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THELUMBARSPINE(BACK)

Ataglance
Chronicbackpain,especiallyintheareaofthelumbarspine(lowerback),isa widespreadcondition.Itcanbeassumedthat75%ofallpeoplehaveitsometimesorall thetime.InGermany,itisthesecondmostdiagnosedconditioninvisitstothe orthopedistandthethirdmostcommoningeneralpractice.OtherEuropeancountries reportcomparablefigures. Inthefollowingpages,wewilldescribethemostimportantclinicalpicturesoflumbar spineproblems,whichmanifestinawidevarietyandareoftendifficulttodiagnose. Ourobjectiveistofamiliarizeyouwiththeimportantdefinitionsassociatedwiththe spinalcolumnasanaidforadeeperconversationwiththephysicianorasageneral introductiontothistopic.
Contents 1.IntroductiontoBack 2. Anatomy and physiology of Back 3.Painsyndromesofthelumbarspine 4.Theherniateddisc 5.HowdoFUTUROBackSupportswork? 6.IntroductiontoNeck 7.AnatomyandphysiologyofNeck Pain syndromes of the cervical spine 8. 9.HowdoFUTURONeckBraceswork? 1.Introduction Page1 Page1 Page2 Page3 Page4 Page5 Page5 Page6 Page7

Thespinalcolumnisthehumanbackbone,providingstabilitytothetrunk(torso).Its individualsectionsallowavariedrangeofmovement,whichwillbedescribedinmore detailbelow.Wewillfocushereondegenerativediseasesofthelumbarspineand deliberatelyexcludeinjuriesandcongenitalmalformations. Aswithallotherjointsandorgansystems,thespinalcolumnissubjecttonormalage relatedprocesses;however,strainoroverload,physicalinactivityandobesity acceleratetheseprocesses.Inaddition,psychologicalfactorssuchasstress,for example,causebadpostureandmusculartension.

2.Anatomyandphysiology
Thelumbarspineconsistsoffivelumbarvertebrae.Thereareelasticintervertebral discsbetweeneachvertebrathatallowthevertebraetomovewhilealsoactingas springsandshockabsorbers.

Bonyprocesseskeepthelumbarvertebraeinclosecontactwitheachother.Their contactsurfaceshaveacartilaginouslayer,allowingthemtofunctionasjoints.The nerverootsextendthroughnerverootcanalslocatedbetweenthelumbarvertebrae. Thelumbarspineallowsthetrunktobend,stretchandtiltsideways.Longitudinal turningonanaxis(rotation)islimited,asthiskindofmovementisdoneinthethoracic andcervicalspinearea.Owingtotheloadthattheyhavetosupport,thelumbar vertebraearebyfarthelargestoftheentirespinalcolumn. Thevertebraeareheldtogetherbyasystemofligaments,musclescontrolboth theunconsciousandactive,consciousmovements Onthebacksideofthenerveroots,theneuralorvertebralarchesformacanalthat enclosesthespinalnerveswhichtheexitthroughtheintervertebralforamina.These nervescontrolthetrunkmusclesandthelimbs. Additionally,thevertebraeareheldtogetherbyapowerfulsystemofligaments. Musclesattachedtovariouspointsalongthespinalcolumncontrolboththe unconsciousstabilizationofthetorsoaswellasactive,consciousmovements.

3.Painsyndromesofthelumbarspine(lowerbackpain,lumbago,lumbar sciatica,lumbarpain)
Agerelatedwearandtearprocessescausemostoftheproblemsinthelumbarregion. Theintervertebraldisksloseelasticityandbecomeflatter.Therefore,thespace betweentheindividualvertebraedecreases;overthelongterm,thiscauseswearand tearontheintervertebraljoints(spondyloarthritis)andanarrowingofthenerveroot canals.Protrusionsinthespinalcanalformaswell. Anyorallofthesechangesleadtopainfulnerverootirritationsandpainfulback muscletension.Often,suchsymptomsaretriggeredbybadposture,liftingheavy loads,orotherphysicalactivities(gardeningormovingfurniture,forexample). Finally,psychologicalstressandstraincanalsocontributetolumbarpain. Painful,tensemusclesoneithersideofthespinearetypical.Sometimesthepainwill radiatetowardsthebuttocksandtheupperlegthetermlumbagoisusedifthepain issharpandsudden. AnXrayofthelumbarspinemayruleoutseriouschangesinthevertebrae. Inyoungandmiddleagedpatients,Xraysoftenfailtoshowanyanatomicalchanges, creatingadiscrepancybetweentheXrayreadingandthepatientssymptoms.Xrays ofolderpatients

