How to Understand Back Pain
The pain of it all, what do you know about back pain until you feel it yourself. You
cannot truly know anything, yet according to statistics, the majority of people in the
world suffer some degree of back pain. Some people go through pain. Yet, these people
have never survived injuries. Yet others go through pain from injuries, and feel the worst.
Ironically, however, injuries are not the only cause of back pain, rather few medical
conditions, including multiple sclerosis can cause back pain. Learn more about the
diseases that ache, the back.
When considering back pain one must
Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.
How to Understand Back Pain
The pain of it all, what do you know about back pain until you feel it yourself. You
cannot truly know anything, yet according to statistics, the majority of people in the
world suffer some degree of back pain. Some people go through pain. Yet, these people
have never survived injuries. Yet others go through pain from injuries, and feel the worst.
Ironically, however, injuries are not the only cause of back pain, rather few medical
conditions, including multiple sclerosis can cause back pain. Learn more about the
diseases that ache, the back.
When considering back pain one must
Sports and Physical Therapy Associates share a informational slideshow documenting prevention of back pain, causes, and treatment.
Most adults will experience back pain, find out how to prevent it and how to treat it.
Low back pain is an extremely common symptom in both the general population and also among sports people. Hartvigsen et al states that, Low back pain is a very common symptom. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015. Low back pain is now the leading cause of disability worldwide.
Introduction to low back pain
Reasons for low back pain
Epidemiology of LBP
Causes of LBP
Risk factors of LBP
Diagnosis of LBP
Treatment for LBP
Occupational therapy interventions for LBP
Patrick S. Pabian, PT, presents "Rehabilitation Considers of Lower Extremity Tendinopathy" at the 2013 9th Annual Cutting Edge Concepts in Orthopaedics & Sports Medicine Seminar presented by Orlando Orthopaedic Center Foundation.
Percutaneous discectomy is a minimally invasive surgical procedure that treats contained, herniated discs. Specific procedures within the class include: manual percutaneous lumbar discectomy, Automated percutaneous lumbar discectomy (APLD) laser discectomy and nucleoplasty percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil.
Low back pain is an extremely common symptom in both the general population and also among sports people. Hartvigsen et al states that, Low back pain is a very common symptom. Globally, years lived with disability caused by low back pain increased by 54% between 1990 and 2015. Low back pain is now the leading cause of disability worldwide.
Introduction to low back pain
Reasons for low back pain
Epidemiology of LBP
Causes of LBP
Risk factors of LBP
Diagnosis of LBP
Treatment for LBP
Occupational therapy interventions for LBP
Patrick S. Pabian, PT, presents "Rehabilitation Considers of Lower Extremity Tendinopathy" at the 2013 9th Annual Cutting Edge Concepts in Orthopaedics & Sports Medicine Seminar presented by Orlando Orthopaedic Center Foundation.
Percutaneous discectomy is a minimally invasive surgical procedure that treats contained, herniated discs. Specific procedures within the class include: manual percutaneous lumbar discectomy, Automated percutaneous lumbar discectomy (APLD) laser discectomy and nucleoplasty percutaneous intradiscal radiofrequency thermocoagulation is a procedure that allows the controlled delivery of heat to the intervertebral disc via an electrode or coil.
The McKenzie method was developed in 1960’s by Robin McKenzie , a physical therapist in new Zealand and A central tenet of McKenzie Method is that self-healing and self-treatment are important for patient’s pain relief and rehabilitation.
Back pain
Etiology
Anatomical & pathophysiological concepts
Diagnostic approach
Clinical approach
Red flags & yellow flags
Investigations
Back pain in children & elderly
Musculoskeletal Health Concerns of the Aging PopulationAllan Corpuz
A lecture on low back pain, osteoarthritis and soft tissue rheumatisms delivered to nurses, nursing attendants and institutional workers at the the Philippine General Hospital
Manual and physical therapists use a postural-structural-biomechanical (PSB) model to ascertain the causes of various musculoskeletal conditions.
