Taxi Driver (Back Pain)

Taxi Driver (Back Pain)

1. Demography

   • Name: Mr. Singh
     • complains from back pain
       • aggravated by
         • carrying heavy objects
         • long periods of sitting
         • wrong movements
           • movements of the spine
             • cervical movements
               • neck
                 • forward flexion
                 • lateral flexion
                 • backward extension
                 • rotation
             • thoracolumbar movements
               • back
                 • flexion
                 • extension
                 • flexion
                 • lateral bending
       • most commonly L4-S3
         • lumbar region (5)
           • no foramen and no facet
         • Sacral region (5)
           • fused bones
   • Age: 43 years old
   • Occupation: taxi driver

2. Vertebral column

   • facets on the side of the body
     • Thoracic region (121)
       • Articulate with heads of ribs
       • 1 complete facet
         • transverse process
           • 10th vertebra
         • no transverse process
           • 11th vertebra
           • inferiorly articulating process
             • 12th vertebra
       • 1 demi facet
         • 9th vertebra
       • 1 complete facet and one Demi facet
         • 1st vertebra
       • typical 2-8
         • Inferiorly pointing spine
         • 2 Demi facets on side of body
   • foramen in transverse process
     • cervical (7)
       • typical 3-6
       • atypical 1,2, & 7
   • fused bones
     • coccyx
   • orientation
     • lordosis
       • cervical
         • Develops when baby puts head erect
       • lumbar
         • Develops when child walks and runs
       • secondary curvature
     • kyphosis
       • thoracic
         • Give space for lung and heart
       • sacral
         • Gives space for pelvic organs
       • primary curvature
         • Forms in embryonic life

3. Possible causes

   • Sciatica
     • spinal causes
       • stenosis
         • due to
           • trauma
           • inflammation
       • Spondylolisthesis
         • forward slip of one of the vertebra
       • herniation
         • protrusion
           • Bulging of nucleus through annulus
             • Contained: annulus intact
           • Prolapse
             • Rupture of nucleus through annulus
               • Not through anterior/ posterior longitudinal ligament
             • Non-contained: annulus not intact
             • extrusion
               • Rupture of nucleus through annulus
                 • through anterior/posterior longitudinal ligament
               • Sequestration
                 • Fragmentation of extruded segment
                   • Displaces through spinal canal away from site of rupture
       • degenerative disc disease
         • mainly due to dehydration
         • factors affecting the disc
           • lifestyle factors
           • growth factors
           • genetic factors
             • Aggrecan gene polymorphism
               • Aggrecan is proteoglycan that traps water
                 • Along with proteoglycans certain sulfate trap water
                   • Chondroitin sulfate A and C
                     • strongly hydrophilic
                     • Keratan:chondroitin ratio increases
                       • leads to
                   • Keratan sulfate
                     • Less hydrophilic and forms aggregates with hyaluronic acid
                 • When fragmented causes more water to escape
                   • leads to
                     • dehydration of the disc
                       • Structural framework of disc is changed
                         • Loses function of shock absorbance
                           • Tension is radiated to the edge
                             • Cracks form in the annulus
                               • May lead to
           • nutrient environment
         • affects
           • intervertebral discs
             • largest avascular tissue
               • any loss of blood supply
                 • affects
                 • can lead to
             • composed of
               • central nucleus pulposus
               • surrounding annulus fibrosus
       • growths
         • cysts
         • inflammation
     • non-spinal causes
       • trauma to leg
       • pelvic tumors
       • Piriformis syndrome
       • Pregnancy
       • Wallet sciatica
     • Pain in lower back traveling towards the toes
       • Happens because sciatic nerve is injured or compressed
         • Longest and thickest nerve
   • Infection
     • Pott's disease

4. Treatment

   • pharmacological
     • analgesics
   • non-pharmacological
     • activity
     • manual therapies
     • psychological therapy
   • alternative medicine
     • spinal manipulation

5. Epidemiology of low back pain

   • YLD due to low back pain
     • Maximum in Europe
       • due to office work
     • MENA region
       • females
         • maximum iran
       • males
         • maximum morocco