Download BACK INJURY BASICS Michael J. Mullin, ATC, PTA

BACK INJURY BASICS
Michael J. Mullin, ATC, PTA
Clinical Athletic Trainer
Orthopaedic Athletic Performance Therapy
Portland, ME
ANATOMY
• Bones (26)
– Vertebrae
Sacrum
• Cervical (7)
-3 fused bones
• Thoracic (12)
• Lumbar (5)
Coccyx
-tailbone
Soft Tissue
• Muscle / tendon
– movers
– stabilizers
• Ligament
– anterior longitudinal (hyperextension)
– posterior longitudinal
Soft Tissue
• Nerves
– motor vs. sensory
– brachial plexus, sciatic (sacral plexus)
• Fascia
– superficial--just below the skin, permits free movement
– deep--which envelopes, invests, and separates muscles
• a. irregular sheaths of collagen and elastin fibers
• b. continuous with each other
• c. separates muscles and structures while allowing
independent function & absorbing shock
Intervertebral discs
• Gelatinous structures separating the
vertebral bodies
– foremost function is to separate and allow for
movement between the vertebral bodies
– well-designed to withstand compression
– poorly designed to withstand rotation or
excessive bending
POSTURE
–Alignment: natural spinal curves
designed for shock absorption
and to withstand compression
POSTURE
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Ideal (plumb line) vs. reality
Kyphosis (“Hunchback”)
Lordosis (“gymnast”)
Flat-back (“nerd”)
Sway-back (“The Matrix”)
Scoliosis
SCOLIOSIS
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lateral curvature (S- or C-curve)
most often corrects to midline
can be functional or structural
can be lifelong or adult onset
if a contributing factor to back pain, pain is most often
present at the apex of the curve
– adult onset can be due to chronic laxity (looseness) of
the ligaments, osteoporosis, previous injury or surgery
Effect on musculature
• Standing
– regular standing posture vs. habitual patterns
• Sitting
– affected by position, chair, activity while sitting, time
spent sitting
• Activity
– how much movement, kind of motion, repetition
Prevention of injury or reducing
stress following injury
• Work posture and modification
– seated posture (head, arm pelvis and foot position)
– computer, telephone, repetitive positioning
– standing posture—weight shifting, locked joint
positions
– lifting, carrying, moving, repetitive positioning
– postural “cues”—use pain, tightness or
recognition of your back as a reminder
– get up and move around regularly!!
Other considerations
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Travel posture and modification
Day-to-day activities
Day-to-day activities
Getting adequate sleep
Psychosocial considerations
BACK PAIN
• RISK FACTORS
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Poor posture
Poor conditioning
Weakness
Stiffness
Faulty body mechanics
Poor work, sleep, or eating habits
Smoking
Psychosocial--bad attitude, stress, emotional
Other pathology (i.e. fibromyalgia, chronic fatigue or pain
syndrome, osteoporosis)
Everyone’s favorite treatment
works short term
WARNING SIGNS
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Numbness into any limb (especially persistent)
Radicular symptoms (i.e. numbness/tingling down an extremity)
Persistent headaches (especially following traumatic neck injury)
Transient weakness
“Off-balance” (persistently)
Central, localized persistent back pain / especially if consistently
reproduced with one specific movement
• Persistent resting pain
• Unexpected weight loss associated with back pain
INITIAL TREATMENT
• Bedrest vs. measured activity
• Medications
– NSAID’S, acetominophen, ibuprofen
• Modalities
– ice (15-20 min.) regularly
– heat--when stiff during day
– analgesic balms
• Physical therapy / exercise / pool therapy
• Education
INITIAL TREATMENT
• Traction (?)
• Manipulation (?)
