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1. Anatomy

   • Vertebral column
     • Cervical segment
       • 7 bones
     • Thoracic segment
       • 12 bones
     • Lumbar
       • 5 bones
     • Sacrum
       • 5 fused bones
     • Coccyx
       • 2-4 fused bones
   • Spinal cord
     • located
       • In the central canal
     • passes
       • from foramen magnum to L1/L2

2. Radicular pain

   • Radicular pain is a type of pain that radiates into the lower extremity directly along the course of a spinal nerve root
   • Caused by
     • compression, inflammation and/or injury to a spinal nerve root
       • arised by:
         • herniated disc, foraminal stenosis and peridural fibrosis

3. Types of back pain

   • Acute
     • 1. A sudden injury to the muscles and ligaments supporting the back. 2.Muscle spasms or a strain or tear in the muscles and ligaments.
   • Chronic
     • pain that lasts more than 3 to 6 months, or beyond the point of tissue healing.
   • Causes
     • 1. Herniated disc
     • 2. Lower back strain
     • 3. Osteoarthritis of the spine
     • 4. Spinal stenosis

4. Dermatomes of lower limb

5. Visual analogue scale

6. Sciatic nerve

   • Originates from
     • Sacral plexus
   • Branches
     • Common peroneal n.
     • Superficial peroneal n.
     • Deep peroneal n.
   • Pathology
     • SCIATICA
       • refers to pain that radiates along the path of the sciatic nerve
       • Causes
         • irritation of the root(s) of the lower lumbar and lumbosacral spine
       • Risk factors
         • being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
       • Symptoms
         • pain radiating from the lower spine to the buttock and down the back of the leg
         • jolt or electric shock.
         • Usually only one side of the body is affected.
         • numbness, tingling or muscle weakness in the affected leg or foot.
       • Clinical presentation
         • Scoliosis
           • sideways curvature of the spine
         • Claudication
           • Limping
         • Inability to walk on tip toes
       • Management
         • Heat/Ice packs
         • Medications
         • Epidural steroid injections
         • Physiotherapy
           • Objectives
             • To centralise the pain
             • To restore functionality
             • To restore lumbar curvature
         • Alternative therapy
           • Biofeedback
           • Acupuncture
           • Cupping
           • Chiropractic
           • Massage
         • Surgery
           • Indications
             • Sudden bowel and/or bladder incontinence
             • 4-6 weeks of sever leg pain
             • 6-12 months of persistent back pain
             • Sever abdominal and back pain
           • Types
             • Microdiscectomy
             • Lumbar laminectomy

7. Disc problems

   • Degenarative disc diseas
   • Bulging disc
   • Scoliosis
   • Lordosis
   • kyphosis

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