BACK INJURIES
Conducted by
Ms farzana ashfaq
OBJECTIVES
at the end of this topic students will be able to:
Define the term back injuries
Describe the anatomy of spine
List the various causes of back injuries
Discuss different types of back injuries
Make the treatment plan including aim of therapist for different types of
back injuries
Show practically demos of different home tips to avoid back injuries
Give practical demons in front of your class about exercises to strengthen
back and some tips to care of your back
keep one day group discussion on all above points in class
BACK PAIN
Back pain (also known as dorsalgia) is pain felt in the back that usually originates
from the muscles, nerves, bones ,joints or other structures in the spine.
It may be a dull ache, or a sharp or piercing or burning sensation.
The pain may radiate into the arm and hand, in the upper back, or in the low
back, and might radiate into the leg or foot, and
may include symptoms other than pain, such as weakness, numbness or
tingling.
BACK INJURIES
General or unspecified injuries to the posterior part of the trunk. It includes
injuries to the muscles of the back
A person with a back injury has damage to the structures that make up the back:
bones, muscles, ligaments, tendons, disks or spinal cord. The
acute lumbar strain is probably the most common back injury
COMMON SYMPTOMS OF A BACK INJURY
Back pain
Back stiffness
tenderness overlying the back muscles.
Symptoms of a more serious injury include:
Severe back pain that shoots down the leg,
Leg numbness , or leg weakness
Before going towards the causes and
further more details ….we have to
know about a little anatomy of spine
SPINE
It is one of the most important parts of your body. Without it, you could not
keep yourself upright or even stand up.
It gives your body structure and support
. It allows you to move about freely and to bend with flexibility.
The spine is also designed to protect your spinal cord.
SECTIONS OF SPINE
CERVICAL SPINE: make up neck and having 7 vertebrae
THORACIC SPINE : to attaché with ribs having 12
vertebrae (chest/trunk)
LUMBAR SPINE : to make lower back having 6 vertebrae
SACRUM : 5 bones which fused or stuck together and 5
coccyx made up of tiny bones and used to be a tail
A TYPICAL VERTEBRA CONSISTS OF :
1. large vertebral body in the front
2. two strong bony areas called pedicles connecting the vertebral body and
the posterior arch
3. an arch of bony structures in the back (posterior arch) = (the spinous
process).
body
Pedicles
Transverse process
Spinous process
TYPES OF VERTEBRAE IN VERTEBRAL F
LARGER LARGEST
SMALL
NEURAL ELEMENTS
The neural elements consist of the
spinal cord and nerve roots.
The spinal cord runs from the base of
the brain down through the cervical and
thoracic spine.
Below the L1–L2 level the spinal
cord ends, as an array of nerve roots
INTERVERTIBRAL DISCS
The intervertebral discs make up one
fourth of the spinal column's length.
There are no discs between the Atlas
(C1), Axis (C2), and Coccyx. Discs are
not vascular and therefore depend on
the end plates to diffuse needed
nutrients
Each vertebrae is separated by
IntervertibraL discs which are
flexible cartilage discs. These allow
movement in the spine and have a
shock absorbing or cushioning
function as well.
DISC
Discs are composed of two parts:
• The outer portion of the disc
(annulus fibroses) composed of
concentric sheets of collagen fibers..
The annulus fibrosus encloses the
nucleus pulposus.
• The inner core (nucleus pulposus)
The nucleus pulposus contains a
hydrated gel–like matter that resists
compression. Also a shock
absorbing fluid
•
The outer portion and inner core of
the spinal disc fit together like two
concentric cylinders and are
interconnected by cartilaginous end-
plates
THE SUPPORTING STRUCTURES:
LIGAMENTS
FASCIA
MUSCLES
NERVES
NERVES:
Motor nerves signal the key
muscles to grip and hold and to
guide and control the spine.
