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Joint PainsJoint Pains
Mediplex Health CareMediplex Health Care
The Story of …..The Story of …..
 Alok Sharma & Rahul Gupta….Alok Sharma & Rahul Gupta….
 Class matesClass mates
 Age: early 20’s :Bright ComputerAge: early 20’s :Bright Computer
Professionals.Professionals.
 Recruited in Good Software company.Recruited in Good Software company.
 Long stressful working hours.Long stressful working hours.
 Sometimes working late in nights.Sometimes working late in nights.
Story of Alok…Story of Alok…
 He never had time for himself or he neverHe never had time for himself or he never
tried to find some time.tried to find some time.
 He was advised to do some exercise, relaxHe was advised to do some exercise, relax
and adopt right posture while working.and adopt right posture while working.
 He is always saying “ Once I complete thisHe is always saying “ Once I complete this
project then only I will start taking care ofproject then only I will start taking care of
myself”.myself”.
 Now he is in late 20’s …married ….Now he is in late 20’s …married ….
The story goes on …The story goes on …
 Now he is getting tired easily, he has put onNow he is getting tired easily, he has put on
weight and becoming irritated easily. He hasweight and becoming irritated easily. He has
started experiencing pain & stiffness instarted experiencing pain & stiffness in
neck.neck.
 He is advised that its high time …..take careHe is advised that its high time …..take care
of body…ready made excuse ….No time.of body…ready made excuse ….No time.
No time ?No time ?
 Time to think !Time to think !
 Drive your car to different places andDrive your car to different places and
important meetings. Don’t get it refueled asimportant meetings. Don’t get it refueled as
there is no time to do that ……there is no time to do that ……
 What is going to happen ?What is going to happen ?
 You are ultimately going to stuck in theYou are ultimately going to stuck in the
middle of road ….loosing all your clients …..middle of road ….loosing all your clients …..
 What about your body ?What about your body ?
Now his body crashed !Now his body crashed !
 He is in early 30’sHe is in early 30’s
 Suffering from cervical spondylosis….Suffering from cervical spondylosis….
 Can’t even work on computers for 15Can’t even work on computers for 15
minutes.minutes.
 Feels giddy whenever he turns his head.Feels giddy whenever he turns his head.
 Lost strength in hands & can’t lift even 1-2Lost strength in hands & can’t lift even 1-2
Kg of weights.Kg of weights.
Story still continues !Story still continues !
 Bed ridden !Bed ridden !
 On sick leaves !On sick leaves !
 Promotions are stopped & job is at stake !Promotions are stopped & job is at stake !
 Rising medical bills !Rising medical bills !
 Financial insecurity as he is sole breadFinancial insecurity as he is sole bread
winner !winner !
 Emotional and social problem !Emotional and social problem !
Whereas Mr. Gupta !Whereas Mr. Gupta !
 Mr. Gupta …his class mate, has beenMr. Gupta …his class mate, has been
promoted to senior position….promoted to senior position….
 Energetic and enthusiastic.Energetic and enthusiastic.
 Challenging assignments.Challenging assignments.
 Financially very well off.Financially very well off.
 Almost nil medical bills.Almost nil medical bills.
 Enjoys vacations, work and family life.Enjoys vacations, work and family life.
AnalysisAnalysis
 You have to invest time on yourself.You have to invest time on yourself.
 Time or money are just excuses. You haveTime or money are just excuses. You have
to steal 40 minutes per day, 3-4 times in ato steal 40 minutes per day, 3-4 times in a
week.week.
 Healthy body and mind is just what countsHealthy body and mind is just what counts
in long run !in long run !
 What will you do with rest of things and ifWhat will you do with rest of things and if
you are not well !you are not well !
DefinitionDefinition
 Pain affecting joints !Pain affecting joints !
 Joint pain can be caused by many types ofJoint pain can be caused by many types of
injuries or conditions. No matter whatinjuries or conditions. No matter what
causes it, joint pain can be verycauses it, joint pain can be very
bothersome.bothersome.
Lets understand about jointsLets understand about joints
 Skeleton SystemSkeleton System
 JointsJoints
 Parts of jointsParts of joints
Lets understand about joints !Lets understand about joints !
Causes of Joint painsCauses of Joint pains
Joint injury : Strain, Sprain & previous joint injury
Infections - many infections cause aching joints and aching muscles
Viral infection, Common cold, Flu etc
Arthritis – Osteoarthritis, Rheumatoid arthritis , Psoriatic arthritis , & Gout
Joint infection : Tendinitis, Bursitis etc
Common Joint ProblemsCommon Joint Problems
 Osteoarthritis (OA)Osteoarthritis (OA)
 Rheumatoid ArthritisRheumatoid Arthritis
 Based Upon LocationsBased Upon Locations
 Lumbar SpondylosisLumbar Spondylosis
 Cervical SpondylosisCervical Spondylosis
OAOA
 Osteoarthritis is the most common form of arthritis.Osteoarthritis is the most common form of arthritis.
 This is the form that usually comes with age andThis is the form that usually comes with age and
most often affects the fingers, knees, and hips.most often affects the fingers, knees, and hips.
 Sometimes osteoarthritis follows an injury to aSometimes osteoarthritis follows an injury to a
joint. For example, a young person might hurt hisjoint. For example, a young person might hurt his
knee badly playing cricket. Then, years after theknee badly playing cricket. Then, years after the
knee has apparently healed, he might get arthritisknee has apparently healed, he might get arthritis
in his knee joint.in his knee joint.
What Causes OA ?What Causes OA ?
 Primary osteoarthritis is mostly related toPrimary osteoarthritis is mostly related to
agingaging..
 Protein makeup of cartilage degenerates.Protein makeup of cartilage degenerates.
 Repetitive use of the joints over the yearsRepetitive use of the joints over the years
irritates and inflames the cartilage, causingirritates and inflames the cartilage, causing
joint pain and swelling.joint pain and swelling.
PathologyPathology
 Eventually, cartilage begins to degenerateEventually, cartilage begins to degenerate
by flaking or forming tiny crevasses.by flaking or forming tiny crevasses.
 Loss of cartilage cushion causes frictionLoss of cartilage cushion causes friction
between the bones, leading to pain andbetween the bones, leading to pain and
limitation of joint mobility.limitation of joint mobility.
 Osteoarthritis occasionally can be found inOsteoarthritis occasionally can be found in
multiple members of the same family,multiple members of the same family,
implying animplying an heredityheredity (genetic) basis for this(genetic) basis for this
condition.condition.
PathologyPathology
 InflammationInflammation of the cartilage can alsoof the cartilage can also
stimulate new bone outgrowths (spurs) tostimulate new bone outgrowths (spurs) to
form around the joints.form around the joints.
Comparison of Normal Vs DiseasedComparison of Normal Vs Diseased
JointsJoints
Secondary osteoarthritisSecondary osteoarthritis
 Secondary osteoarthritis is caused bySecondary osteoarthritis is caused by
another disease or condition.another disease or condition.
 Conditions that can lead to secondaryConditions that can lead to secondary
osteoarthritis includeosteoarthritis include obesityobesity, repeated, repeated
traumatrauma oror surgerysurgery to the joint structures,to the joint structures,
abnormal joints at birth (congenitalabnormal joints at birth (congenital
abnormalities),abnormalities), goutgout,, diabetesdiabetes and otherand other
hormone disorders.hormone disorders.
Risk FactorsRisk Factors
 ObesityObesity causes osteoarthritis by increasingcauses osteoarthritis by increasing
the mechanicalthe mechanical stressstress on the cartilage.on the cartilage.
 In fact, next to aging, obesity is the mostIn fact, next to aging, obesity is the most
powerfulpowerful risk factorrisk factor for osteoarthritis of thefor osteoarthritis of the
knees.knees.
 The early development of osteoarthritis ofThe early development of osteoarthritis of
the knees among weight lifters is believed tothe knees among weight lifters is believed to
be in part due to their high body weight.be in part due to their high body weight.
Risk FactorsRisk Factors
 Crystal deposits in the cartilage can causeCrystal deposits in the cartilage can cause
cartilage degeneration, and osteoarthritis.cartilage degeneration, and osteoarthritis.
Uric acidUric acid crystals cause arthritis in gout,crystals cause arthritis in gout,
while calcium pyrophosphate crystals causewhile calcium pyrophosphate crystals cause
arthritis in pseudogout.arthritis in pseudogout.
 Hormone disturbances, such as diabetesHormone disturbances, such as diabetes
and growth hormone disorders, are alsoand growth hormone disorders, are also
associated with early cartilage wear andassociated with early cartilage wear and
secondary osteoarthritis.secondary osteoarthritis.
SymptomsSymptoms
 Joint pain is usually worse later in the day. ThereJoint pain is usually worse later in the day. There
can be swelling, warmth, and creaking of thecan be swelling, warmth, and creaking of the
affected joints.affected joints.
 Pain and stiffness of the joints can also occurPain and stiffness of the joints can also occur
after long periods of inactivity, for example, sittingafter long periods of inactivity, for example, sitting
in a theater.in a theater.
 In severe osteoarthritis, complete loss of cartilageIn severe osteoarthritis, complete loss of cartilage
cushion causes friction between bones, causingcushion causes friction between bones, causing
pain at rest or pain with limited motion.pain at rest or pain with limited motion.
DiagnosisDiagnosis
 X-rays : loss of joint cartilage, narrowing of the joint spaceX-rays : loss of joint cartilage, narrowing of the joint space
between adjacent bones, and bone spur formation.between adjacent bones, and bone spur formation.
 Arthrocentesis often performed in the doctor's office: aArthrocentesis often performed in the doctor's office: a
sterile needle is used to remove joint fluid for analysis.sterile needle is used to remove joint fluid for analysis.
Joint fluid analysis is useful in excluding gout, infection,Joint fluid analysis is useful in excluding gout, infection,
and other causes of arthritis.and other causes of arthritis.
 Arthroscopy is a surgical technique whereby a doctorArthroscopy is a surgical technique whereby a doctor
inserts a viewing tube into the joint space. Abnormalities ofinserts a viewing tube into the joint space. Abnormalities of
and damage to the cartilage and ligaments can beand damage to the cartilage and ligaments can be
detected and sometimes repaired through the arthroscope.detected and sometimes repaired through the arthroscope.
Cervical spondylosisCervical spondylosis
 Cervical spondylosis is a chronicCervical spondylosis is a chronic
degeneration of the bones (vertebrae) of thedegeneration of the bones (vertebrae) of the
neck (cervical spine) and the cushionsneck (cervical spine) and the cushions
between the vertebrae (disks).between the vertebrae (disks).
Cause (Same as OA)Cause (Same as OA)
 As you age, the disks of your spine become drier and lessAs you age, the disks of your spine become drier and less
elastic. Degeneration can cause some of the disks to bulgeelastic. Degeneration can cause some of the disks to bulge
and, in some cases, cause the central cartilage of the disksand, in some cases, cause the central cartilage of the disks
to protrude through a crack in the ring that surrounds theto protrude through a crack in the ring that surrounds the
disk (herniate). The surrounding ligaments become lessdisk (herniate). The surrounding ligaments become less
flexible, and the vertebrae may develop bone spurs.flexible, and the vertebrae may develop bone spurs.
 These degenerative changes may be a result of wear andThese degenerative changes may be a result of wear and
tear throughout your life. An earlier injury to your neck maytear throughout your life. An earlier injury to your neck may
predispose you to this degeneration. By age 60, mostpredispose you to this degeneration. By age 60, most
people will show signs of cervical spondylosis on X-ray,people will show signs of cervical spondylosis on X-ray,
although they may not have signs or symptoms.although they may not have signs or symptoms.