• Alternative treatments
– acupuncture / acupressure
– massage / craniosacral / myofascial release
– Pilates
– psychological / psychosomatic
• Supplements
– glucosamine and chondroitin sulfate
We all want that magic pill
Exercise and back pain
• Functional neutral positioning
– Optimal position or range within which the spine functions most
efficiently
– Position where the spine is least symptomatic
– Variable from patient to patient
– Changes as symptoms and pathology changes
– Imperative for patient to master and understand to successfully
learn and utilize functional training
– NEEDS TO BE MAINTAINED DURING ALL MOVEMENTS
(i.e. activities of daily living, working out, back exercises)
Isolation of the deep abdominal
muscles (transverse abdominus)
• Designed for long-term use versus more superficial muscles (Type I
vs. Type II muscle fibers)
• Acts as the main active stabilizer for spine and pelvis control
• Recruited by actively “drawing in” on abdominals like you are trying
to pull your bellybutton up between your shoulder blades
• NOT a pelvic tilt
• Causes a co-contraction of the deep back stabilizers (multifidus)
• NEEDS TO BE MAINTAINED DURING ALL MOVEMENTS
FLEXIBILITY
• Joint / structural restrictions
– hyper- or hypomobility of the sacrum or any of the vertebrae
– structural vs. functional
• Soft tissue tightness
– hamstrings, hip flexors, hip rotators, lateral stabilizers
– intercostals between the ribs
– decreased shoulder motion
• Stretching
– static stretching vs. active or active-isolated
General considerations
• All exercise must be PAIN-FREE
• Start slowly and gradually increase as tolerated
• Exercises should be performed evenly for the
abdominals and back muscles
• Weight bearing exercises need to be performed in
order to increase the strength of the base of
support
• Some form of controlled cardiovascular exercise
needs to be incorporated
TIPS & TRICKS
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When in doubt, breathe out
Your back is your alarm clock
Chuck the wallet from the pocket
“Come on baby, don’t do the twist”
You’ve seen the pictures and heard it
before, bend at the knees
• It’s all in the abds. . .
MOST COMMON CAUSES OF POOR
POSTURE
AND THEIR SOLUTIONS
• Forgetfulness--Let’s face it, the main
reason most people cannot maintain good
posture is forgetfulness. Unless someone is
in pain and is able to use that as their
reminder, people just do not think of it often
enough.
SOLUTION:
• Use a Reminder--Pick something that you think of
regularly during the day--your spouse, your
children, driving, every time the phone rings--and
use that as your “alarm clock” to remind yourself
to correct your posture. The more often good
posture is practiced, the easier it is to maintain, the
more natural and comfortable it feels--and it
makes up for the times which you forget.
CAUSE:
• Lack of Understanding--Most people do
not truly have a thorough understanding of
proper postural positioning. They view it as
a “military-style” posture by thrusting their
shoulders back, or straighten up through
their mid-back and forget the head and
neck.
SOLUTION:
• Use Your Pelvis and Abdominals-There are two keys to proper
posture--enough mobility through the pelvis, and a good idea of what
to tighten through the abdominals. Start by sitting up straight in a
chair with your feet planted or lying on your back on the floor with
your knees bent. Place your hands on your hips so you can monitor
hip motion, then start by tilting your hips forward like you are arching
your back, and hold for 3 seconds. Then tilt them back and up by
pulling up on your deep abdominal muscles and hold for 3 seconds.
Do this 5 or 10 times, then find what is roughly midway between both
stopping points. This is where you want to be. If you think about your
deepest abdominal muscles holding this position, you will not only
find it easier to maintain, but an almost automatic tension reliever.
CAUSE:
• Work--Whether the job is at a desk,
performing manual labor, traveling long
distances, or performing surgery, it all takes
its toll on our bodies. We have a tendency
to tighten up into positions which we are
regularly in and this eventually causes a
breakdown somewhere along that chain.
SOLUTION:
• Change Your Ergonomics--Both physically and
structurally. Physically by modifying your work
environment to be more movement friendly, and
structurally by the way the tasks are performed. Whatever
the job is that you do, you need to think of putting yourself
in the optimal position to perform the task. Desk and
keyboard height, repetitious tasks, and heavy lifting all
need to be evaluated to make sure that the work station and
environment do not predispose or exacerbate injuries.
CAUSE:
• Deconditioned--With today’s hectic world and
pace, people have been finding it increasingly
difficult to maintain some form of regular
exercise. This not only prevents the release of the
much needed stress-relieving endorphins, but it
also contributes to weakening of the muscles,
bones and joints of the body and reducing the
amount of good synovial fluid into the
intervertebral discs.
SOLUTION:
• Exercise--You are only as good in your personal
and professional life as you feel. When the body
does not get some form of regular exercise or
activity, things just do not work as well. You
never let your car go much more then a few days
without running it, so why should you think that
the body is any different. Any combination of
home exercise programs, pool workouts, outdoor
exercise, gym routines, yoga, or Pilates will work.
Just make it consistent.
CAUSE:
• Anatomical--Some of us are born with,
develop, or acquire physical conditions
which make what would be considered
good posture extremely difficult. Mother
Nature can be cruel sometimes.
SOLUTION:
• Treatment—First, don’t blame it on your mom.
There are a number of different quality
practitioners such as physical therapists,
physiatrists, and chiropractors, which can help to
treat individual conditions. If the system is not
functioning properly, forcing it will not help. The
longer people wait to seek treatment or do not
maintain their recommended routine, then the
worse the condition will get.