Sensory nerves transmit
sensations such as heat, cold,
touch, pressure, and pain. They
also give us our sense of
position
ORIGIN OF BACK PAIN
PRIMARY VERTEBRAL COLUMN AND RELATED TISSUES
SECONDARY IRRITATION OF DORSAL NERVE ROOTS AND
BRACHES
REFLEX PAIN INVOLVING THE MUSCLES OF BACK
SOME CAUSES OF BACK INJURIES /BACK PAIN
Acute filamentous injury or sprain
Muscular problems or strain due to poor posture or by mechanical
factor
Chronic osteoarthritis
Ankylosing spondylitis
Protruding or rupture interverbral disk
Traumatic ligament rupture
Tears of erectospinae
Congenital defects of low lumbar and upper sacral; spine
Spondylosis (loss of substances in the pars interarticularis
Narrowing of spinal canal from spinal stenosis
OSTEOPHYTIC FORMATION /SPONDYLOSIS
It is a degenerative disorder that may cause loss of normal spinal structure and
function. Although aging is the primary cause, The degenerative process of
spondylosis may affect the cervical (neck), thoracic (mid-back), or lumbar (low
back) regions of the spine.
Cervical spondylosis is a chronic degenerative condition of the cervical spine that affects
the vertebral bodies and intervertebral disks of the neck, as well as the contents of the
spinal canal (nerve roots and/or spinal cord)
Spondylosis progresses with age and often develops at multiple interspaces. Chronic
cervical degeneration is the most common cause of progressive spinal cord and nerve root
compression.
THINNED DISC
The thinning of a disc in the back or neck can be a key indicator of degenerative
disc disease. Over time, the water and protein content of our spongy
intervertebral discs changes, resulting in discs that become weaker, more brittle,
and potentially thinner as they experience the pressures of everyday movement.
This can sometimes cause of foraminal stenosis in which some broken
fragments can block the space b/w vertebrae, where the nerve roots travel from
spinal cord to rest of body
DISC PROTRUSION/HERNIATION
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like
substance) breaks through the annulus fibrosus (tire-like structure) of an
intervertebral disc (spinal shock absorber).
herniated disc occurs most often in the lumbar region of the spine
especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral).
Pain resulting from herniation may be combined with a radiculopathy,
which means neurological deficit. The deficit may include sensory changes
(i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss).
These changes are caused by nerve compression created by pressure from
interior disc material.
DISC HERNIATION
NORMAL DISC
DISC HERNIATION
Picture is
showing
some disc
problems
Another very important cause of back
pain is…………..
Abnormal and poor
posture
WHY ITS NECESSARY TO MAINTAIN CORRECT
POSTURE
to prevent back injuries
to reduce the chance of lordosis ,kyphosis and scoliosis
to prevent your back from mechanical disorders
To prevent deformities
To prevent postural stress and pain
CAUSES OF POOR POSTURE
POSITIONAL FACTORS
Appearance of increased height (social stigma)
Muscle imbalances/contractures
Pain
Respiratory conditions
STRUCTURAL FACTORS
Congenital anomalies
Developmental problems
Trauma
Disease
s
DIFFERENCE BETWEEN CORRECT AND FAULTY POSTURE
Correct posture
› “Position in which minimum stress is
› placed on each joint.” (Magee)
Faulty posture
› Any position that increases
› stress on joints
COMMON SPINAL ABNORMALITIES AFFECT THE
POSTURE
KYPHOSIS
Excessive anterior curvature of the spine
Round back
Humpback/
Flat back
Dowager’s Hump
LORDOSIS
Excessive posterior curvature of the spine
SCOLIOSIS
Lateral curve of spine
ASSESSMENT
AREAS ;
Body mechanics used in lifting ,carrying reaching ,
bending ,twisting and stooping
Posture used in standing sitting and walking
Range of motion
Muscle strength
work tolerance
Repetitive movements
Pain behavior
Vibration experienced during work activity
Coping skills
Self care and daily living task
Home management
INSTRUMENTS
GONIOMETRY
MANUAL MUSCLE TESTING
ASSESSMENT OF BODY MECHANICS IN ACTIVITIES IN DAILY LIVING
DAILY ACTIVITY SCALE
LEISURE CHECKLIST
For spine forward movements
Ask patient to bend forward
as if to touch your
toes keeping his knees straight
True lumbar flexion only occurs when
there is reversal of lumbar lordosis
SOME AREAS OF ASSESSMENT AND TECHNIQUES
Lateral flexion to left
FOR LATERAL FLEXION
and right with out
bending forward
NECK MOVEMENTS Movements of cervical spine
namely flexion, extension
,lateral flexion and rotation to
left and right
During assessment of spine
movements ,pain and its
location /distribution should
be experienced
ASSESSMENT THRU NECK MOVEMENT
Neck
flexion Neck rotation Neck flexion laterally
TO ASSESS THE PAIN DURING DIFFERENT
POSITIONS
TO ASSESS THE PAIN DURING NORMAL AND
ABNORMAL POSTURE
PAIN
Patient should be asked to
described the pain
How to assess the pain
He may use the terms like
dull ache , burning pain or
stabbing pain
permanent or intermittent
A ssess by apply
Assess
localizing or radiating
position in which patient
touch on different practically by feel less pain or some
areas around the asking patient to comfortable
back or by press show different
on different sides positions and
on back postures
ASSESSMENT OF LIMBS
o n occasion patient may complain of limb
involvement such as
pain
Weakness
wasting
numbness
motor or sensory disturbances
Majority of patient may have only one limb involve but some have both limb involve
LIMB ASSESSMENT (CONT)…….