The most important question is consistently being ignored is can a person’s physical shape/posture/structure/biomechanics be the cause of pain in spine
Evaluation of Lumbar Spine Disease starts with understanding the clinical back grounds. It starts with good history and physical examination. This is a teaching lecture given twice by Prof. Dr. Mohamed Mohi Eldin, professor of neurosurgery, in the Basic Spine Course, Egyptian Medical Syndicate, Cairo, March 2009 and in 2010.
This presentation is a comprehensive summary about all aspects of back pain. Back pain is one of the most common orthopaedic morbidity or orthopedic disability. Sciatica and lumbar disc diseases are common cause of spinal disability. Back pain are divided into Red flags, green flags and yellow flags for quick clinical screening. both treatment, prevention aspects are covered. Spinal anatomy and Biomechanics are covered. Epidemiology and role of various types of spine surgery, microdiscectomy, endoscopic spine surgery are also described.
This is a lecture focused on pelvic floor dysfunction in elite male sport especially football. It addressed the assessment and management of Pelvic pain in elite sport. Gerard Greene is a men's health physio who works in Birmingham UK ( Birmingham Men's Health Physio Clinic ) and Southampton UK ( Dr Ruth Jones ) .
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists
Msg practical session-!!!
1. Clinical Reasoning
Lumbosacral Dysfunction
Assessment & Treatment
Alex Wong
Senior Physiotherapist
Queen Elizabeth Hospital
3 January 2009
1
2. Contents
Classification of Lumbo-sacral
Dysfunctions
Clinical Reasoning Practice
Case Illustration
Examination /Treatment Skills
Take Home Message
2
3. Vague Diagnosis of LBP
80% no structural diagnosis
Limited evidence to support
classification
Vague complaints to relate pathology
Poor understanding biomechanics
Complicated treatment outcomes
impairment, disability, capability
psychosocial……….
3
5. Classification of
Lumbo-sacral Dysfunctions
Treatment Based
Specific exercise – extension / flexion
/ lateral shift syndrome
Mobilization – lumbar / sacroiliac
mobilization
Immobilization – immobilization
syndrome
Traction – traction / lateral shift
syndrome
George & Delitto, 2005
5
6. Classification of
Lumbo-sacral Dysfunctions
McKenzie Approach
Postural – symptoms after static
position
Dysfunctional – symptoms at end
range
Derangement – symptoms
through range
MeKenzie
6
7. Classification of
Lumbo-sacral Dysfunctions
Physical Therapy Reviews 2007
632 papers retrieved from data base
77 papers reviewed full document
55% uni-dimensional
6% multi-dimensional
Ford et al, 2007
7
8. Classification of
Lumbo-sacral Dysfunctions
Physical Therapy Reviews 2007
Classification Dimensions
Patho-anatomy (47%)
Signs and Symptoms (58%)
Psychological (51%)
Social (14%) Ford et al, 2007
No clear guideline to classify
8
10. Hypothesis-Oriented Algorithm for
Clinicians II (HOAC II)
Physical Therapy, Vol 83, No.5, 2003
A Guide for Patient Management
A framework for science-based
clinical practice
Focus on remediation of functional
deficits
How changes in impairments
related to these deficits
Rothstein, 2003
10
11. Clinical Reasoning Process
Generate Patient Identified and
Non-identified Problem Lists (S/E)
Formulate Exam. Strategy
Conduct Examination and Analyze (O/E)
Generate Working Hypotheses
Intervention
Re-assessment
Rothstein, 2003
11
12. Clinical Reasoning Process
Subjective Complaint
(generate the clinical hypothesis)
Examination, O/E
(confirm the clinical hypothesis)
