small nerves enter and exit the spinal cord through spaces in exit the spinal cord through spaces in your vertebrae.your vertebrae.

The vertebrae are held together by The vertebrae are held together by muscles, tendons and ligaments. muscles, tendons and ligaments. Between the vertebrae are intervertebral Between the vertebrae are intervertebral disks, which act as "shock absorbers" by disks, which act as "shock absorbers" by preventing the vertebrae from hitting one preventing the vertebrae from hitting one another when you walk, run or jump. another when you walk, run or jump. The intervertebral disks also allow your The intervertebral disks also allow your spine to twist, bend and extend.spine to twist, bend and extend.

The lower back — which carries most of The lower back — which carries most of your weight — is the site of most back your weight — is the site of most back pain. Here are some of the most pain. Here are some of the most common common

Strains, sprains and spasmsStrains, sprains and spasms The most common cause of back pain is The most common cause of back pain is

an injury to a muscle (strain) or a an injury to a muscle (strain) or a ligament (sprain). Strains and sprains ligament (sprain). Strains and sprains can occur for many reasons, including can occur for many reasons, including improper lifting, excess body weight and improper lifting, excess body weight and poor posture. Strains and sprains can poor posture. Strains and sprains can also develop from hauling around a also develop from hauling around a heavy handbag or sleeping at an heavy handbag or sleeping at an awkward angle. As a pivot point for awkward angle. As a pivot point for turning at the waist, the lower back is turning at the waist, the lower back is especially vulnerable to muscle strains especially vulnerable to muscle strains (shown here).(shown here).

Sometimes a strain or sprain causes Sometimes a strain or sprain causes immediate back pain. In other cases, immediate back pain. In other cases, soreness and stiffness come later. An soreness and stiffness come later. An injured muscle may also "knot up." This injured muscle may also "knot up." This muscle spasm is your body's way of muscle spasm is your body's way of immobilizing the affected area to prevent immobilizing the affected area to prevent further damage.further damage.