To assess the strength in
limbs related back problem
It should be detailed to find If one limb is involve the
out exact cause like in motor
unaffected can
or sensory
be helpful for comparison
disturbance ,weakness or
on testing
limitation in range of
movement
TOLERANCES
some patient may have fined the pain on walking and some patient may prevent
the pain
sitting ,standing or work tolerance are often restricted or may be very relevant when
deciding n possibility of return to work
ACTIVITIES OF DAILY LIVING
mostly patients with back ache getting the problem in walking , doing their household ,
bathing , toileting and in dressing
It can assess by giving any task
to perform and observe
the inability and pain causing
inability to do the task
PROBLEMS AFFECTING THE BACK PATIENT RELATED TO
OCCUPATIONAL THERAPY
AREAS OF PROBLEM
MOTOR
SENSORY
POSTURE ABNORMALITIES
MOTOR
Loss of range of motion
Loss of muscle strength
Decreased ability to lift or carry object
Decrease physical tolerance
Decreased postural reaction
Dec balance and equilibrium
SENSORY:
may experience of pain upon exertion
MECHANICAL DISORDER CAN BE CAUSE OF;
Stress which cause of strain on joints of back
and
incorrect the structure of spine
so
P ostural training should be encourage to reduce
the chances of lordosis or scoliosis and to maintain Your
posture
SO….
WE SHOULD ENCOURAGE THE CLIENTS TO
MAINTAIN CORRECT POSTURE THRU POSTURAL
TRAINING
BEFORE THE TRAINING
JUST WATCH ……………………………………………..
SOME PATTERNS OF NORMAL POSTURE HERE
JUST LOOK ALL ABOVE POSTURE ,
AND ….THINK …. THEN GIVE THE CORRECT ANSWER OF :
Q……If u follow above all postures in ur daily
life ,,then really get ready any time to go to:
HERBALIST
PSYCHIATRIST
PSCHOTHERAPIST
ORTHOPEADICS
ANY DOCTOR
ITS NECESSARY TO MAINTAIN CORRECT POSTURE IN
ALL ACTIVITIES TO PREVENT:
BACK INJURIES
THE CHANCE OF LORDOSIS ,KYPHOSIS AND SCOLIOSIS
YOUR BACK FROM MECHANICAL DISORDERS
SEVERE DEFORMITIES
POSTURAL STRESS AND PAIN
SOMETHING ABOUT IDEAL POSTURE
relax shoulders
keep head directly over shoulders
use a tucked chin vs. a poked out chin
rest feet flat on the floor
sit with legs bent at approximately 90°
back supported by chair especially lumbar region
WHILE SITTING ON CHAIR TO USE COMPUTER
sit with elbows resting at your sides, forearms approx. 90 °
adjust screen so the first line of text is 2-6” below eye level
if wearing bi-focal, place the screen as low as possible
PROBLEMS OCCUR IN POSITIONING WHEN:
the body is held in one position for long periods
body or head is significantly tilted or bent over
the joints are near their extremes of range of movement
forearm is rapidly twisted while the hands grip an object body twisted
while holding an object
arms raised for long periods
same movements repeated frequently
wrists & fingers bent in combination
Attention plzzzzzzzzz……………
what u have read about ideal posture in previous
slides
And sitting like this till now ………..did not understand ??