Intervention
(base on the O/E, findings)
12
14. Formulate Problem Lists
(base on clinical presentations)
Case 1 (Housewife, aged 48)
C/O
• right dull LBP down to right lateral calf
• aggravated after prolonged walking
• relieved by short duration of sitting
• standing much worse
• morning pain
14
15. Generate Clinical Hypothesis
(base on clinical presentations)
Case 1 (Housewife, aged 48)
Clinical Concerns
• somatic referred symptoms (L4,5)
• regular compression pattern
• decrease lordosis
• worst in static extension
• favourable to movement
15
16. Facet Joint / Extension Syndrome
Common with increasing age
Facet Joints block excessive
extension, associate with OA
changes (morning stiff)
Aggravate in prolonged
compression usually
Regular pattern presentation
Relieve in stretch pattern
(opposite to lig./mm strain)
Palpable local joint sign
Positive finding in local
diagnostic injection
Harris-Hayes, et al, 2005
16
17. Conduct Examination, O/E
(base on clinical hypothesis)
Case 1
O/E
• postural defect
• movement quality (L4,5)
• regular movement pattern
• quadrant
• palpation (extension)
17
18. Treatment Choice
(base on examination findings)
Case 1
Treatment
• facet joint passive mobilization
• mobilize in extended position (L4,5)
• extension exercises
18
19. Formulate Problem Lists
(base on clinical presentations)
Case 2 (Construction site worker, aged 38)
C/O
• minor sprained 2 days ago
• left stabbing LBP down to left lateral ankle
gradually afterwards
• aggravated after prolonged sitting, walking
• relieved by lying only
• moderate morning pain – difficult to bend for
brushing teeth and wearing shoes
• listing pain
• can’t tolerate public transport (bus, mini-bus)
19
20. Generate Clinical Hypothesis
(base on clinical presentations)
Case 2 (Construction site worker, aged 38)
Clinical Concerns
• associated with injury
• delayed onset of neurogenic symptoms
• relieved by decreasing disc pressure
• morning symptoms
• restricted neurodynamic movement
• sensitive to vibration irritation
• listing postural defect
20
21. Discogenic Back Pain
Nature of injury (F/Rot)
Delayed symptoms after injury
Sensitive to vibration
Morning symptoms
Increase symptoms on changing
intra-abdominal pressure
Restricted mov’t of neuro-tissues
Lumbar listing (ipsilat. / contralat.)
Diagnosed by MRI (match with sym)
Peng, et al, 2006
21
22. Conduct Examination, O/E
(base on examination strategy)
Case 2 (relieving approach)
O/E
• postural defect (listing)
• movement quality (L4,5), extension
• neurodynamic movement
• neuro assessment
• vibration
• manual traction
• MRI confirmed
22
23. Treatment Choice
(base on examination findings)
Case 2
Treatment
• listing correction
• rotation mobilization
• Mckenzie exercises
• extension with listing correction
23
24. Formulate Problem Lists
(base on clinical presentations)
Case 3 (3 children housewife, aged 33)
C/O
• minor ankle sprained 7 days ago
• dull pain from right buttock down to thigh
• aggravated after prolonged sitting, stairs
• relieved by walking around
• moderate night pain – difficult to roll in bed
• can’t tolerate cross leg sitting & pulling
activities
24
25. Generate Clinical Hypothesis
(base on clinical presentations)
Case 3 (3 children housewife, aged 33)
Clinical Concerns
• associated with injury / child-birth
• symptoms usually not below knee
• aggravated if asymmetrical stress to SI
Joint & pulling activities
• rolling pain in bed at night
25
26. Sacral Iliac Joint Syndrome
Age / Sex
History of Trauma / child-birth
Buttock pain / tender over PSIS
Symptoms likely not below knee