aremorelikelytoshowchangesinthevertebrae(flattenedshape,wedgeshapeor formationofjaggededges(spondylophytes),allsignsofosteoarthritis.Ifthereare neurologicalsymptomssuchastingling,paresthesiaorevenparalysisinthelegs, furtherdiagnosticssuchasaCTorMRIscanshouldbeusedtofindapossibleherniated disk,thoughmostherniateddiscsarenotsymptomatic.Electodiagnosis(EMG)canbe usedtodetectnervedamage. Bothstrongpainkillersandbedresthelprelievepainduringanacuteattack Torelievepainduringanacuteattack,patientsshouldtakepainkillersasorderedby theirphysician.Physicaltherapy,heat,iceorrestcanhelprelievepain. Avoidanyunusualstrainonthespine,focusonmovingandholdingthespineproperly duringeverydayactivitiesandfollowadvicegivenbyphysicians.Officeworkersshould notremaingluedtothechairallday,butinsteadgetupandchangepositions frequently.Movementisessential. Lastbutnotleast:Ifpsychologicalstresscouldbeafactor,themeasuresoutlinedabove willprovidelittleornorelief.Forthosecases,usefulrelaxationtechniquesandeven psychotherapycouldhelp.

4.Theherniateddisk
Wearandtearprocessesintheintervertebraldiskscanleadtothiscondition.Theouter fiberringstear,allowingthecoreoftheintervertebraldisktoprotrudeandthiscan irritateorcompressthespinalnerves.Herniateddisksareoftencausedbyimproper stressonthespine,poorliftingtechnique,andobesity. Generally,thepatienthashadbackpainforalongtime;theherniateddiskoccurs followingexcessiveliftingoranunaccustomedrotatingmovement. Neurologicaldisorderssuchasparethesiaandweaknessoccurwithatimedelay Thebackmusclescanbeextremelytenseandpainfulduringanattack,andmovement isdifficult;patientsassumeanoticeableprotectiveposture.Paincanradiatetowardthe buttocksandlegs. Sometimes,neurologicaldisorderssuchasparethesiaandweaknessoccursuddenly, butmostofthetimetheyaredelayed.AnXrayofthelumbarspinemayhelptorule outseriouschangesinthevertebrae.Ifthereareclinicalindicationsofaherniateddisk,

suchasparesthesiaorweaknessinthelegs(difficultyinraisingthefootforexample), furtherdiagnosticsshouldbeattempted.Electrodiagnosis(EMG)candetectnerve damage.CTandMRIscansallowthephysiciantoassesstheconditionofthe intervertebraldiscs. Painreliefmustbethefirstpriority.Patientsshouldtakeantirheumatoidagentsand musclerelaxantsasprescribedbytheirphysician.Theyshouldnotexacerbatespinal irritationduringanacuteattack. Oncetheacutesymptomshavesubsided,physicaltherapymaybenecessary.Elastic backbandagescanbeapartofrehabilitation. Ifthepreviouslydescribedtreatmentsfailtorelieveneurologicalsymptoms,surgery maybenecessary.Manydifferentproceduresareavailable,dependingonthetypeand locationoftheherniateddisk,butduetospaceconstraintswecannotdescribethemin detailhere.Onlyanexpertcanobjectivelydecideonacasebycasebasiswhether surgeryisnecessaryandlikelytohelpthepatient.

5.HowdoFUTUROBackSupportswork?
Thankstotheirelasticityandabilitytoconformtothebodysshape,FUTUROback supportshugthetorsoandthelumbarspinescurves,providingheat,whichaids treatment.Theyalsosupportthepatientscompromisedlumbarspineandhinder extrememovements. Peopleoftenfearthatthesetypesofbacksupportswillfurtherweakentheback muscles,butnewresearchhasdemonstratedthatthisisnotthecase.

THECERVICALSPINE(NECK)

Ataglance
Inthefollowingpages,wewilldescribethemostimportantclinicalpicturesofthe cervicalspine.Ourobjectiveistofamiliarizeyouwiththeimportantdefinitions associatedwiththespinalcolumnasanaidforadeeperconversationwiththephysician orasageneralintroductiontothistopic.

