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Low Back Pain
John Ebnezar
SECTION I: INTRODUCTION
CHAPTER 1:
Introduction to Low Backache
HOW IS BACKACHE DIFFERENT FROM OTHER DISEASES?
WHAT IS THE BEST WAY TO DEAL WITH BACK PAIN (FIG. 1.2)
DESIGN OF YOUR BACK
What is Back?
Structure of Your Back
Disks
Role of Your Back Muscles and Ligaments
Nerves
Arrangement of Your Spine into a S-shaped Structure
This S-curve, Nature's Plan for us Human Beings
How has this S-curve Evolved in We Humans?
Advantages of Your S-curve
FUNCTIONS OF YOUR SPINE
Weight Transmission
Process of Weight Transmission
Movements
Protection
Know the Pressures Your Spine is subjected to, Day in and Day out
EVERYTHING YOU NEED TO KNOW ABOUT HUMAN POSTURE
YOUR LIFE DAY IN AND DAY OUT
ALSO CONSIDER OTHER FACTORS BURDENING YOUR SPINE
WELCOME TO THE WORLD OF BACKACHES
LOW BACKACHE
Causes of Low Backache (LBA)
SECTION II: UNCOMMON BACKACHE
CHAPTER 2:
Uncommon Causes for Low Backaches
LOW BACKACHE DUE TO REASONS RELATED TO YOUR SPINE
LOW BACKACHE DUE TO REASONS UNRELATED TO YOUR SPINE
PRESENTATION IN OTHER UNCOMMON CAUSES OF LOW BACKACHE
CHAPTER 3:
Spina Bifida (Occulta and Manifesta)
INTRODUCTION
SPINA BIFIDA OCCULTA
Treatment
SPINA BIFIDA APERTA OF MANIFESTA
Causes of Spina Bifida
RELEVANT HISTORY
Significant Past History
RELEVANT CLINICAL FINDINGS (FIGS 3.3 TO 3.10)
Inspection (Occulta Type)
Palpation
INVESTIGATIONS
Early Diagnostic Tools to Detect Neural Tube Defects (Dysraphism)
Other Investigations
Treatment
Preventive Measures
Curative Measures
TREATMENT IN A NUTSHELL
CHAPTER 4:
Ankylosing Spondylitis
INTRODUCTION
Causes
Pathology
RELEVANT HISTORY
CLINICAL FINDINGS (FIGS 4.1 AND 4.2)
EXTRA-ARTICULAR FEATURES
Relevant Investigations
TREATMENT IN A NUTSHELL
CHAPTER 5:
Scoliosis
INTRODUCTION
Mystifying Facts
Varieties
RELEVANT HISTORY
Significant Past History
Significant Present History
RELEVANT CLINICAL FINDINGS
Inspection (Figs 5.1 to 5.7)
Palpation
In Idiopathic Scoliosis
In Paralytic Scoliosis
Congenital Scoliosis
RELEVANT INVESTIGATIONS
TREATMENT IN A NUTSHELL 3 0's
CHAPTER 6:
Osteoporosis
INTRODUCTION
CAUSES
CLINICAL FEATURES
INVESTIGATIONS
MANAGEMENT OF OSTEOPOROSIS
Genera measures
Exercises
Drug Therapy in Osteoporosis
Hormone Replacement Therapy
Biphosphonates
Calcitonin
Alfacalcidol
Fluorides
Drug Options in the Treatment of Osteoporosis
ANTI-FALL MEASURES IN OSTEOPOROSIS
CHAPTER 7:
Spondylolisthesis
DEFINITION
Interesting Facts about Spondylolysis
Classification (Wiltse, Macnab and Newman)
Types
RELEVANT HISTORY
Significant Past History
Significant Present History
RELEVANT CLINICAL FINDINGS
Inspection (Figs 7.3 to 7.6)
Palpation
RELEVANT INVESTIGATIONS
TREATMENT IN A NUTSHELL
DIFFERENTIAL DIAGNOSIS
CHAPTER 8:
Seronegative Spondyloarthropathies
INTRODUCTION
ETIOLOGY
SIGNS AND SYMPTOMS
Articular Features
Extra-articular Features
DIAGNOSIS
Radiological Diagnosis
CAT Scan
HLA-B27
TREATMENT
CHAPTER 9:
Lumbar Spondylosis and Lumbar Canal Stenosis
INTRODUCTION
RISK FACTORS
Clinical Features
DIAGNOSIS
TREATMENT
RELEVANT INVESTIGATIONS
Treatment
INTRODUCTION
DEFINITION
CLASSIFICATION
Causes
Clinical Features
RELEVANT HISTORY
RELEVANT CLINICAL FINDINGS
Symptoms
Signs
RELEVANT INVESTIGATIONS
DIFFERENTIAL DIAGNOSIS
TREATMENT IN A NUTSHELL
CHAPTER 10:
Old Thoracic and Thoracolumbar Injuries
INTRODUCTION
Mechanism of Injury
McAfee's Classification—3-Column Classification (Figs 10.1A to D)
Wedge Compression
Stable Burst Fractures
Unstable Burst Fractures
Chance Fracture (Seatbelt injury)
Flexion Distraction Injury
Translational Injuries
RELEVANT HISTORY
Significant Past History