Cause (Same as OA)Cause (Same as OA)
 As you age, the disks ofAs you age, the disks of
your spine become drieryour spine become drier
and less elastic.and less elastic.
Degeneration can causeDegeneration can cause
some of the disks to bulgesome of the disks to bulge
and, in some cases, causeand, in some cases, cause
the central cartilage of thethe central cartilage of the
disks to protrude through adisks to protrude through a
crack in the ring thatcrack in the ring that
surrounds the disksurrounds the disk
(herniate). The(herniate). The
surrounding ligamentssurrounding ligaments
become less flexible, andbecome less flexible, and
the vertebrae may developthe vertebrae may develop
bone spurs.bone spurs.
Signs and symptomsSigns and symptoms
 Neck pain and stiffness that gets progressivelyNeck pain and stiffness that gets progressively
worseworse
 Numbness or weakness in the arms, hands andNumbness or weakness in the arms, hands and
fingersfingers
 Headaches that radiate to the back of the headHeadaches that radiate to the back of the head
 Loss of balanceLoss of balance
 Numbness or weakness in the legs, if the spinalNumbness or weakness in the legs, if the spinal
cord is compressedcord is compressed
 Loss of bladder or bowel control, if the spinal cordLoss of bladder or bowel control, if the spinal cord
is compressedis compressed
BackacheBackache
IntroductionIntroduction
 The back is a well-designed structureThe back is a well-designed structure
made up of bone, muscles, nerves andmade up of bone, muscles, nerves and
other soft tissues. You rely on your backother soft tissues. You rely on your back
to be theto be the workhorseworkhorse of the body — itsof the body — its
function is essential for nearly everyfunction is essential for nearly every
move you make. Because of this, themove you make. Because of this, the
back can be particularly vulnerable toback can be particularly vulnerable to
injury and back pain can be disabling.injury and back pain can be disabling.
 Four out of five adults have at least oneFour out of five adults have at least one
bout of back pain sometime during life.bout of back pain sometime during life.
In fact, back pain is one of the mostIn fact, back pain is one of the most
common reasons for health care visitscommon reasons for health care visits
and missed work.and missed work.
 On the bright side, you can prevent mostOn the bright side, you can prevent most
back pain. Simple home treatment andback pain. Simple home treatment and
proper body mechanics will often healproper body mechanics will often heal
your back within a few weeks and keepyour back within a few weeks and keep
it functional for the long haul.it functional for the long haul.
CausesCauses
 Spondylosis.Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerativeSpondylosis is a type of arthritis affecting the spine. It is due to the degenerative
changes in the spine that often come with aging.changes in the spine that often come with aging.
Spinal stenosis.Spinal stenosis. This condition occurs when the space around the spinal cord and nerve rootsThis condition occurs when the space around the spinal cord and nerve roots
narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.
 Spondylolisthesis.Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward overThis condition occurs when one vertebra in the spinal column slips forward over
another.another.
 These rare but far more serious causes of back pain also have specific treatment related to theThese rare but far more serious causes of back pain also have specific treatment related to the
underlying cause.underlying cause.
 Cauda equina syndrome.Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs,This is a serious neurological problem causing weakness in the legs,
numbness in the "saddle" or groin area, and loss of bowel or bladder control.numbness in the "saddle" or groin area, and loss of bowel or bladder control.
 Cancer in the spine.Cancer in the spine. A tumor on the spine can press on a nerve causing back pain.A tumor on the spine can press on a nerve causing back pain.
 Infection of the spine.Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could beIf a fever and a tender, warm area accompany back pain, the cause could be
an infection.an infection.
 Injury.Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain.Damage to the bones, ligaments, or muscles of the back can cause severe pain.
 Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic backRepeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back
pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can bepain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be
difficult to treat.difficult to treat.
Screening and diagnosisScreening and diagnosis
 X-ray.X-ray. These images show the alignment of your bones and whether you haveThese images show the alignment of your bones and whether you have
degenerative joint disease or broken bones. X-ray images won't directly showdegenerative joint disease or broken bones. X-ray images won't directly show
problems with your spinal cord, muscles, fibrous tissues (fascia), nerves orproblems with your spinal cord, muscles, fibrous tissues (fascia), nerves or
disks.disks.
 Magnetic resonance imaging (MRI) or computerized tomography (CT)Magnetic resonance imaging (MRI) or computerized tomography (CT)
scans.scans. These scans can generate images that may reveal herniated disks orThese scans can generate images that may reveal herniated disks or
problems with bones, muscles, tissue, tendons, nerves, ligaments and bloodproblems with bones, muscles, tissue, tendons, nerves, ligaments and blood
vessels.vessels.
 Bone scan.Bone scan. In rare cases, your doctor may use a bone scan to look for boneIn rare cases, your doctor may use a bone scan to look for bone
tumors or compression fractures caused by osteoporosis. In this procedure,tumors or compression fractures caused by osteoporosis. In this procedure,
you'll receive an injection of a small amount of a radioactive substance (tracer)you'll receive an injection of a small amount of a radioactive substance (tracer)
into one of your veins. The substance collects in your bones and allows yourinto one of your veins. The substance collects in your bones and allows your
doctor to detect bone problems using a special camera.doctor to detect bone problems using a special camera.
 Nerve studies (electromyography, or EMG).Nerve studies (electromyography, or EMG). This test measures theThis test measures the
electrical impulses produced by the nerves and the responses of your muscles.electrical impulses produced by the nerves and the responses of your muscles.
Studies of your nerve-conduction pathways can confirm nerve compressionStudies of your nerve-conduction pathways can confirm nerve compression
caused by herniated disks or narrowing of your spinal canal (spinal stenosis).caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
Role of PhysiotherapyRole of Physiotherapy
Dr. Tarique AzamDr. Tarique Azam
Consultant Physiotherapist, MIAPConsultant Physiotherapist, MIAP
Mediplex PhysiotherapyMediplex Physiotherapy
Physiotherapy RolePhysiotherapy Role
 Physiotherapy is a non –pharmacologicalPhysiotherapy is a non –pharmacological
,Exercise oriented,natural based approach,Exercise oriented,natural based approach
which has assumed important role inwhich has assumed important role in
management of joints and muscularmanagement of joints and muscular
problems.problems.
– Relieves pains & stiffness.Relieves pains & stiffness.
– Increases strength of muscles.Increases strength of muscles.
– Restores movements and function.Restores movements and function.
 _ prevent joint problems._ prevent joint problems.
Modalities UsedModalities Used
 A. ElectrotherapyA. Electrotherapy
– LaserLaser
– Long & Micro WaveLong & Micro Wave
Short Wave Diathermy (SWD)Short Wave Diathermy (SWD)
– Interferential Therapy (IFT)Interferential Therapy (IFT)
– Trans CutaneousTrans Cutaneous
Electrical Stimulations (TENS)Electrical Stimulations (TENS)
– Ultrasound, Muscle &Ultrasound, Muscle &
Nerve Stimulation,Nerve Stimulation,
– Wax and Hot PacksWax and Hot Packs
Exercise TherapyExercise Therapy
 Manual Manipulations:Manual Manipulations:
Mulligan & Mackenzee TechniquesMulligan & Mackenzee Techniques
 Shoulder wheelShoulder wheel
 TractionTraction
Quadricep tableQuadricep table
etcetc
Importance of Good PostureImportance of Good Posture
 Why is good posture important?Why is good posture important?
 When it comes to posture, yourWhen it comes to posture, your
mother did know best. Her frequentmother did know best. Her frequent
reminders to "stand up straight" andreminders to "stand up straight" and
"stop slouching" were good advice."stop slouching" were good advice.
 Your spine is strong and stable whenYour spine is strong and stable when
you practice healthy posture. But whenyou practice healthy posture. But when
you stoop or slouch, your body'syou stoop or slouch, your body's
center of gravity shifts. Your musclescenter of gravity shifts. Your muscles
and ligaments struggle to keep youand ligaments struggle to keep you
balanced. This can lead to painfulbalanced. This can lead to painful
strains and sprains of ligaments andstrains and sprains of ligaments and
muscles in your back. It can alsomuscles in your back. It can also
cause neck pain, joint stiffness, fatiguecause neck pain, joint stiffness, fatigue
and other health problems.and other health problems.
 If you have chronic backaches, healthyIf you have chronic backaches, healthy
posture will help relax your backposture will help relax your back
muscles and may reduce your pain.muscles and may reduce your pain.
Practicing good posture may alsoPracticing good posture may also
prevent backaches and otherprevent backaches and other
problems.problems.
Your spine's curvesYour spine's curves
 A healthy back has threeA healthy back has three
natural curves: an inward ornatural curves: an inward or
forward curve at the neckforward curve at the neck
(cervical curve), an outward(cervical curve), an outward
or backward curve at theor backward curve at the
upper back (thoracic curve),upper back (thoracic curve),
and an inward curve at theand an inward curve at the
lower back (lumbar curve).lower back (lumbar curve).
Good posture doesn't meanGood posture doesn't mean
balancing a book on yourbalancing a book on your
head or standing at military-head or standing at military-
style attention. It simplystyle attention. It simply
aims to maintain theseaims to maintain these
natural curves. In contrast,natural curves. In contrast,
poor posture actually leadspoor posture actually leads
to changes in natural spinalto changes in natural spinal
curves, which can stress orcurves, which can stress or
pull muscles and causepull muscles and cause
pain.pain.
Good standing postureGood standing posture
 When standing, keep yourWhen standing, keep your
chest held high and yourchest held high and your
shoulders back andshoulders back and
relaxed. Try not to tilt yourrelaxed. Try not to tilt your
head forward, backward orhead forward, backward or
sideways. Instead, tucksideways. Instead, tuck
your chin down slightly andyour chin down slightly and
pull your head back and uppull your head back and up
as if to flatten your neckas if to flatten your neck
against a wall.against a wall.
 Pull in your abdomen andPull in your abdomen and
buttocks. Make sure yourbuttocks. Make sure your
knees are relaxed, notknees are relaxed, not
locked. Keep your feetlocked. Keep your feet
parallel and your weightparallel and your weight
balanced evenly on bothbalanced evenly on both
feet.feet.
Take the wall testTake the wall test
 To test your standing posture, take theTo test your standing posture, take the
wall test. Stand with your head, shoulderwall test. Stand with your head, shoulder
blades and buttocks touching a wall,blades and buttocks touching a wall,
with your heels about two to four incheswith your heels about two to four inches
away from the wall. Reach back andaway from the wall. Reach back and
slide your hand behind the curve in yourslide your hand behind the curve in your
lower back, with your palm flat againstlower back, with your palm flat against
the wall.the wall.
 There should be about one hand'sThere should be about one hand's
thickness of space between your backthickness of space between your back
and the wall. If there's too much space,and the wall. If there's too much space,
tighten your abdominal muscles totighten your abdominal muscles to
flatten the curve in your back. If there'sflatten the curve in your back. If there's
too little space, arch your back so thattoo little space, arch your back so that
your hand fits comfortably behind you.your hand fits comfortably behind you.
Walk away from the wall whileWalk away from the wall while
maintaining this posture. Then return tomaintaining this posture. Then return to
the wall to check your success. Practicethe wall to check your success. Practice
maintaining healthy posture during yourmaintaining healthy posture during your
daily activities.daily activities.
Good sitting postureGood sitting posture
 Good sitting posture keeps your neck,Good sitting posture keeps your neck,
shoulders and upper back musclesshoulders and upper back muscles
relaxed. Choose a chair that allows yourelaxed. Choose a chair that allows you
to rest both feet flat on the floor, whileto rest both feet flat on the floor, while
keeping your knees level with your hips.keeping your knees level with your hips.