1.Introduction
Thespinalcolumnisthehumanbackbone,providingstabilitytothetrunk(torso).Its individualsectionsallowavariedrangeofmovement,whichwillbedescribedinmore detailbelow.Wewillfocushereondegenerativediseasesofthecervicalspineand deliberatelyexcludeinjuriesandcongenitalmalformations. Aswithallotherjointsandorgansystems,thespinalcolumnissubjecttonormalage relatedprocesses,butstrainoroverloadleadstopainfulchangesaswell.Inaddition, psychologicalfactorssuchasstress,forexample,causebadpostureandmuscular tension.

2.Anatomyandphysiology
Thecervicalspineconsistsofsevencervicalbodiesorvertebrae.Thereareelastic intervertebraldiscsbetweeneachvertebrathatallowthecervicalbodiestomovewhile alsoactingasspringsandshockabsorbers. Bonyprocesseskeepthecervicalvertebraeinclosecontactwitheachother.Their contactsurfaceshaveacartilaginouslayer,allowingthemtofunctionasjoints.The nervesthatcontroltheneckandarmsprotrudethroughtheintervertebralforamina locatedbetweentheindividualvertebrae.Therearealsoforaminainthelateral transverseprocessessoanarteryleadingtothebraincanpassthroughthem. Additionally,thevertebraeareheldtogetherbyapowerfulsystemofligaments. Musclesattachedtovariouspointsalongthespinalcolumncontrolboththe unconsciousstabilizationofthetorsoaswellastheactive,consciousmovement.

Duetoitsanatomicalconditionsandtheintensityandwiderangeofmotion,the cervicalspineispronetodisorders Anormal,undamagedcervicalspineallowsawiderangeofmovementrotationtothe leftandright,bendingforwardandtothesides,andstretchingbackwardsaswell. Becausesomanybones,ligaments,andvertebraearepackedinsuchalittlespace especiallyinthecervicalregionandbecauseofthesheernumberandintensityof movementsitundergoes,thecervicalspineispronetoagreatdealofprematurewear andtear.

3.Painsyndromesofthecervicalspine(neckpain,cervicalsyndrome, cervicobrachialsyndrome,shoulderarmsyndrome)
Pathologicalconstrictionsoftheintervertebralforamina,compressionofthe intervertebraldisks,andosteoarthritisofthecervicaljointsareespeciallyproblematic. Thismayresultincompressionofnerveroots,butthearteriesthatleadtothebraincan alsobecomenarrowed,aconditionknownasvertebralarterysyndrome. Changesintheintervertebraldisks,suchasthecommonherniateddisk,alsoplaya role.Here,thefiberringsofthedisctears,allowingthecoreoftheintervertebraldiskto protrudeandpressonthespinalcordorthenerveroots. Painoccursintheneckmusclearea,whichistenseandhard;theheadcanonlybe slightlymovedortiltedsideways;theneckisstiff.Changesintheintervertebral foraminacauseirritationorevencompressionofthenerverootslocatedalongthem,so thatpaincanradiatetowardthearmsandshoulder.Thismaycauseparesthesia(a prickly,tingly,orcreepycrawlysensation)orweaknessinthearmsandhands. Thepaincanalsoradiatetowardthebackofthehead.Ifthecerebralarteriesbecome constricted,dizziness,ringingintheears,impairedvision,etc.mayoccur.Xraysofthe cervicalspinewithadditionalpicturesoftheintervertebralforaminaorthevesselswill generallyexplainthesymptoms.MRIandCTscanswillshowtheconditionofthe intervertebraldisks. Mostofthetime,intensivephysicaltherapythatincludesmassageoftheneckmuscles andlocalheatapplicationswillprovidefastrelief.Intheacutestage,rheumatoid painkillersandmusclerelaxantstoeliminatepainasquicklyaspossiblearealso recommended. Socalledneckcollarsorsupportsthatrestrictpainfulmovementswhileprovidingheat canhaveasupportiveeffect.

Ifthesetreatmentsproveunsuccessful,theninjectionsorsurgerymaybeneeded.After criticallyexaminingthecondition,theorthopaedicspecialistmustdecidewhetheran operationisnecessaryornot. Iftherearenodetectableanatomicalchanges,andallmeasuresoutlinedaboveare unsuccessful,therearestillspecificrelaxationexercisesthatpatientscanbenefitfrom toprovidesomerelieffrompain.

4.HowdoFUTURONeckSupportswork?
Thankstotheirabilitytofitanypartofthepatientsanatomyandtheelasticityofthe material,FUTUROsupportstaketheshapeoftheanatomicalcontoursverywell.They exertaslightcompressionontheaffectedpainfulpartsofthejointandprovidesome warmth,whichhelpsrelievemuscletension.

Developed in collaboration with a panel of specialized physicians and medical therapists.