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
WHILE CARRYING THE LOAD
 Make sure you can see
 Take small, stable steps
 Do not twist your back
THINK ABOUT UR BACK
 Don’t be lazy
 Think long term
 Don’t try to lift too much
 Consider your back in all
things
 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;;;;