If this doesn't feel comfortable, tryIf this doesn't feel comfortable, try
placing a foot support under your feet toplacing a foot support under your feet to
find the best position for you.find the best position for you.
 Stretch the top of your head toward theStretch the top of your head toward the
ceiling. Tuck your chin in slightly. Keepceiling. Tuck your chin in slightly. Keep
your upper back and neck comfortablyyour upper back and neck comfortably
straight. Keep your shoulders relaxed,straight. Keep your shoulders relaxed,
not elevated, rounded or pullednot elevated, rounded or pulled
backward. Sit with your back firmlybackward. Sit with your back firmly
against the chair. Place a small cushionagainst the chair. Place a small cushion
or rolled towel to support your loweror rolled towel to support your lower
back curve if your chair doesn't provideback curve if your chair doesn't provide
the support you need.the support you need.
Keep your shoulders straightKeep your shoulders straight
 Pay attention to the position ofPay attention to the position of
your shoulders when you'reyour shoulders when you're
sitting or standing. Slouching orsitting or standing. Slouching or
rolling your shoulders forwardrolling your shoulders forward
shortens your chest musclesshortens your chest muscles
and reduces their flexibilityand reduces their flexibility
(kyphosis). But, if you pull your(kyphosis). But, if you pull your
shoulders too far back, you canshoulders too far back, you can
develop swayback (lordosis), indevelop swayback (lordosis), in
which your abdomen sticks outwhich your abdomen sticks out
too far in front and your buttockstoo far in front and your buttocks
stick out too far in back.stick out too far in back.
Check out your reflectionCheck out your reflection
 Stand in front of a mirror toStand in front of a mirror to
see if you're keeping yoursee if you're keeping your
shoulders straight, or ask ashoulders straight, or ask a
friend to evaluate yourfriend to evaluate your
shoulder position. Yourshoulder position. Your
shoulders should be in theshoulders should be in the
same position as thesame position as the
picture on the left. Youpicture on the left. You
may find that this is difficultmay find that this is difficult
for you, especially if youfor you, especially if you
work at a computer or sitwork at a computer or sit
for long periods to read.for long periods to read.
It all adds upIt all adds up
 Although good posture should beAlthough good posture should be
natural, you may feel wooden or stiffnatural, you may feel wooden or stiff
at first if you've forgotten what goodat first if you've forgotten what good
posture feels like. The key is toposture feels like. The key is to
practice good posture all the time.practice good posture all the time.
You can make improvements at anyYou can make improvements at any
age. Stretching and coreage. Stretching and core
strengthening exercises may helpstrengthening exercises may help
because they strengthen the lowerbecause they strengthen the lower
abdominal muscles that supportabdominal muscles that support
your spine. Talk with your doctor ifyour spine. Talk with your doctor if
you're concerned about youryou're concerned about your
posture or if you need help decidingposture or if you need help deciding
if certain exercises are right for you.if certain exercises are right for you.
Proper lifting techniquesProper lifting techniques
 Start in the best positionStart in the best position
 Before you lift a load, thinkBefore you lift a load, think
through your task. Decidethrough your task. Decide
where you'll place the loadwhere you'll place the load
and how you'll get it there. Ifand how you'll get it there. If
an object is too heavy, getan object is too heavy, get
some help.some help.
 When you're lifting an objectWhen you're lifting an object
from the floor, don't lift from afrom the floor, don't lift from a
standing position with yourstanding position with your
waist bent and your legswaist bent and your legs
locked. Instead, plant yourlocked. Instead, plant your
feet firmly on the ground,feet firmly on the ground,
standing as close to the loadstanding as close to the load
as possible. Then kneel down,as possible. Then kneel down,
resting one knee on theresting one knee on the
ground. Lift the object fromground. Lift the object from
between your legs and hold itbetween your legs and hold it
close to your body.close to your body.
Let your leg muscles do the workLet your leg muscles do the work
 Your leg muscles areYour leg muscles are
some of the strongestsome of the strongest
muscles in your body.muscles in your body.
Use them to lift theUse them to lift the
load. Keep your backload. Keep your back
as upright as possible.as upright as possible.
As you lift, tighten yourAs you lift, tighten your
abdominal muscles.abdominal muscles.
This helps supportThis helps support
your spine.your spine.
Carry the load close to your bodyCarry the load close to your body
 When you're standing andWhen you're standing and
ready to move, hold theready to move, hold the
load close to your body toload close to your body to
lessen the strain on yourlessen the strain on your
lower back. Avoid turninglower back. Avoid turning
or twisting while holdingor twisting while holding
the load. Turn by pivotingthe load. Turn by pivoting
your feet, not your back.your feet, not your back.
Avoid lifting heavy loadsAvoid lifting heavy loads
above your waist.above your waist.
Squatting instead of kneelingSquatting instead of kneeling
 You can follow the same procedureYou can follow the same procedure
from a squatting position instead offrom a squatting position instead of
a kneeling position, if that's morea kneeling position, if that's more
comfortable for you. Stand as closecomfortable for you. Stand as close
to the load as possible. Whileto the load as possible. While
maintaining your balance, squatmaintaining your balance, squat
down, with one foot slightly in frontdown, with one foot slightly in front
of the other. Lift the object fromof the other. Lift the object from
between your legs, holding it closebetween your legs, holding it close
to your body. Then stand up usingto your body. Then stand up using
your leg muscles to lift the load.your leg muscles to lift the load.
Tighten the abdominal muscles thatTighten the abdominal muscles that
support your spine, keeping yoursupport your spine, keeping your
back as straight as possible as youback as straight as possible as you
rise from the floor.rise from the floor.
Lifting items out of the trunk ofLifting items out of the trunk of
your caryour car
 When you're lifting an item outWhen you're lifting an item out
of your trunk, place one of yourof your trunk, place one of your
knees on your car's bumper forknees on your car's bumper for
balance and support. Lift objectsbalance and support. Lift objects
in two steps. First, lift the objectin two steps. First, lift the object
to rest on the car frame. Thento rest on the car frame. Then
lift it from the car frame to carrylift it from the car frame to carry
it. Keep your back as straight asit. Keep your back as straight as
possible as you lift the load.possible as you lift the load.
 Consider storing items in theConsider storing items in the
trunk close to the bumper. It willtrunk close to the bumper. It will
be easier for you to lift them outbe easier for you to lift them out
correctly.correctly.
Your daily back routineYour daily back routine
 Keep your back strongKeep your back strong
 You can stretch and strengthenYou can stretch and strengthen
your back and supportingyour back and supporting
muscles with the basicmuscles with the basic
exercises shown here. Try toexercises shown here. Try to
work at least 15 minutes of backwork at least 15 minutes of back
exercises into your daily routine.exercises into your daily routine.
Remember to breathe fully andRemember to breathe fully and
deeply as you do thesedeeply as you do these
exercises. If you've hurt yourexercises. If you've hurt your
back before, or if you have otherback before, or if you have other
health problems such ashealth problems such as
osteoporosis, talk to your doctorosteoporosis, talk to your doctor
before you get started.before you get started.
Knee-to-chest stretchKnee-to-chest stretch
 Lie on your back on a firmLie on your back on a firm
surface with your kneessurface with your knees
bent and feet flat. Pull yourbent and feet flat. Pull your
left knee toward your chestleft knee toward your chest
with both hands. Hold forwith both hands. Hold for
15 to 30 seconds. Return15 to 30 seconds. Return
to the starting position.to the starting position.
Repeat with opposite leg.Repeat with opposite leg.
Repeat with each leg threeRepeat with each leg three
or four times.or four times.
Cat stretchCat stretch
 Get down on your handsGet down on your hands
and knees. Slowly let yourand knees. Slowly let your
back and abdomen sagback and abdomen sag
toward the floor (A).toward the floor (A).
 Slowly arch your backSlowly arch your back
away from the floor. Pullaway from the floor. Pull
your abdomen up to theyour abdomen up to the
ceiling (B). Repeat severalceiling (B). Repeat several
times.times.
Half sit-upHalf sit-up
 Lie on your back on a firmLie on your back on a firm
surface with your kneessurface with your knees
bent and feet flat. Withbent and feet flat. With
your arms outstretched,your arms outstretched,
reach toward your kneesreach toward your knees
until your shoulder bladesuntil your shoulder blades
no longer touch theno longer touch the
ground. Don't grab yourground. Don't grab your
knees. Hold for a fewknees. Hold for a few
seconds and slowly returnseconds and slowly return
to the starting position.to the starting position.
Repeat several times.Repeat several times.
Leg lifts with bent kneeLeg lifts with bent knee
 Lie on your stomach on aLie on your stomach on a
firm surface with your headfirm surface with your head
turned to the side. Bendturned to the side. Bend
one knee back. Keepingone knee back. Keeping
your knee bent, raise thatyour knee bent, raise that
leg slightly off the surfaceleg slightly off the surface
and hold for about fiveand hold for about five
seconds. Return to theseconds. Return to the
starting position. Repeatstarting position. Repeat
several times. Changeseveral times. Change
legs and repeat thelegs and repeat the
exercise.exercise.
Leg lifts with leg straightLeg lifts with leg straight
 Lie on your stomachLie on your stomach
on a firm surface withon a firm surface with
your head turned toyour head turned to
the side. Raise one legthe side. Raise one leg
slightly off the surfaceslightly off the surface
and hold for about fiveand hold for about five
seconds. Return to theseconds. Return to the
starting position.starting position.
Repeat several times.Repeat several times.
Change legs andChange legs and
repeat the exercise.repeat the exercise.
Chair stretchChair stretch
 Sit in a chair. Slowly bendSit in a chair. Slowly bend
forward toward the floorforward toward the floor
until you feel a mild stretchuntil you feel a mild stretch
in your back. Hold for 15 toin your back. Hold for 15 to
30 seconds. Return to the30 seconds. Return to the
starting position. Repeatstarting position. Repeat
three or four times. Don'tthree or four times. Don't
do this exercise if youdo this exercise if you
have osteoporosis.have osteoporosis.
Shoulder blade squeezeShoulder blade squeeze
 Sit upright in a chair. KeepSit upright in a chair. Keep
your chin tucked in andyour chin tucked in and
your shoulders down. Pullyour shoulders down. Pull
your shoulder bladesyour shoulder blades
together, straighten yourtogether, straighten your
upper back and hold yourupper back and hold your
chest high. Hold a fewchest high. Hold a few
seconds. Return to theseconds. Return to the
starting position. Repeatstarting position. Repeat
several times.several times.
Mediplex ArthritisMediplex Arthritis
Reversal/Prevention ProgramReversal/Prevention Program
 Integrated Program (Yoga, Physiotherapy,Integrated Program (Yoga, Physiotherapy,
Life Style Modifications and Super SpecialtyLife Style Modifications and Super Specialty
Homeopathic Medicines)Homeopathic Medicines)
 Scientific program (Formulated after 5Scientific program (Formulated after 5
years of Clinical & Research work).years of Clinical & Research work).
 Over 3000 clients.Over 3000 clients.
 Success Rate is over 90 %.Success Rate is over 90 %.
 On an average in 8 days relief starts inOn an average in 8 days relief starts in
patients.patients.
Features…Features…
 Managed by highly qualified andManaged by highly qualified and
experienced team of doctors,experienced team of doctors,
Physiotherapists, Yoga experts andPhysiotherapists, Yoga experts and
dieticians.dieticians.