Symptoms when rolling at night
Occ cross SLR / Step forward pain
Muscle imbalance
Priformis, Hamstring, iliopsoas,
Gluteus maximus
Cluster of tests to confirm
DonTigny, 1990 DeMann, 1997
26
27. Conduct Examination, O/E
(base on examination strategy)
Case 3 (aggravating approach)
O/E
• PSIS tender
• anterior / posterior stress tests
• cross SLR
• Long sitting leg length difference
• cluster tests to confirm
• hip rotation tests
27
28. Treatment Choice
(base on examination findings)
Case 3
Treatment
• leg traction
• posterior pelvic tilting
• hamstring strengthening
(muscle energy)
28
29. Formulate Problem Lists
(base on clinical presentations)
Case 4 (retired policeman, aged 65)
C/O
• gradually onset LBP within one year
• stretching pain down to left lateral calf
• aggravated after prolonged walking
• relieved by sitting
• moderate mid-range pain when bending
forward
• difficult to resume hiking and carry
back-pack
29
30. Generate Clinical Hypothesis
(base on clinical presentations)
Case 4 (retired policeman, aged 65)
Clinical Concerns
• clinical / functional instability
• observable kink of spinal curvature
• aggravating with dynamic flexion stress
• variable catching pain during mid-range
• flexion / extension x-ray to confirm
(usually inferior disc problem
67% at L5 level)
Luk, 2003
30
31. Lumbar Dynamic Stability
Decrease the cross section
area of multifidus over the
injured / defect segment
Clinically ‘catching pain’ in
different range of motion
esp. forward flexion
Intrinsic muscles minimize
unnecessary rotational stress
over the disc
Hides, 1994; Lee et Al, 2006
31
32. Conduct Examination, O/E
(base on examination strategy)
Case 4 (aggravating approach)
O/E
• postural defect (hyperlordosis)
• movement quality (L4,5)
• catching pain during movement
• shearing test
• abdominus weakness & hamstring
tightness
32
34. Formulate Problem Lists
(base on clinical presentations)
Case 5 (Student, aged 22)
C/O
• back sprain injury half year ago
• stretching pain down to lateral calf gradually
• recent P&Ns over lateral calf
• difficult to wear shock in the morning
• unfavorable to sit sofa
• relieved by walking around
34
35. Generate Clinical Hypothesis
(base on clinical presentations)
Case 5 (student, aged 22)
Clinical Concerns
• associated history
• stable neurogenic symptoms
• distal symptoms dominated
• regular stretching pattern
• morning symptoms
• not related to loading stress
• favorable to movement
35
36. Neurodynamic Dysfunction
Relative dynamic mov’t of neuro-
connective tissues deficiency:
- total length insufficiency, adhesion to
sensitive structures, poor excursion /
gliding movements
Distal symptoms dominated
Morning severity
Associated with spine post-op
complication
Aware latency effect after neurodynamic
treatment
- prefer for stable symptoms Bulter, 1992; Ko et al, 2006
36
37. Conduct Examination, O/E
(base on examination strategy)
Case 5 (aggravating approach)
O/E
• stable symptoms
• relative dynamic mov’t of
neuroconnective tissues deficiency:
- total length insufficiency, adhesion to
sensitive structures, poor excursion /
gliding movements
• ULTT, Slump
37
38. Treatment Choice
(base on examination findings)
Case 5
Treatment
• hamstring stretching (cadual
/ cephelic direction)
• slump
38
39. Formulate Problem Lists
(base on clinical presentations)
Case 6 (Teacher, aged 56)
C/O
• no history of injury
• stretching & squeezing pain over left calf
muscle
• symptoms aggravated after walking ~ 15 min.
• relieved by sitting or squatting ~ 15 min.
• tolerate standing ~ half hr.