Immediately correct your posture to prevent
the chance of deduction of marks of this session
……… And make sure to never be wrong to prevent
back injury
THERE ARE SOME NORMAL AND ABNORMAL
POSTURES AND POSITIONS TO UNDERSTAND
DIFFERENT PATTERNS
Don’t sleep
Awake now
Coz
This section
is just to observe keenly because you all
have to give practical demos at the end
of this section………..
Do u know??????????
How to sit with
correct pattern
s
YES!!!!It’s
correct
Notice the 3 curves of the spine are maintained.
The spine is strong and there is no
“BIG C”
a
This is also correct with the use of a
Lumbar Roll or special Back Support
Is This Correct???
NO!!!!!!!!
Just note the
“Big C”
Notice the 3
curves of the
spine are maintained?
Notice the knees
LOWER than the hips?
Sitting wedge
This Helps you sit
up correctly.
z
SOME LIFTING PATTERNS WITH CORRECT AND
INCORRECT POSITIONS
CORRECT AND INCORRECT PATTERN OF
LIFTING
THE PICTURE SHOW THE CORRECT PATTERN OF
LIFT SOME OBJECT FROM FLOOR
q
Notice the big C in all picture
and observe which picture
show the normal
…..
WHILE SITTING ON CHAIR AND USING COMPUTER
Normal pattern of sitting
Abnormal and poor
pattern of sitting which may
cause back strain
a
AVOID THIS POSTURE OF SITTING OR LYING BECAUSE
CAN BE CAUSE OF BACK INJURY
z
WHILE SITTING AND FORWARD BENDING
Sitting
posture
Forward
bending
x
PULLING AN OBJECT
NORMAL STANDING POSTURE
SOME INSTRUCTIONS TO PREVENT ANY
INJURY AND TO CORRECT POSTURE
a
High heel shoes can
encourage lordosis
so its instruction to
use flat or low heel
during activities
Use of small foot stool or brick
for those who spend prolonged
period in standing
• to relaxes the iliopsoas
• flattening the lumbar curve
• relaxing the posture
s
ALWAYS REMEMBER TO
CORRECT YOUR POSTURE AND
POSITIONING DURING ALL
ACTIVITIES
LIFTING PLAN
Size up the load
Weight
Shape and size
Clear the path
Objects
Tight doorways or corners
Stand close with a shoulder-width stance
Squat by bending your knees and hips
Proper lifting Pull the load close and grip it
Tighten your stomach, lift your head
Rise up with your legs
x
THINK ABOUT UR BACK
Don’t be lazy
Think long term
Don’t try to lift too much
WHILE CARRYING THE LOAD Consider your back in all
Make sure you can see things
Take small, stable steps
Do not twist your back
1
Avoid to use Avoid heavy lifting Don’t work in
alone
wet or awkward and
slippery floor . . Especially uncomfortable
repetitive position
SOME EXERCISES TO CORRECT YOUR
POSTURE AND BACK SUPPORT
This help to
strengthens
and stabilizes
the spine when
done several
times per week.
q
s
Exercise to strengthen To decrease the strain
on back
back and hip
Ergonomic chair also help to maintain posture
Necessary Ergonomic Chair Features
requires lumbar support
armrests - if desired
adjustable seat & back height
adjustable seat & back tilt
SUMMARY
Back pain (also known as dorsalgia) is pain felt in the back that usually
originates from the muscles, nerves, bones ,joints or other structures in the
spine. A person with a back injury has damage to the structures that make up
the back: bones, muscles, ligaments, tendons, disks or spinal cord the causes of
back injuries could be abnormalities in spine and also poor posture…while
assessment the could be observed by touch , ask and practical observation.
while patient come to therapist mostly die to postural abnormalities so the aim
of therapist should be to train the patient in different techniques of correction of
posture and give home guidelines to prevent further deformity………..just like
that ,avoid to lifting heavy weight alone and in wrong way and also should
know that high heel could be the cause of lordosis and how we prevent our
back from injury by following different instruction and also we knew different
strengthening exercises for back ……
We should follow the guidelines to prevent back injury and try to maintain
correct posture for happy life without pain
Oh oh oh;;;;;Care your posture
AND THANKS TO TOLERATE;;;;