 Clients from NIIT, GE, GENPACT, WIPROClients from NIIT, GE, GENPACT, WIPRO
etcetc
ComponentsComponents
MPX Arthritis Reversal
/ Prevention Program
Power Yoga
Super Specialty
Homeopathic
medicines
Advanced Physiotherapy
Life Style Modifications
ProcessProcess
Evaluation and
Assessment
Arthritis
started
Reversal
Program
Prevention
Program
No
Yes
Reversal Program
Super Specialty
Homeopathic
Consultation
and Medicine
Advanced
Physiotherapy
Sittings
Specially Designed
Yoga Asans
• Diet
• Exercise
• Positive Thinking
• Meditation
Life Style
Modifications
Prevention Program
Super Specialty
Homeopathic
Consultation
and
Preventive Medicine
Preventive
Physiotherapy
Sittings
Preventive
Yoga Asans
• Diet
• Exercise
• Positive Thinking
• Meditation
Life Style
Modifications
Where do you want to see yourself ?Where do you want to see yourself ?
 Mr. Sharma or Mr. Gupta !Mr. Sharma or Mr. Gupta !
 Choice is yours !Choice is yours !
Thank you !Thank you !
 Mr. Ashfaq, Welfare Officer, NICMr. Ashfaq, Welfare Officer, NIC
 NIC staffNIC staff
 Mediplex TeamMediplex Team
 mediplex@gmail.com for booklet on “How to use computermediplex@gmail.com for booklet on “How to use computer
for preventing backache ? “for preventing backache ? “
 www.mediplex.inwww.mediplex.in
 P-15-A; Jangpura Extn New Delhi 14P-15-A; Jangpura Extn New Delhi 14
 9313520295;9313520295;
 TreatmentTreatment
 Most back pain gets better with a few weeks of home treatment and careful attention. AMost back pain gets better with a few weeks of home treatment and careful attention. A
regular schedule of pain relievers and hot or cold therapy may be all that you need toregular schedule of pain relievers and hot or cold therapy may be all that you need to
improve your pain. A short period of bed rest is okay, but more than a couple of daysimprove your pain. A short period of bed rest is okay, but more than a couple of days
actually does more harm than good. If home treatments aren't working, your doctor mayactually does more harm than good. If home treatments aren't working, your doctor may
suggest stronger medications or other therapy.suggest stronger medications or other therapy.
 Medications and therapiesMedications and therapies
 Physical therapy and exercise.Physical therapy and exercise. A physical therapist can apply a variety of treatments,A physical therapist can apply a variety of treatments,
such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, tosuch as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, to
your back muscles and soft tissues to reduce pain. As pain improves, the therapist canyour back muscles and soft tissues to reduce pain. As pain improves, the therapist can
teach you specific exercises to increase your flexibility, strengthen your back andteach you specific exercises to increase your flexibility, strengthen your back and
abdominal muscles, and improve your posture. Regular use of these techniques will helpabdominal muscles, and improve your posture. Regular use of these techniques will help
pain from recurringpain from recurring
 e techniques will help pain from recurring.e techniques will help pain from recurring.
 Prescription medications.Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatoryYour doctor may prescribe nonsteroidal anti-inflammatory
drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain thatdrugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that
doesn't get better with over-the-counter pain relievers.doesn't get better with over-the-counter pain relievers.
 Cortisone injections.Cortisone injections. If pain isn't relieved using other measures and you have painIf pain isn't relieved using other measures and you have pain
radiating down your leg from a "pinched nerve," your doctor may prescribe cortisoneradiating down your leg from a "pinched nerve," your doctor may prescribe cortisone
injections — an anti-inflammatory medication — into the space around your spinal cordinjections — an anti-inflammatory medication — into the space around your spinal cord
(epidural space). A cortisone injection helps decrease inflammation around the nerve(epidural space). A cortisone injection helps decrease inflammation around the nerve
roots.roots.
 Electrical stimulation.Electrical stimulation. A procedure called transcutaneous electrical nerve stimulationA procedure called transcutaneous electrical nerve stimulation
(TENS) uses a unit that sends a weak electrical current through specific points on the(TENS) uses a unit that sends a weak electrical current through specific points on the
BackacheBackache
 IntroductionIntroduction
 The back is a well-designed structure madeThe back is a well-designed structure made
up of bone, muscles, nerves and other softup of bone, muscles, nerves and other soft
tissues. You rely on your back to be thetissues. You rely on your back to be the
workhorse of the body — its function isworkhorse of the body — its function is
essential for nearly every move you make.essential for nearly every move you make.
Because of this, the back can be particularlyBecause of this, the back can be particularly
vulnerable to injury and back pain can bevulnerable to injury and back pain can be
disabling.disabling.
 Four out of five adults have at least one boutFour out of five adults have at least one bout
of back pain sometime during life. In fact,of back pain sometime during life. In fact,
back pain is one of the most common reasonsback pain is one of the most common reasons
for health care visits and missed work.for health care visits and missed work.
 On the bright side, you can prevent most backOn the bright side, you can prevent most back
pain. Simple home treatment and proper bodypain. Simple home treatment and proper body
mechanics will often heal your back within amechanics will often heal your back within a
few weeks and keep it functional for the longfew weeks and keep it functional for the long
haul. Surgery is rarely needed to treat backhaul. Surgery is rarely needed to treat back
pain.pain.
 the buttocks and back of the leg.the buttocks and back of the leg.
 Spinal stenosis.Spinal stenosis. This condition occurs when the space around the spinal cord and nerve rootsThis condition occurs when the space around the spinal cord and nerve roots
narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.
 Spondylosis.Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerativeSpondylosis is a type of arthritis affecting the spine. It is due to the degenerative
changes in the spine that often come with aging.changes in the spine that often come with aging.
 Spondylolisthesis.Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward overThis condition occurs when one vertebra in the spinal column slips forward over
another.another.
 These rare but far more serious causes of back pain also have specific treatment related to theThese rare but far more serious causes of back pain also have specific treatment related to the
underlying cause.underlying cause.
 Cauda equina syndrome.Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs,This is a serious neurological problem causing weakness in the legs,
numbness in the "saddle" or groin area, and loss of bowel or bladder control.numbness in the "saddle" or groin area, and loss of bowel or bladder control.
 Cancer in the spine.Cancer in the spine. A tumor on the spine can press on a nerve causing back pain.A tumor on the spine can press on a nerve causing back pain.
 Infection of the spine.Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could beIf a fever and a tender, warm area accompany back pain, the cause could be
an infection.an infection.
 Injury.Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain.Damage to the bones, ligaments, or muscles of the back can cause severe pain.
 Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic backRepeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back
pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can bepain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be
difficult to treat.difficult to treat.
 Screening and diagnosisScreening and diagnosis
 Diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you doDiagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you do
see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand,see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand,
walk and lift your legs. He or she may also test your reflexes with a rubber reflex- hammer. Thesewalk and lift your legs. He or she may also test your reflexes with a rubber reflex- hammer. These
assessments help determine where the pain is, what degree of motion you have without pain andassessments help determine where the pain is, what degree of motion you have without pain and
whether you have muscle spasms. They will also help rule out more serious causes of back pain.whether you have muscle spasms. They will also help rule out more serious causes of back pain.
 If there is reason to suspect that you have a tumor, fracture, infection or other condition that may beIf there is reason to suspect that you have a tumor, fracture, infection or other condition that may be
causing your back pain, your doctor may order one or more tests:causing your back pain, your doctor may order one or more tests:
 X-ray.X-ray. These images show the alignment of your bones and whether you have degenerative jointThese images show the alignment of your bones and whether you have degenerative joint
disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles,disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles,
fibrous tissues (fascia), nerves or disks.fibrous tissues (fascia), nerves or disks.
 Magnetic resonance imaging (MRI) or computerized tomography (CT) scans.Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans canThese scans can
generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons,generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons,
nerves, ligaments and blood vessels.nerves, ligaments and blood vessels.
 Bone scan.Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compressionIn rare cases, your doctor may use a bone scan to look for bone tumors or compression
fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of afractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a
radioactive substance (tracer) into one of your veins. The substance collects in your bones andradioactive substance (tracer) into one of your veins. The substance collects in your bones and
allows your doctor to detect bone problems using a special camera.allows your doctor to detect bone problems using a special camera.
 Nerve studies (electromyography, or EMG).Nerve studies (electromyography, or EMG). This test measures the electrical impulses producedThis test measures the electrical impulses produced
by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways canby the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can
confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinalconfirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal
stenosis).stenosis).
 TreatmentTreatment
 Most back pain gets better with a few weeks of home treatment and careful attention. AMost back pain gets better with a few weeks of home treatment and careful attention. A
regular schedule of pain relievers and hot or cold therapy may be all that you need toregular schedule of pain relievers and hot or cold therapy may be all that you need to
improve your pain. A short period of bed rest is okay, but more than a couple of daysimprove your pain. A short period of bed rest is okay, but more than a couple of days
actually does more harm than good. If home treatments aren't working, your doctor mayactually does more harm than good. If home treatments aren't working, your doctor may
suggest stronger medications or other therapy.suggest stronger medications or other therapy.
 Medications and therapiesMedications and therapies
 Physical therapy and exercise.Physical therapy and exercise. A physical therapist can apply a variety of treatments,A physical therapist can apply a variety of treatments,
such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, tosuch as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, to
your back muscles and soft tissues to reduce pain. As pain improves, the therapist canyour back muscles and soft tissues to reduce pain. As pain improves, the therapist can
teach you specific exercises to increase your flexibility, strengthen your back andteach you specific exercises to increase your flexibility, strengthen your back and
abdominal muscles, and improve your posture. Regular use of these techniques will helpabdominal muscles, and improve your posture. Regular use of these techniques will help
pain from recurringpain from recurring
 e techniques will help pain from recurring.e techniques will help pain from recurring.
 Prescription medications.Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatoryYour doctor may prescribe nonsteroidal anti-inflammatory
drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain thatdrugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that
doesn't get better with over-the-counter pain relievers.doesn't get better with over-the-counter pain relievers.
 Cortisone injections.Cortisone injections. If pain isn't relieved using other measures and you have painIf pain isn't relieved using other measures and you have pain
radiating down your leg from a "pinched nerve," your doctor may prescribe cortisoneradiating down your leg from a "pinched nerve," your doctor may prescribe cortisone
injections — an anti-inflammatory medication — into the space around your spinal cordinjections — an anti-inflammatory medication — into the space around your spinal cord
(epidural space). A cortisone injection helps decrease inflammation around the nerve(epidural space). A cortisone injection helps decrease inflammation around the nerve
roots.roots.
 Electrical stimulation.Electrical stimulation. A procedure called transcutaneous electrical nerve stimulationA procedure called transcutaneous electrical nerve stimulation
(TENS) uses a unit that sends a weak electrical current through specific points on the(TENS) uses a unit that sends a weak electrical current through specific points on the
 How your back is builtHow your back is built
 Your backbone (vertebral column) isYour backbone (vertebral column) is
actually a stack of more than 30 bonesactually a stack of more than 30 bones
called vertebrae. Together they create acalled vertebrae. Together they create a
bony canal that surrounds and protectsbony canal that surrounds and protects
your spinal cord. Small nerves enter andyour spinal cord. Small nerves enter and
exit the spinal cord through spaces inexit the spinal cord through spaces in
your vertebrae.your vertebrae.
 The vertebrae are held together byThe vertebrae are held together by
muscles, tendons and ligaments.muscles, tendons and ligaments.
Between the vertebrae are intervertebralBetween the vertebrae are intervertebral
disks, which act as "shock absorbers" bydisks, which act as "shock absorbers" by
preventing the vertebrae from hitting onepreventing the vertebrae from hitting one
another when you walk, run or jump.another when you walk, run or jump.
The intervertebral disks also allow yourThe intervertebral disks also allow your
spine to twist, bend and extend.spine to twist, bend and extend.
