Physical therapy & Surgery - Back pain

A physical therapist can apply a variety of treatments, such 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 can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from returning.

Injections
If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space).
Surgery
Types of back surgery include:

• Spine navigation surgery. It is a new techniques that can enhance the precision in the surgical regions, reduce the surgical time, reduce radiation exposures to patients and surgeon. Increase safety and accuracy through more precise screw placement and enables minimally invasive approaches.
• Partial removal of disk. If disk material is pressing or squeezing a nerve, your orthopaedics doctor may be able to remove just the portion of the disk that's causing the problem.
• Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, orthopaedics surgeons can remove a small section of the offending vertebra, to open up the passage.
• Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.

Reference information: knowyourback.org, ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your personal physician.

Back pain Prevention

The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back.

·        Specific exercises: Talk to your doctor about how to perform these exercises.

Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease the tendency to suffer back pain.

·         Although not useful to treat back pain, stretching exercises are helpful in alleviating tight back muscles.

·       The pelvic tilt also helps alleviate tight back muscles.

·        Lumbar support belts: Workers who frequently perform heavy lifting are often required to wear these belts. There is no proof that these belts prevent back injury. One study even indicated that these belts increased the likelihood of injury.

• Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Do not wear high heels.
• Sitting: Chairs of appropriate height for the task at hand with good lumbar support are preferable. To avoid putting stress on the back, chairs should swivel. Automobile seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support.
• Sleeping: Individual needs vary. If the mattress is too soft, many people will experience backaches. The same is true for sleeping on a hard mattress. Trial and error may be required. A piece of plywood between the box spring and mattress will stiffen a soft bed. A thick mattress pad will help soften a mattress that is too hard.
• Lifting: Don't lift objects that are too heavy for you. If you attempt to lift something, keep your back straight up and down, head up, and lift with your knees. Keep the object close to you, don't stoop over to lift. Tighten your stomach muscles to keep your back in balance.

Reference information: knowyourback.org, ispine.com.hk

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your personal physician.

如何得知自己患有骨質疏鬆症？

如屬上述高危人士，可尋求骨科醫生之專業意見，並接受檢查。常見測量骨質密度的方法有：

l  雙能量 X 光吸收測量儀 (DEXA) ： 用於診斷及監察治療的效果。

l  超聲波儀器 (Quantitative Ultrasound QUS) ：只可以作為骨質密度的初步普查方法，並不能作為確診工具。

患上骨質疏鬆症應怎麼辦？

即使已證實患上骨質疏鬆症，亦可透過上述的飲食和運動習慣，減慢骨質流失的速度。骨科醫生會因應個別的情況而建議患者服用治療藥物，例如二磷酸類藥物、選擇性雌激素受體調節劑、降鈣素 / 降血鈣素、副甲狀腺素、鍶及維生素 D 、鈣質補充劑等。

此外，骨質疏鬆症患 者 在日常生活中要提高警覺，慎防跌倒，以減低骨折的機會。例如﹕注意家居安全、過馬路要小心、穿防滑的鞋子、避免服用令人暈眩的藥物、改善視力障礙等。

參考資料: www.info.gov.hk/elderly

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

頸的脊椎病

人體頸部的結構與腰部類似，所以頸椎與腰椎相同，都會出現退化的情況，退化的速度及程度則因人而異。

如果頸椎椎間盤突出就會壓住神經，如果病人本身屬於發育性椎管狹窄的話，只要椎間盤向後突出少許，就會令病人感到十分疼痛。

那麼頸部的椎間盤突出與腰部的椎間盤突出又有何不同呢？

首先，頸部的脊椎中有脊髓神經（即中樞神經）和神經根。而，腰1,2以下就只有神經根，沒有中樞神經了。

所以，頸部的椎間盤突出會引發三種情況：

脊髓神經受壓

神經根受壓

兩者均受壓

其中，神經根受壓比較容易發現，因為它的症狀是：痛楚呈放射性，從頸部一直延伸至肩、手臂、手指。然而，如果是單一的神經根受壓，大多數病人都不需要接受手術治療，藥物及物理治療即可幫助他們康復。

然而，如果是脊髓神經受壓的話，在開始的階段，病人只會感覺到雙手開始不靈活，伴隨著麻痺的感覺，在使用筷子或扣鈕扣時會顯得笨重，卻不會有痛的感覺。因此，往往容易被病人忽略。

這樣子的忽略往往會拖延了治療的最佳時機，造成惡化。脊髓神經長期受壓，會造成神經的水腫及產生疤痕。5%的病人會突然惡化，原因可能是一些輕微的撞擊，例如：突然的煞車或跌倒，便會導致病人四肢癱瘓。

以上的情況又常常會被誤會為中風，它們兩者間有何區分呢？

通常中風只影響半邊身體以及運動神經。如果影響到四肢及感覺神經，就要立刻去檢查是否是由於頸部受傷而引起的。

張啟然醫生 骨科專科醫生

參考資料: www.mingpao.com

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。

後十字韌帶受傷

後十字韌帶受傷並不像前十字韌帶那樣常見。後十字韌帶扭傷通常是因為韌帶被過份拉扯或舒展，膝蓋關節在前方被撞擊，或失足而發生的。

後十字韌帶受傷會影響膝蓋關節的穩定因為脛骨可能向後沉。股骨和脛骨的末端會直接地互相摩擦，對光滑的關節軟骨造成磨損而變成稀薄。這磨損是會導致關節炎的。

處理後十字韌帶受傷

後十字韌帶撕裂的傷者通常都沒有關節不穩定的症狀，因此手術一般是不需要的。在完成一個复康療程以後，許多運動員能回复到傷前的活動能力而沒有重大的損傷。

但是，如果後十字韌帶的受傷情況是後十字韌帶連著部份脛骨一起撕掉，手術是需要將依附在韌帶上的骨固定在原來的位置。這手術後膝蓋關節的功能通常是相當好的。

參考資料: www.hkcos.org.hk, www.ispine.com.hk

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，應向自己的骨科醫生查詢，而不應單倚賴以上提供的資料。