PBL5: A taxi driver

PBL5: A taxi driver

1. Vertebrae

   • backbone that forms the central axis of the skeleton.
   • 33 vertebrae
   • formed of body and arch

2. Intervertebral discs

   • Made up of annulus fibrosis ( collagen bundles)
   • Nucleus pulposus (gelatinous material) act as shock absorber
   • Elasticity decreases and it dehydrates with age

3. Joints

   • Zygapo-physeal joints
     • synovial plane
       • articulation between inferior articular process of superior vertebra and superior art.
         • movements
           • flexion, extension, and rotation of cervical and lumbar vertebrae.
   • Atlanto-occipital joint
     • condyloid synovial
       • articulation between superior articular facets on lateral masses of C1 (atlas) and occipital condyles of skull
         • movement
           • Nodding

4. Lower back pain

   • causes
     • Herniation
       • Anterior herniation usually is asymptomatic.
       • Posterior herniation puts pressure on nerve roots or spinal canal and produces symptoms.
       • Types
         • Protrusion
           • Bulging of nucleus pulposus through weakened annulus fibrosus, usually posterior or posteriolateral
         • Prolapse
           • Rupture of nucleus pulposus through annulus but not the posterior or anterior longitudinal ligament
         • Extrusion
           • rupture of nucleus pulposus through annulus and posterior or anterior longitudinal ligament
         • sequestration
           • Fragmentation of extruded segment, may extend into spinal canal or far from site of rupture
     • Degenerative disc disease
       • Disc gradually dries out, loses height and volume.
       • NP changes from a turgid gelatinous bulb to brownish dessicated structure.
         • AF develops fissures parallel to the vertebral end plates.
           • Compressive loads transfer away from nucleus to margins
             • Sclerosis of endplate reduces disc nutrition.
               • Facet joints wear away cartilage, begin to override
                 • Motion segment becomes hypermobile
                   • Osteophytes develop to attempt to stabilize motion segment
                     • Osteophytes may encroach on neural structure
     • Facet joint dysfunction.
     • Sacroiliac joint dysfunction.

5. Sciatica

   • pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg.
   • It originates from the anterior rami of the lower lumbar (L4-L5) and upper sacral spinal nerves (S1, S2, S3).
   • causes
     • Normal wear and tear of aging
     • Muscle spasm in the back or buttocks
     • Herniated disc, bone spur or narrowing of the spine compresses a part of the nerve
   • symptoms
     • numbness and tingling or muscle weakness in the affected leg.
   • Diagnosis
     • Doctors usually check for muscle strength and reflexes in a physical examination.
     • You may be asked to walk on your heels or toes or to rise from a squatting position.
   • Presentation
     • Decreased range of motion of the lumbosacral spine.
     • Straight leg raising test is positive.
     • Lowered or loss of deep tendon reflex.
     • Sensory or motor deficit in the territory of the involved nerve root.
   • Physiotherapy modalities
     • Electromagnetic
     • Thermal
     • Mechanical

6. Alternative therapies for lower back pain

   • Acupuncture
     • involves inserting thin needles in your skin at specific points to help relieve pain.
     • Stimulates nervous system
     • Releases opioid-like chemicals produced in the body
     • Releases neurotransmitters.
     • Triggers electromagnetic impulses in the body.
   • chiropractic spinal manipulation
     • involve one or more manual adjustments in which the chiropractor manipulates the joints, using a controlled, sudden force to improve range and quality of motion
   • Osteopathic treatments
     • Apply gentle pressure to manipulate the muscles, soft tissues and joints.
     • Treat mechanical pain (muscle, tendon or bone pain due to structural imbalance).
   • Herbal Remedies
   • Yoga, Pilates and exercise

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