 The lower back — which carries most ofThe lower back — which carries most of
your weight — is the site of most backyour weight — is the site of most back
pain. Here are some of the mostpain. Here are some of the most
commoncommon
 Strains, sprains and spasmsStrains, sprains and spasms
 The most common cause of back pain isThe most common cause of back pain is
an injury to a muscle (strain) or aan injury to a muscle (strain) or a
ligament (sprain). Strains and sprainsligament (sprain). Strains and sprains
can occur for many reasons, includingcan occur for many reasons, including
improper lifting, excess body weight andimproper lifting, excess body weight and
poor posture. Strains and sprains canpoor posture. Strains and sprains can
also develop from hauling around aalso develop from hauling around a
heavy handbag or sleeping at anheavy handbag or sleeping at an
awkward angle. As a pivot point forawkward angle. As a pivot point for
turning at the waist, the lower back isturning at the waist, the lower back is
especially vulnerable to muscle strainsespecially vulnerable to muscle strains
(shown here).(shown here).
 Sometimes a strain or sprain causesSometimes a strain or sprain causes
immediate back pain. In other cases,immediate back pain. In other cases,
soreness and stiffness come later. Ansoreness and stiffness come later. An
injured muscle may also "knot up." Thisinjured muscle may also "knot up." This
muscle spasm is your body's way ofmuscle spasm is your body's way of
immobilizing the affected area to preventimmobilizing the affected area to prevent
further damage.further damage.
Joint pains 1 Treatment at Mediplex

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Joint pains 1 Treatment at Mediplex

  • 1. Joint PainsJoint Pains Mediplex Health CareMediplex Health Care
  • 2. The Story of …..The Story of …..  Alok Sharma & Rahul Gupta….Alok Sharma & Rahul Gupta….  Class matesClass mates  Age: early 20’s :Bright ComputerAge: early 20’s :Bright Computer Professionals.Professionals.  Recruited in Good Software company.Recruited in Good Software company.  Long stressful working hours.Long stressful working hours.  Sometimes working late in nights.Sometimes working late in nights.
  • 3. Story of Alok…Story of Alok…  He never had time for himself or he neverHe never had time for himself or he never tried to find some time.tried to find some time.  He was advised to do some exercise, relaxHe was advised to do some exercise, relax and adopt right posture while working.and adopt right posture while working.  He is always saying “ Once I complete thisHe is always saying “ Once I complete this project then only I will start taking care ofproject then only I will start taking care of myself”.myself”.  Now he is in late 20’s …married ….Now he is in late 20’s …married ….
  • 4. The story goes on …The story goes on …  Now he is getting tired easily, he has put onNow he is getting tired easily, he has put on weight and becoming irritated easily. He hasweight and becoming irritated easily. He has started experiencing pain & stiffness instarted experiencing pain & stiffness in neck.neck.  He is advised that its high time …..take careHe is advised that its high time …..take care of body…ready made excuse ….No time.of body…ready made excuse ….No time.
  • 5. No time ?No time ?  Time to think !Time to think !  Drive your car to different places andDrive your car to different places and important meetings. Don’t get it refueled asimportant meetings. Don’t get it refueled as there is no time to do that ……there is no time to do that ……  What is going to happen ?What is going to happen ?  You are ultimately going to stuck in theYou are ultimately going to stuck in the middle of road ….loosing all your clients …..middle of road ….loosing all your clients …..  What about your body ?What about your body ?
  • 6. Now his body crashed !Now his body crashed !  He is in early 30’sHe is in early 30’s  Suffering from cervical spondylosis….Suffering from cervical spondylosis….  Can’t even work on computers for 15Can’t even work on computers for 15 minutes.minutes.  Feels giddy whenever he turns his head.Feels giddy whenever he turns his head.  Lost strength in hands & can’t lift even 1-2Lost strength in hands & can’t lift even 1-2 Kg of weights.Kg of weights.
  • 7. Story still continues !Story still continues !  Bed ridden !Bed ridden !  On sick leaves !On sick leaves !  Promotions are stopped & job is at stake !Promotions are stopped & job is at stake !  Rising medical bills !Rising medical bills !  Financial insecurity as he is sole breadFinancial insecurity as he is sole bread winner !winner !  Emotional and social problem !Emotional and social problem !
  • 8. Whereas Mr. Gupta !Whereas Mr. Gupta !  Mr. Gupta …his class mate, has beenMr. Gupta …his class mate, has been promoted to senior position….promoted to senior position….  Energetic and enthusiastic.Energetic and enthusiastic.  Challenging assignments.Challenging assignments.  Financially very well off.Financially very well off.  Almost nil medical bills.Almost nil medical bills.  Enjoys vacations, work and family life.Enjoys vacations, work and family life.
  • 9. AnalysisAnalysis  You have to invest time on yourself.You have to invest time on yourself.  Time or money are just excuses. You haveTime or money are just excuses. You have to steal 40 minutes per day, 3-4 times in ato steal 40 minutes per day, 3-4 times in a week.week.  Healthy body and mind is just what countsHealthy body and mind is just what counts in long run !in long run !  What will you do with rest of things and ifWhat will you do with rest of things and if you are not well !you are not well !
  • 10. DefinitionDefinition  Pain affecting joints !Pain affecting joints !  Joint pain can be caused by many types ofJoint pain can be caused by many types of injuries or conditions. No matter whatinjuries or conditions. No matter what causes it, joint pain can be verycauses it, joint pain can be very bothersome.bothersome.
  • 11. Lets understand about jointsLets understand about joints  Skeleton SystemSkeleton System  JointsJoints  Parts of jointsParts of joints
  • 12. Lets understand about joints !Lets understand about joints !
  • 13. Causes of Joint painsCauses of Joint pains Joint injury : Strain, Sprain & previous joint injury Infections - many infections cause aching joints and aching muscles Viral infection, Common cold, Flu etc Arthritis – Osteoarthritis, Rheumatoid arthritis , Psoriatic arthritis , & Gout Joint infection : Tendinitis, Bursitis etc
  • 14. Common Joint ProblemsCommon Joint Problems  Osteoarthritis (OA)Osteoarthritis (OA)  Rheumatoid ArthritisRheumatoid Arthritis  Based Upon LocationsBased Upon Locations  Lumbar SpondylosisLumbar Spondylosis  Cervical SpondylosisCervical Spondylosis
  • 15. OAOA  Osteoarthritis is the most common form of arthritis.Osteoarthritis is the most common form of arthritis.  This is the form that usually comes with age andThis is the form that usually comes with age and most often affects the fingers, knees, and hips.most often affects the fingers, knees, and hips.  Sometimes osteoarthritis follows an injury to aSometimes osteoarthritis follows an injury to a joint. For example, a young person might hurt hisjoint. For example, a young person might hurt his knee badly playing cricket. Then, years after theknee badly playing cricket. Then, years after the knee has apparently healed, he might get arthritisknee has apparently healed, he might get arthritis in his knee joint.in his knee joint.
  • 16. What Causes OA ?What Causes OA ?  Primary osteoarthritis is mostly related toPrimary osteoarthritis is mostly related to agingaging..  Protein makeup of cartilage degenerates.Protein makeup of cartilage degenerates.  Repetitive use of the joints over the yearsRepetitive use of the joints over the years irritates and inflames the cartilage, causingirritates and inflames the cartilage, causing joint pain and swelling.joint pain and swelling.
  • 17. PathologyPathology  Eventually, cartilage begins to degenerateEventually, cartilage begins to degenerate by flaking or forming tiny crevasses.by flaking or forming tiny crevasses.  Loss of cartilage cushion causes frictionLoss of cartilage cushion causes friction between the bones, leading to pain andbetween the bones, leading to pain and limitation of joint mobility.limitation of joint mobility.  Osteoarthritis occasionally can be found inOsteoarthritis occasionally can be found in multiple members of the same family,multiple members of the same family, implying animplying an heredityheredity (genetic) basis for this(genetic) basis for this condition.condition.
  • 18. PathologyPathology  InflammationInflammation of the cartilage can alsoof the cartilage can also stimulate new bone outgrowths (spurs) tostimulate new bone outgrowths (spurs) to form around the joints.form around the joints.
  • 19. Comparison of Normal Vs DiseasedComparison of Normal Vs Diseased JointsJoints
  • 20. Secondary osteoarthritisSecondary osteoarthritis  Secondary osteoarthritis is caused bySecondary osteoarthritis is caused by another disease or condition.another disease or condition.  Conditions that can lead to secondaryConditions that can lead to secondary osteoarthritis includeosteoarthritis include obesityobesity, repeated, repeated traumatrauma oror surgerysurgery to the joint structures,to the joint structures, abnormal joints at birth (congenitalabnormal joints at birth (congenital abnormalities),abnormalities), goutgout,, diabetesdiabetes and otherand other hormone disorders.hormone disorders.
  • 21. Risk FactorsRisk Factors  ObesityObesity causes osteoarthritis by increasingcauses osteoarthritis by increasing the mechanicalthe mechanical stressstress on the cartilage.on the cartilage.  In fact, next to aging, obesity is the mostIn fact, next to aging, obesity is the most powerfulpowerful risk factorrisk factor for osteoarthritis of thefor osteoarthritis of the knees.knees.  The early development of osteoarthritis ofThe early development of osteoarthritis of the knees among weight lifters is believed tothe knees among weight lifters is believed to be in part due to their high body weight.be in part due to their high body weight.
  • 22. Risk FactorsRisk Factors  Crystal deposits in the cartilage can causeCrystal deposits in the cartilage can cause cartilage degeneration, and osteoarthritis.cartilage degeneration, and osteoarthritis. Uric acidUric acid crystals cause arthritis in gout,crystals cause arthritis in gout, while calcium pyrophosphate crystals causewhile calcium pyrophosphate crystals cause arthritis in pseudogout.arthritis in pseudogout.  Hormone disturbances, such as diabetesHormone disturbances, such as diabetes and growth hormone disorders, are alsoand growth hormone disorders, are also associated with early cartilage wear andassociated with early cartilage wear and secondary osteoarthritis.secondary osteoarthritis.
  • 23. SymptomsSymptoms  Joint pain is usually worse later in the day. ThereJoint pain is usually worse later in the day. There can be swelling, warmth, and creaking of thecan be swelling, warmth, and creaking of the affected joints.affected joints.  Pain and stiffness of the joints can also occurPain and stiffness of the joints can also occur after long periods of inactivity, for example, sittingafter long periods of inactivity, for example, sitting in a theater.in a theater.  In severe osteoarthritis, complete loss of cartilageIn severe osteoarthritis, complete loss of cartilage cushion causes friction between bones, causingcushion causes friction between bones, causing pain at rest or pain with limited motion.pain at rest or pain with limited motion.
  • 24. DiagnosisDiagnosis  X-rays : loss of joint cartilage, narrowing of the joint spaceX-rays : loss of joint cartilage, narrowing of the joint space between adjacent bones, and bone spur formation.between adjacent bones, and bone spur formation.  Arthrocentesis often performed in the doctor's office: aArthrocentesis often performed in the doctor's office: a sterile needle is used to remove joint fluid for analysis.sterile needle is used to remove joint fluid for analysis. Joint fluid analysis is useful in excluding gout, infection,Joint fluid analysis is useful in excluding gout, infection, and other causes of arthritis.and other causes of arthritis.  Arthroscopy is a surgical technique whereby a doctorArthroscopy is a surgical technique whereby a doctor inserts a viewing tube into the joint space. Abnormalities ofinserts a viewing tube into the joint space. Abnormalities of and damage to the cartilage and ligaments can beand damage to the cartilage and ligaments can be detected and sometimes repaired through the arthroscope.detected and sometimes repaired through the arthroscope.