Significant Present History
RELEVANT CLINICAL FINDINGS (FIGS 10.2 TO 10.8)
Inspection
Palpation
INTRODUCTION
Causes
Clinical Features
Symptoms
RELEVANT HISTORY
Signs
INVESTIGATIONS
TREATMENT IN A NUTSHELL
CHAPTER 11:
Tuberculosis Spine
SITES OF INVOLVEMENT WITHIN THE VERTEBRA
Clinical Features
Physical Findings
Investigations
Laboratory Tests
Radiographs
Earliest Change
Late Change
Paravertebral Shadow
CT Scans
MRI
Biopsy
Ultrasound
Treatment
Indications for Surgery
Surgical Procedures
Objectives of Surgery
Complications of tuberculosis spine
SECTION III: COMMON BACKACHE
CHAPTER 12:
Intervertebral Disk Prolapse
INTRODUCTION
DISK PHYSIOLOGY
NATURAL HISTORY OF LUMBAR DISK DISEASE
Interesting Facts
ETIOLOGY OF DISK HERNIATION
Risk Factors
DEFINITIVE CAUSES
RELEVANT HISTORY
Significant Past History
Significant Present History (Figs 12.5 to 12.14)
RELEVANT FINDINGS (FIGS 12.15 TO 12.19)
Inspection
Palpation
DIFFERENTIAL DIAGNOSIS
RELEVANT INVESTIGATIONS
TREATMENT IN A NUTSHELL
CHAPTER 13:
Common Causes for Low Backache
SUDDEN INSULTS TO YOUR BACK (FIGS 13.1 AND 13.2)
GRADUAL INSULTS TO YOUR BACK
Ponder over Your Various Faulty Postural Habits Adopted by Your Sleeping Habits
Your Standing Habits
Your Walking Habit
Your Sitting Habits
Your Sedentary Life
Urbanization Hazards (Our Life in Cities)
Our Working Environment
The Upper Group
The Middle Group
The Lower Group
Special Groups (High Backache Risk Professionals)
SUMMARY OF THE REASONS FOR COMMON LOW BACKACHE
Various Presentations of Low Backache
Common Low Backache
Common Low Back Pain (80%)
FEATURES OF COMMON LBA
Disk Related Pain
Muscle/Ligament Pain
DIFFERENTIAL DIAGNOSIS OF COMMON LOW BACK PAIN
SLIPPED DISK
Features in a Patient Suffering from Prolapses Disk
VARIOUS INVESTIGATIONS IN LOW BACKACHE
TREATMENT OPTIONS
Doctor's Role
Drugs
Surgery
Physiotherapy
Heat Therapy
Cold Therapy
Traction
Massage
Adjuvant Measures
Exercises of the Back
YOU AS YOUR DOCTOR
Sitting
Types of Bad Sitting
Proper Sitting
Required Features of the Proper Chair (Fig. 13.24)
Correct Methods of Sitting
Standing
Correct Methods of Standing
Walking (Figs 13.27A and B)
Sleeping (Figs 13.28A and B)
Getting up from the Sleep Correctly (Figs 13.30A to F)
Going to the Bed Correctly (Figs 13.31A to C)
Practice Correct Weight Lifting Methods
Bending and Lifting
Important Do's and Don'ts Weightlifting
Dont's
Methods of Turning
Learn Proper Driving Habits
While Driving Two Wheelers
Cars and Other Four Wheelers (Fig. 13.34)
Public Transport Systems
Traveling Habits
Use of Hotel Mattresses
Kitchen Habits (Fig. 13.36)
What Bad Habits Mean to Your Back?
Stress
Avoid Stress
EXERCISE YOUR BACKACHE AWAY
Aims and Objectives
General Instructions
Start with Warm-up Exercises
EXERCISES RECOMMENDED FOR THE BACK
Abdominal Muscle Exercises
Exercises of the Trunk Hip, Thigh and Leg Muscles
Methods
Procedure
YOGA
The Role of Yoga in the Treatment of Low Backaches (LBA)
OTHER USEFUL MEASURES TO COUNTER LOW BACKACHE
DO THESE AND BACKACHE WILL VISIT YOU LESS OFTEN
Swimming
Cycling
Running and Jogging
Body Building and Body Shaping
Golf (Fig. 13.49)
TREATMENT MEASURES YOU CAN SAFELY PRACTICE
Simple Screening Tests to Rule out Major Back Problems
Simple Screening Tests to Detect when you Need Surgery
SELF-TREATMENT METHODS YOU CAN SAFELY PRACTICE
WHEN TO SEE A DOCTOR?
BACKACHE IN SPECIAL SITUATIONS
Occupational Backache
Ergonomics
Frequent of Complaints in Occupational Backaches
Putting Ergonomics into Practice
Computer Back
LBA in Pregnant Women
SCHOOL BAG SYNDROME
REPETITIVE STRESS INJURY (RSI)
Treatment
INDEX
TOC
Index
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