• much worse when up & down slop
39
40. Generate Clinical Hypothesis
(base on clinical presentations)
Case 6 (Teacher, aged 56)
Clinical Concerns
• dynamic flex / ext problem
• relieved by (static) flexion
• distal symptoms dominated
• not significantly related to loading
• not immediately relieved by standing
• variable in walking distance
• worse in slope walking
40
41. Spinal Claudication
Spinal:
Symptoms aggravated by walking
and change of body positions
Slow relieve by sitting or squatting
Worse even in prolonged standing
Various walking tolerance
Neuropathy symptoms
Gelderen Bicycle test
Gray, 1999
41
42. Conduct Examination, O/E
(base on examination strategy)
Case 6 (relieving approach)
O/E
• distal symptoms dominated
• fluctuated symptoms
• repeated flex & ext
• step standing extension
• flex with rotation test
• Gelderen Test
• x-ray oblique view
42
43. Treatment Choice
(base on examination findings)
Case 6
Treatment
• crook lying traction
• rotation mobilization
• rotation with SLR
• abdominal strengthening
43
44. Reference
Butler DS (1992) Mobilization of Nervous System. Churchill Livingstones
Cibulka MT,Koldehoff R.(1999) Clinical usefulness of a cluster of sacroiliac
joint test in patietns with and without low back pain.Journal of orthopaedic
and sports Physical Therapy 29(2): 83-92
DeMann LE (1997) Sacroiliac Dysfunction in Dancers with Low Back Pain,
Manual Therapy 2(1), 2-10.
DonTigny RY (1990) Anterior Dysfunction of the Sacroiliac Joint as a Major
Factor in the Etiology of the Idiopathic Low Back Pain Syndrome. Physical
Therapy 70: 250-256
Ford J, Story I, O’Sullivan P and McMeeken J (2007) Classification Systems
for Low Back Pain: A Review of the Methodology for Development and
Validation Physical Therapy Reviews 12: 33-42.
Gay R E, Ilharrebode B, Zhao K, Zhao C and An K N (2006) Sagittal Plane
Motion in the Human Lumbar Spine: Comparsion of the in Vitro Quasistatic
Neutral Zone and Dynamic Motion Parameters, Clinical Biomechanics 21,
p.914-919.
George SZ, Delitto A (2005) Clinical Examination Variables Discriminate
Among Treatment-based Classification Groups: A Study of Construct
Validity in Patients with Acute Low Back Pain, Physical Therapy vol 85 (4)
306-314.
Harris-Hayes M, Linda R, Van Dillen, Sahrmann S A (2005) Classification,
Treatment and Outcomes of a patient with Lumbar Extension Syndrome
Physiotherapy Theory and Practice, 21: 3, 181-196.
44
45. Reference
Hides JA, Stokes MJ, Saide M, Jull GA, Copper DH (1994) Evidence of
Lumbar Multifidus Wasting Isilateral to Symptoms in Patients with
Acute/Subacute Low Back Pain. Spine. 19: 165-172.
Ko HY, Park PK, Park JH, Shin YB, Shon HJ and Lee HC (2006) Intrathecal
Movement and Tension of the Lumbosacral Roots Induced by Straight Leg
Raising. American Physical Medical Rehabilitation. March , 85(3), 222-227.
Kuncewicz E, Gajewska E, Sobiska M and Samborski W (2006) Piriformis
Muscle Syndrome, Ann Acad Med Stetin, 52(3) 99-101.
Lee S W, Chan CKM, Lam TS, Lam C, Lau NC, Lau RWL and Chan ST
(2006) Relationship Between Low Back Pain and Lumbar Multifidus Size at
Different Postures. Spine, vol 31, 19, p. 2258-2262.
Oldreive WL.(1995) A critical review of the literature on tests of the
sacroiliac joint.J.Manual Manipulative Therapy 3(4):156-161.
Peng P, Hao J, Hou S, Wu W, Jiang D, Fu X and Yang Y Possible
Pathogenesis of Painful Intervertebral Disc Degeneration Spine vol 31 (5)
p.560-566
Rothestein J M, Echternack J L and Riddle D (2003) The Hypothesis-
Oriented Algorithm for Clinicians II (HOACII): A guide for Patient
Management, Physical Therapy Vol 83, Number 5, 455-470
Sanders RJ, Hammond SL and Rao NM (2007) Journal of Vascular Surgery.
Sept. 46(3): 601-604.
Sebastian D (2006) Thoracolumbar Junction Syndrome: A case Report.
Physiotherapy Theory and Practice 22:1 53-60.
Wilk V (2004) Acute low back pain: assessment and management, Aust
Fam Physician, June; 33(6): 403-7.
45