  • 25. Cervical spondylosisCervical spondylosis  Cervical spondylosis is a chronicCervical spondylosis is a chronic degeneration of the bones (vertebrae) of thedegeneration of the bones (vertebrae) of the neck (cervical spine) and the cushionsneck (cervical spine) and the cushions between the vertebrae (disks).between the vertebrae (disks).
  • 26. Cause (Same as OA)Cause (Same as OA)  As you age, the disks of your spine become drier and lessAs you age, the disks of your spine become drier and less elastic. Degeneration can cause some of the disks to bulgeelastic. Degeneration can cause some of the disks to bulge and, in some cases, cause the central cartilage of the disksand, in some cases, cause the central cartilage of the disks to protrude through a crack in the ring that surrounds theto protrude through a crack in the ring that surrounds the disk (herniate). The surrounding ligaments become lessdisk (herniate). The surrounding ligaments become less flexible, and the vertebrae may develop bone spurs.flexible, and the vertebrae may develop bone spurs.  These degenerative changes may be a result of wear andThese degenerative changes may be a result of wear and tear throughout your life. An earlier injury to your neck maytear throughout your life. An earlier injury to your neck may predispose you to this degeneration. By age 60, mostpredispose you to this degeneration. By age 60, most people will show signs of cervical spondylosis on X-ray,people will show signs of cervical spondylosis on X-ray, although they may not have signs or symptoms.although they may not have signs or symptoms.
  • 27. Cause (Same as OA)Cause (Same as OA)  As you age, the disks ofAs you age, the disks of your spine become drieryour spine become drier and less elastic.and less elastic. Degeneration can causeDegeneration can cause some of the disks to bulgesome of the disks to bulge and, in some cases, causeand, in some cases, cause the central cartilage of thethe central cartilage of the disks to protrude through adisks to protrude through a crack in the ring thatcrack in the ring that surrounds the disksurrounds the disk (herniate). The(herniate). The surrounding ligamentssurrounding ligaments become less flexible, andbecome less flexible, and the vertebrae may developthe vertebrae may develop bone spurs.bone spurs.
  • 28. Signs and symptomsSigns and symptoms  Neck pain and stiffness that gets progressivelyNeck pain and stiffness that gets progressively worseworse  Numbness or weakness in the arms, hands andNumbness or weakness in the arms, hands and fingersfingers  Headaches that radiate to the back of the headHeadaches that radiate to the back of the head  Loss of balanceLoss of balance  Numbness or weakness in the legs, if the spinalNumbness or weakness in the legs, if the spinal cord is compressedcord is compressed  Loss of bladder or bowel control, if the spinal cordLoss of bladder or bowel control, if the spinal cord is compressedis compressed
  • 29. BackacheBackache IntroductionIntroduction  The back is a well-designed structureThe back is a well-designed structure made up of bone, muscles, nerves andmade up of bone, muscles, nerves and other soft tissues. You rely on your backother soft tissues. You rely on your back to be theto be the workhorseworkhorse of the body — itsof the body — its function is essential for nearly everyfunction is essential for nearly every move you make. Because of this, themove you make. Because of this, the back can be particularly vulnerable toback can be particularly vulnerable to injury and back pain can be disabling.injury and back pain can be disabling.  Four out of five adults have at least oneFour out of five adults have at least one bout of back pain sometime during life.bout of back pain sometime during life. In fact, back pain is one of the mostIn fact, back pain is one of the most common reasons for health care visitscommon reasons for health care visits and missed work.and missed work.  On the bright side, you can prevent mostOn the bright side, you can prevent most back pain. Simple home treatment andback pain. Simple home treatment and proper body mechanics will often healproper body mechanics will often heal your back within a few weeks and keepyour back within a few weeks and keep it functional for the long haul.it functional for the long haul.
  • 30. CausesCauses  Spondylosis.Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerativeSpondylosis is a type of arthritis affecting the spine. It is due to the degenerative changes in the spine that often come with aging.changes in the spine that often come with aging. Spinal stenosis.Spinal stenosis. This condition occurs when the space around the spinal cord and nerve rootsThis condition occurs when the space around the spinal cord and nerve roots narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.  Spondylolisthesis.Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward overThis condition occurs when one vertebra in the spinal column slips forward over another.another.  These rare but far more serious causes of back pain also have specific treatment related to theThese rare but far more serious causes of back pain also have specific treatment related to the underlying cause.underlying cause.  Cauda equina syndrome.Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs,This is a serious neurological problem causing weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.numbness in the "saddle" or groin area, and loss of bowel or bladder control.  Cancer in the spine.Cancer in the spine. A tumor on the spine can press on a nerve causing back pain.A tumor on the spine can press on a nerve causing back pain.  Infection of the spine.Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could beIf a fever and a tender, warm area accompany back pain, the cause could be an infection.an infection.  Injury.Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain.Damage to the bones, ligaments, or muscles of the back can cause severe pain.  Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic backRepeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can bepain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be difficult to treat.difficult to treat.
  • 31. Screening and diagnosisScreening and diagnosis  X-ray.X-ray. These images show the alignment of your bones and whether you haveThese images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly showdegenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves orproblems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks.disks.  Magnetic resonance imaging (MRI) or computerized tomography (CT)Magnetic resonance imaging (MRI) or computerized tomography (CT) scans.scans. These scans can generate images that may reveal herniated disks orThese scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and bloodproblems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.vessels.  Bone scan.Bone scan. In rare cases, your doctor may use a bone scan to look for boneIn rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure,tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer)you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones and allows yourinto one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.doctor to detect bone problems using a special camera.  Nerve studies (electromyography, or EMG).Nerve studies (electromyography, or EMG). This test measures theThis test measures the electrical impulses produced by the nerves and the responses of your muscles.electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compressionStudies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
  • 32. Role of PhysiotherapyRole of Physiotherapy Dr. Tarique AzamDr. Tarique Azam Consultant Physiotherapist, MIAPConsultant Physiotherapist, MIAP Mediplex PhysiotherapyMediplex Physiotherapy
  • 33. Physiotherapy RolePhysiotherapy Role  Physiotherapy is a non –pharmacologicalPhysiotherapy is a non –pharmacological ,Exercise oriented,natural based approach,Exercise oriented,natural based approach which has assumed important role inwhich has assumed important role in management of joints and muscularmanagement of joints and muscular problems.problems. – Relieves pains & stiffness.Relieves pains & stiffness. – Increases strength of muscles.Increases strength of muscles. – Restores movements and function.Restores movements and function.  _ prevent joint problems._ prevent joint problems.
  • 34. Modalities UsedModalities Used  A. ElectrotherapyA. Electrotherapy – LaserLaser – Long & Micro WaveLong & Micro Wave Short Wave Diathermy (SWD)Short Wave Diathermy (SWD) – Interferential Therapy (IFT)Interferential Therapy (IFT) – Trans CutaneousTrans Cutaneous Electrical Stimulations (TENS)Electrical Stimulations (TENS) – Ultrasound, Muscle &Ultrasound, Muscle & Nerve Stimulation,Nerve Stimulation, – Wax and Hot PacksWax and Hot Packs
  • 35. Exercise TherapyExercise Therapy  Manual Manipulations:Manual Manipulations: Mulligan & Mackenzee TechniquesMulligan & Mackenzee Techniques  Shoulder wheelShoulder wheel  TractionTraction Quadricep tableQuadricep table etcetc
  • 36. Importance of Good PostureImportance of Good Posture  Why is good posture important?Why is good posture important?  When it comes to posture, yourWhen it comes to posture, your mother did know best. Her frequentmother did know best. Her frequent reminders to "stand up straight" andreminders to "stand up straight" and "stop slouching" were good advice."stop slouching" were good advice.  Your spine is strong and stable whenYour spine is strong and stable when you practice healthy posture. But whenyou practice healthy posture. But when you stoop or slouch, your body'syou stoop or slouch, your body's center of gravity shifts. Your musclescenter of gravity shifts. Your muscles and ligaments struggle to keep youand ligaments struggle to keep you balanced. This can lead to painfulbalanced. This can lead to painful strains and sprains of ligaments andstrains and sprains of ligaments and muscles in your back. It can alsomuscles in your back. It can also cause neck pain, joint stiffness, fatiguecause neck pain, joint stiffness, fatigue and other health problems.and other health problems.  If you have chronic backaches, healthyIf you have chronic backaches, healthy posture will help relax your backposture will help relax your back muscles and may reduce your pain.muscles and may reduce your pain. Practicing good posture may alsoPracticing good posture may also prevent backaches and otherprevent backaches and other problems.problems.
  • 37. Your spine's curvesYour spine's curves  A healthy back has threeA healthy back has three natural curves: an inward ornatural curves: an inward or forward curve at the neckforward curve at the neck (cervical curve), an outward(cervical curve), an outward or backward curve at theor backward curve at the upper back (thoracic curve),upper back (thoracic curve), and an inward curve at theand an inward curve at the lower back (lumbar curve).lower back (lumbar curve). Good posture doesn't meanGood posture doesn't mean balancing a book on yourbalancing a book on your head or standing at military-head or standing at military- style attention. It simplystyle attention. It simply aims to maintain theseaims to maintain these natural curves. In contrast,natural curves. In contrast, poor posture actually leadspoor posture actually leads to changes in natural spinalto changes in natural spinal curves, which can stress orcurves, which can stress or pull muscles and causepull muscles and cause pain.pain.
  • 38. Good standing postureGood standing posture  When standing, keep yourWhen standing, keep your chest held high and yourchest held high and your shoulders back andshoulders back and relaxed. Try not to tilt yourrelaxed. Try not to tilt your head forward, backward orhead forward, backward or sideways. Instead, tucksideways. Instead, tuck your chin down slightly andyour chin down slightly and pull your head back and uppull your head back and up as if to flatten your neckas if to flatten your neck against a wall.against a wall.  Pull in your abdomen andPull in your abdomen and buttocks. Make sure yourbuttocks. Make sure your knees are relaxed, notknees are relaxed, not locked. Keep your feetlocked. Keep your feet parallel and your weightparallel and your weight balanced evenly on bothbalanced evenly on both feet.feet.
  • 39. Take the wall testTake the wall test  To test your standing posture, take theTo test your standing posture, take the wall test. Stand with your head, shoulderwall test. Stand with your head, shoulder blades and buttocks touching a wall,blades and buttocks touching a wall, with your heels about two to four incheswith your heels about two to four inches away from the wall. Reach back andaway from the wall. Reach back and slide your hand behind the curve in yourslide your hand behind the curve in your lower back, with your palm flat againstlower back, with your palm flat against the wall.the wall.  There should be about one hand'sThere should be about one hand's thickness of space between your backthickness of space between your back and the wall. If there's too much space,and the wall. If there's too much space, tighten your abdominal muscles totighten your abdominal muscles to flatten the curve in your back. If there'sflatten the curve in your back. If there's too little space, arch your back so thattoo little space, arch your back so that your hand fits comfortably behind you.your hand fits comfortably behind you. Walk away from the wall whileWalk away from the wall while maintaining this posture. Then return tomaintaining this posture. Then return to the wall to check your success. Practicethe wall to check your success. Practice maintaining healthy posture during yourmaintaining healthy posture during your daily activities.daily activities.
  • 40. Good sitting postureGood sitting posture  Good sitting posture keeps your neck,Good sitting posture keeps your neck, shoulders and upper back musclesshoulders and upper back muscles relaxed. Choose a chair that allows yourelaxed. Choose a chair that allows you to rest both feet flat on the floor, whileto rest both feet flat on the floor, while keeping your knees level with your hips.keeping your knees level with your hips. If this doesn't feel comfortable, tryIf this doesn't feel comfortable, try placing a foot support under your feet toplacing a foot support under your feet to find the best position for you.find the best position for you.  Stretch the top of your head toward theStretch the top of your head toward the ceiling. Tuck your chin in slightly. Keepceiling. Tuck your chin in slightly. Keep your upper back and neck comfortablyyour upper back and neck comfortably straight. Keep your shoulders relaxed,straight. Keep your shoulders relaxed, not elevated, rounded or pullednot elevated, rounded or pulled backward. Sit with your back firmlybackward. Sit with your back firmly against the chair. Place a small cushionagainst the chair. Place a small cushion or rolled towel to support your loweror rolled towel to support your lower back curve if your chair doesn't provideback curve if your chair doesn't provide the support you need.the support you need.
  • 41. Keep your shoulders straightKeep your shoulders straight  Pay attention to the position ofPay attention to the position of your shoulders when you'reyour shoulders when you're sitting or standing. Slouching orsitting or standing. Slouching or rolling your shoulders forwardrolling your shoulders forward shortens your chest musclesshortens your chest muscles and reduces their flexibilityand reduces their flexibility (kyphosis). But, if you pull your(kyphosis). But, if you pull your shoulders too far back, you canshoulders too far back, you can develop swayback (lordosis), indevelop swayback (lordosis), in which your abdomen sticks outwhich your abdomen sticks out too far in front and your buttockstoo far in front and your buttocks stick out too far in back.stick out too far in back.
  • 42. Check out your reflectionCheck out your reflection  Stand in front of a mirror toStand in front of a mirror to see if you're keeping yoursee if you're keeping your shoulders straight, or ask ashoulders straight, or ask a friend to evaluate yourfriend to evaluate your shoulder position. Yourshoulder position. Your shoulders should be in theshoulders should be in the same position as thesame position as the picture on the left. Youpicture on the left. You may find that this is difficultmay find that this is difficult for you, especially if youfor you, especially if you work at a computer or sitwork at a computer or sit for long periods to read.for long periods to read.
  • 43. It all adds upIt all adds up  Although good posture should beAlthough good posture should be natural, you may feel wooden or stiffnatural, you may feel wooden or stiff at first if you've forgotten what goodat first if you've forgotten what good posture feels like. The key is toposture feels like. The key is to practice good posture all the time.practice good posture all the time. You can make improvements at anyYou can make improvements at any age. Stretching and coreage. Stretching and core strengthening exercises may helpstrengthening exercises may help because they strengthen the lowerbecause they strengthen the lower abdominal muscles that supportabdominal muscles that support your spine. Talk with your doctor ifyour spine. Talk with your doctor if you're concerned about youryou're concerned about your posture or if you need help decidingposture or if you need help deciding if certain exercises are right for you.if certain exercises are right for you.
  • 44. Proper lifting techniquesProper lifting techniques  Start in the best positionStart in the best position  Before you lift a load, thinkBefore you lift a load, think through your task. Decidethrough your task. Decide where you'll place the loadwhere you'll place the load and how you'll get it there. Ifand how you'll get it there. If an object is too heavy, getan object is too heavy, get some help.some help.  When you're lifting an objectWhen you're lifting an object from the floor, don't lift from afrom the floor, don't lift from a standing position with yourstanding position with your waist bent and your legswaist bent and your legs locked. Instead, plant yourlocked. Instead, plant your feet firmly on the ground,feet firmly on the ground, standing as close to the loadstanding as close to the load as possible. Then kneel down,as possible. Then kneel down, resting one knee on theresting one knee on the ground. Lift the object fromground. Lift the object from between your legs and hold itbetween your legs and hold it close to your body.close to your body.
  • 45. Let your leg muscles do the workLet your leg muscles do the work  Your leg muscles areYour leg muscles are some of the strongestsome of the strongest muscles in your body.muscles in your body. Use them to lift theUse them to lift the load. Keep your backload. Keep your back as upright as possible.as upright as possible. As you lift, tighten yourAs you lift, tighten your abdominal muscles.abdominal muscles. This helps supportThis helps support your spine.your spine.
  • 46. Carry the load close to your bodyCarry the load close to your body  When you're standing andWhen you're standing and ready to move, hold theready to move, hold the load close to your body toload close to your body to lessen the strain on yourlessen the strain on your lower back. Avoid turninglower back. Avoid turning or twisting while holdingor twisting while holding the load. Turn by pivotingthe load. Turn by pivoting your feet, not your back.your feet, not your back. Avoid lifting heavy loadsAvoid lifting heavy loads above your waist.above your waist.
  • 47. Squatting instead of kneelingSquatting instead of kneeling  You can follow the same procedureYou can follow the same procedure from a squatting position instead offrom a squatting position instead of a kneeling position, if that's morea kneeling position, if that's more comfortable for you. Stand as closecomfortable for you. Stand as close to the load as possible. Whileto the load as possible. While maintaining your balance, squatmaintaining your balance, squat down, with one foot slightly in frontdown, with one foot slightly in front of the other. Lift the object fromof the other. Lift the object from between your legs, holding it closebetween your legs, holding it close to your body. Then stand up usingto your body. Then stand up using your leg muscles to lift the load.your leg muscles to lift the load. Tighten the abdominal muscles thatTighten the abdominal muscles that support your spine, keeping yoursupport your spine, keeping your back as straight as possible as youback as straight as possible as you rise from the floor.rise from the floor.
  • 48. Lifting items out of the trunk ofLifting items out of the trunk of your caryour car  When you're lifting an item outWhen you're lifting an item out of your trunk, place one of yourof your trunk, place one of your knees on your car's bumper forknees on your car's bumper for balance and support. Lift objectsbalance and support. Lift objects in two steps. First, lift the objectin two steps. First, lift the object to rest on the car frame. Thento rest on the car frame. Then lift it from the car frame to carrylift it from the car frame to carry it. Keep your back as straight asit. Keep your back as straight as possible as you lift the load.possible as you lift the load.  Consider storing items in theConsider storing items in the trunk close to the bumper. It willtrunk close to the bumper. It will be easier for you to lift them outbe easier for you to lift them out correctly.correctly.
  • 49. Your daily back routineYour daily back routine  Keep your back strongKeep your back strong  You can stretch and strengthenYou can stretch and strengthen your back and supportingyour back and supporting muscles with the basicmuscles with the basic exercises shown here. Try toexercises shown here. Try to work at least 15 minutes of backwork at least 15 minutes of back exercises into your daily routine.exercises into your daily routine. Remember to breathe fully andRemember to breathe fully and deeply as you do thesedeeply as you do these exercises. If you've hurt yourexercises. If you've hurt your back before, or if you have otherback before, or if you have other health problems such ashealth problems such as osteoporosis, talk to your doctorosteoporosis, talk to your doctor before you get started.before you get started.
  • 50. Knee-to-chest stretchKnee-to-chest stretch  Lie on your back on a firmLie on your back on a firm surface with your kneessurface with your knees bent and feet flat. Pull yourbent and feet flat. Pull your left knee toward your chestleft knee toward your chest with both hands. Hold forwith both hands. Hold for 15 to 30 seconds. Return15 to 30 seconds. Return to the starting position.to the starting position. Repeat with opposite leg.Repeat with opposite leg. Repeat with each leg threeRepeat with each leg three or four times.or four times.
  • 51. Cat stretchCat stretch  Get down on your handsGet down on your hands and knees. Slowly let yourand knees. Slowly let your back and abdomen sagback and abdomen sag toward the floor (A).toward the floor (A).  Slowly arch your backSlowly arch your back away from the floor. Pullaway from the floor. Pull your abdomen up to theyour abdomen up to the ceiling (B). Repeat severalceiling (B). Repeat several times.times.
  • 52. Half sit-upHalf sit-up  Lie on your back on a firmLie on your back on a firm surface with your kneessurface with your knees bent and feet flat. Withbent and feet flat. With your arms outstretched,your arms outstretched, reach toward your kneesreach toward your knees until your shoulder bladesuntil your shoulder blades no longer touch theno longer touch the ground. Don't grab yourground. Don't grab your knees. Hold for a fewknees. Hold for a few seconds and slowly returnseconds and slowly return to the starting position.to the starting position. Repeat several times.Repeat several times.
  • 53. Leg lifts with bent kneeLeg lifts with bent knee  Lie on your stomach on aLie on your stomach on a firm surface with your headfirm surface with your head turned to the side. Bendturned to the side. Bend one knee back. Keepingone knee back. Keeping your knee bent, raise thatyour knee bent, raise that leg slightly off the surfaceleg slightly off the surface and hold for about fiveand hold for about five seconds. Return to theseconds. Return to the starting position. Repeatstarting position. Repeat several times. Changeseveral times. Change legs and repeat thelegs and repeat the exercise.exercise.
  • 54. Leg lifts with leg straightLeg lifts with leg straight  Lie on your stomachLie on your stomach on a firm surface withon a firm surface with your head turned toyour head turned to the side. Raise one legthe side. Raise one leg slightly off the surfaceslightly off the surface and hold for about fiveand hold for about five seconds. Return to theseconds. Return to the starting position.starting position. Repeat several times.Repeat several times. Change legs andChange legs and repeat the exercise.repeat the exercise.
  • 55. Chair stretchChair stretch  Sit in a chair. Slowly bendSit in a chair. Slowly bend forward toward the floorforward toward the floor until you feel a mild stretchuntil you feel a mild stretch in your back. Hold for 15 toin your back. Hold for 15 to 30 seconds. Return to the30 seconds. Return to the starting position. Repeatstarting position. Repeat three or four times. Don'tthree or four times. Don't do this exercise if youdo this exercise if you have osteoporosis.have osteoporosis.
  • 56. Shoulder blade squeezeShoulder blade squeeze  Sit upright in a chair. KeepSit upright in a chair. Keep your chin tucked in andyour chin tucked in and your shoulders down. Pullyour shoulders down. Pull your shoulder bladesyour shoulder blades together, straighten yourtogether, straighten your upper back and hold yourupper back and hold your chest high. Hold a fewchest high. Hold a few seconds. Return to theseconds. Return to the starting position. Repeatstarting position. Repeat several times.several times.
  • 57. Mediplex ArthritisMediplex Arthritis Reversal/Prevention ProgramReversal/Prevention Program  Integrated Program (Yoga, Physiotherapy,Integrated Program (Yoga, Physiotherapy, Life Style Modifications and Super SpecialtyLife Style Modifications and Super Specialty Homeopathic Medicines)Homeopathic Medicines)  Scientific program (Formulated after 5Scientific program (Formulated after 5 years of Clinical & Research work).years of Clinical & Research work).  Over 3000 clients.Over 3000 clients.  Success Rate is over 90 %.Success Rate is over 90 %.  On an average in 8 days relief starts inOn an average in 8 days relief starts in patients.patients.
  • 58. Features…Features…  Managed by highly qualified andManaged by highly qualified and experienced team of doctors,experienced team of doctors, Physiotherapists, Yoga experts andPhysiotherapists, Yoga experts and dieticians.dieticians.  Clients from NIIT, GE, GENPACT, WIPROClients from NIIT, GE, GENPACT, WIPRO etcetc
  • 59. ComponentsComponents MPX Arthritis Reversal / Prevention Program Power Yoga Super Specialty Homeopathic medicines Advanced Physiotherapy Life Style Modifications
  • 61. Reversal Program Super Specialty Homeopathic Consultation and Medicine Advanced Physiotherapy Sittings Specially Designed Yoga Asans • Diet • Exercise • Positive Thinking • Meditation Life Style Modifications
  • 62. Prevention Program Super Specialty Homeopathic Consultation and Preventive Medicine Preventive Physiotherapy Sittings Preventive Yoga Asans • Diet • Exercise • Positive Thinking • Meditation Life Style Modifications
  • 63. Where do you want to see yourself ?Where do you want to see yourself ?  Mr. Sharma or Mr. Gupta !Mr. Sharma or Mr. Gupta !  Choice is yours !Choice is yours !
  • 64. Thank you !Thank you !  Mr. Ashfaq, Welfare Officer, NICMr. Ashfaq, Welfare Officer, NIC  NIC staffNIC staff  Mediplex TeamMediplex Team  mediplex@gmail.com for booklet on “How to use computermediplex@gmail.com for booklet on “How to use computer for preventing backache ? “for preventing backache ? “  www.mediplex.inwww.mediplex.in  P-15-A; Jangpura Extn New Delhi 14P-15-A; Jangpura Extn New Delhi 14  9313520295;9313520295;
  • 65.  TreatmentTreatment  Most back pain gets better with a few weeks of home treatment and careful attention. AMost back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you need toregular schedule of pain relievers and hot or cold therapy may be all that you need to improve your pain. A short period of bed rest is okay, but more than a couple of daysimprove your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, your doctor mayactually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.suggest stronger medications or other therapy.  Medications and therapiesMedications and therapies  Physical therapy and exercise.Physical therapy and exercise. A physical therapist can apply a variety of treatments,A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, tosuch as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist canyour back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back andteach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will helpabdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurringpain from recurring  e techniques will help pain from recurring.e techniques will help pain from recurring.  Prescription medications.Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatoryYour doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain thatdrugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that doesn't get better with over-the-counter pain relievers.doesn't get better with over-the-counter pain relievers.  Cortisone injections.Cortisone injections. If pain isn't relieved using other measures and you have painIf pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe cortisoneradiating down your leg from a "pinched nerve," your doctor may prescribe cortisone injections — an anti-inflammatory medication — into the space around your spinal cordinjections — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve(epidural space). A cortisone injection helps decrease inflammation around the nerve roots.roots.  Electrical stimulation.Electrical stimulation. A procedure called transcutaneous electrical nerve stimulationA procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points on the(TENS) uses a unit that sends a weak electrical current through specific points on the
  • 66. BackacheBackache  IntroductionIntroduction  The back is a well-designed structure madeThe back is a well-designed structure made up of bone, muscles, nerves and other softup of bone, muscles, nerves and other soft tissues. You rely on your back to be thetissues. You rely on your back to be the workhorse of the body — its function isworkhorse of the body — its function is essential for nearly every move you make.essential for nearly every move you make. Because of this, the back can be particularlyBecause of this, the back can be particularly vulnerable to injury and back pain can bevulnerable to injury and back pain can be disabling.disabling.  Four out of five adults have at least one boutFour out of five adults have at least one bout of back pain sometime during life. In fact,of back pain sometime during life. In fact, back pain is one of the most common reasonsback pain is one of the most common reasons for health care visits and missed work.for health care visits and missed work.  On the bright side, you can prevent most backOn the bright side, you can prevent most back pain. Simple home treatment and proper bodypain. Simple home treatment and proper body mechanics will often heal your back within amechanics will often heal your back within a few weeks and keep it functional for the longfew weeks and keep it functional for the long haul. Surgery is rarely needed to treat backhaul. Surgery is rarely needed to treat back pain.pain.
  • 67.  the buttocks and back of the leg.the buttocks and back of the leg.  Spinal stenosis.Spinal stenosis. This condition occurs when the space around the spinal cord and nerve rootsThis condition occurs when the space around the spinal cord and nerve roots narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.narrows due to arthritis and bone overgrowth. This can press or pinch a nerve.  Spondylosis.Spondylosis. Spondylosis is a type of arthritis affecting the spine. It is due to the degenerativeSpondylosis is a type of arthritis affecting the spine. It is due to the degenerative changes in the spine that often come with aging.changes in the spine that often come with aging.  Spondylolisthesis.Spondylolisthesis. This condition occurs when one vertebra in the spinal column slips forward overThis condition occurs when one vertebra in the spinal column slips forward over another.another.  These rare but far more serious causes of back pain also have specific treatment related to theThese rare but far more serious causes of back pain also have specific treatment related to the underlying cause.underlying cause.  Cauda equina syndrome.Cauda equina syndrome. This is a serious neurological problem causing weakness in the legs,This is a serious neurological problem causing weakness in the legs, numbness in the "saddle" or groin area, and loss of bowel or bladder control.numbness in the "saddle" or groin area, and loss of bowel or bladder control.  Cancer in the spine.Cancer in the spine. A tumor on the spine can press on a nerve causing back pain.A tumor on the spine can press on a nerve causing back pain.  Infection of the spine.Infection of the spine. If a fever and a tender, warm area accompany back pain, the cause could beIf a fever and a tender, warm area accompany back pain, the cause could be an infection.an infection.  Injury.Injury. Damage to the bones, ligaments, or muscles of the back can cause severe pain.Damage to the bones, ligaments, or muscles of the back can cause severe pain.  Repeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic backRepeated bouts of back pain or multiple failed surgeries can lead to chronic back pain. Chronic back pain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can bepain may be related to changes in how nerves respond to frequent pain stimuli. Chronic pain can be difficult to treat.difficult to treat.
  • 68.  Screening and diagnosisScreening and diagnosis  Diagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you doDiagnostic tests aren't usually necessary to confirm the cause of your back pain. However, if you do see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand,see your doctor for back pain, he or she will examine your back and assess your ability to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rubber reflex- hammer. Thesewalk and lift your legs. He or she may also test your reflexes with a rubber reflex- hammer. These assessments help determine where the pain is, what degree of motion you have without pain andassessments help determine where the pain is, what degree of motion you have without pain and whether you have muscle spasms. They will also help rule out more serious causes of back pain.whether you have muscle spasms. They will also help rule out more serious causes of back pain.  If there is reason to suspect that you have a tumor, fracture, infection or other condition that may beIf there is reason to suspect that you have a tumor, fracture, infection or other condition that may be causing your back pain, your doctor may order one or more tests:causing your back pain, your doctor may order one or more tests:  X-ray.X-ray. These images show the alignment of your bones and whether you have degenerative jointThese images show the alignment of your bones and whether you have degenerative joint disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles,disease or broken bones. X-ray images won't directly show problems with your spinal cord, muscles, fibrous tissues (fascia), nerves or disks.fibrous tissues (fascia), nerves or disks.  Magnetic resonance imaging (MRI) or computerized tomography (CT) scans.Magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These scans canThese scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons,generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.nerves, ligaments and blood vessels.  Bone scan.Bone scan. In rare cases, your doctor may use a bone scan to look for bone tumors or compressionIn rare cases, your doctor may use a bone scan to look for bone tumors or compression fractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of afractures caused by osteoporosis. In this procedure, you'll receive an injection of a small amount of a radioactive substance (tracer) into one of your veins. The substance collects in your bones andradioactive substance (tracer) into one of your veins. The substance collects in your bones and allows your doctor to detect bone problems using a special camera.allows your doctor to detect bone problems using a special camera.  Nerve studies (electromyography, or EMG).Nerve studies (electromyography, or EMG). This test measures the electrical impulses producedThis test measures the electrical impulses produced by the nerves and the responses of your muscles. Studies of your nerve-conduction pathways canby the nerves and the responses of your muscles. Studies of your nerve-conduction pathways can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinalconfirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).stenosis).
  • 69.  TreatmentTreatment  Most back pain gets better with a few weeks of home treatment and careful attention. AMost back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of pain relievers and hot or cold therapy may be all that you need toregular schedule of pain relievers and hot or cold therapy may be all that you need to improve your pain. A short period of bed rest is okay, but more than a couple of daysimprove your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, your doctor mayactually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.suggest stronger medications or other therapy.  Medications and therapiesMedications and therapies  Physical therapy and exercise.Physical therapy and exercise. A physical therapist can apply a variety of treatments,A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, tosuch as heat, ice, ultrasound, electrical stimulation, and muscle release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist canyour back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back andteach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will helpabdominal muscles, and improve your posture. Regular use of these techniques will help pain from recurringpain from recurring  e techniques will help pain from recurring.e techniques will help pain from recurring.  Prescription medications.Prescription medications. Your doctor may prescribe nonsteroidal anti-inflammatoryYour doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain thatdrugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that doesn't get better with over-the-counter pain relievers.doesn't get better with over-the-counter pain relievers.  Cortisone injections.Cortisone injections. If pain isn't relieved using other measures and you have painIf pain isn't relieved using other measures and you have pain radiating down your leg from a "pinched nerve," your doctor may prescribe cortisoneradiating down your leg from a "pinched nerve," your doctor may prescribe cortisone injections — an anti-inflammatory medication — into the space around your spinal cordinjections — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve(epidural space). A cortisone injection helps decrease inflammation around the nerve roots.roots.  Electrical stimulation.Electrical stimulation. A procedure called transcutaneous electrical nerve stimulationA procedure called transcutaneous electrical nerve stimulation (TENS) uses a unit that sends a weak electrical current through specific points on the(TENS) uses a unit that sends a weak electrical current through specific points on the
  • 70.  How your back is builtHow your back is built  Your backbone (vertebral column) isYour backbone (vertebral column) is actually a stack of more than 30 bonesactually a stack of more than 30 bones called vertebrae. Together they create acalled vertebrae. Together they create a bony canal that surrounds and protectsbony canal that surrounds and protects your spinal cord. Small nerves enter andyour spinal cord. Small nerves enter and exit the spinal cord through spaces inexit the spinal cord through spaces in your vertebrae.your vertebrae.  The vertebrae are held together byThe vertebrae are held together by muscles, tendons and ligaments.muscles, tendons and ligaments. Between the vertebrae are intervertebralBetween the vertebrae are intervertebral disks, which act as "shock absorbers" bydisks, which act as "shock absorbers" by preventing the vertebrae from hitting onepreventing the vertebrae from hitting one another when you walk, run or jump.another when you walk, run or jump. The intervertebral disks also allow yourThe intervertebral disks also allow your spine to twist, bend and extend.spine to twist, bend and extend.  The lower back — which carries most ofThe lower back — which carries most of your weight — is the site of most backyour weight — is the site of most back pain. Here are some of the mostpain. Here are some of the most commoncommon
  • 71.  Strains, sprains and spasmsStrains, sprains and spasms  The most common cause of back pain isThe most common cause of back pain is an injury to a muscle (strain) or aan injury to a muscle (strain) or a ligament (sprain). Strains and sprainsligament (sprain). Strains and sprains can occur for many reasons, includingcan occur for many reasons, including improper lifting, excess body weight andimproper lifting, excess body weight and poor posture. Strains and sprains canpoor posture. Strains and sprains can also develop from hauling around aalso develop from hauling around a heavy handbag or sleeping at anheavy handbag or sleeping at an awkward angle. As a pivot point forawkward angle. As a pivot point for turning at the waist, the lower back isturning at the waist, the lower back is especially vulnerable to muscle strainsespecially vulnerable to muscle strains (shown here).(shown here).  Sometimes a strain or sprain causesSometimes a strain or sprain causes immediate back pain. In other cases,immediate back pain. In other cases, soreness and stiffness come later. Ansoreness and stiffness come later. An injured muscle may also "knot up." Thisinjured muscle may also "knot up." This muscle spasm is your body's way ofmuscle spasm is your body's way of immobilizing the affected area to preventimmobilizing the affected area to prevent further damage.further damage.