An Approach to Back Pain

An overview of the etiologies and work-up of both acute and chronic back pain, with focus on lumbosacral strain, arthritis (a.k.a. spondylosis), herniated disc, spinal stenosis, and inflammatory back pain (e.g. ankylosing spondylitis).
#backpain #lumbarstrain #discherniation

[@dr.d.terrencefoster7886]

As a Pain Management Specialist myself, I can say that your presentation will be helpful to many.

[@StrongMed]

As pointed out by viewers, there are a few additional causes of back pain worthy of inclusion to make a more complete framework: - Pregnancy and menstrual cramps (hopefully not a diagnostic mystery) - An unusually large uterine fibroid (can cause back pain by physical compression of structures posterior to the uterus) - Pott's disease (a.k.a. TB of the spine, which is a combination of vertebral osteomyelitis and infectious arthritis, which presents with a more gradual onset than other causes of these conditions) - Also, back pain can be seen in patients with depression and is one of the more common physical symptoms in patients experiencing intimate partner violence (even in those without physical injuries of the back). This is sometimes labelled "psychogenic back pain", but not everyone agrees with this term. (I appreciate the objections of some, but I don't know if there is a better term for the phenomenon.)

[@fuchsiadeema2658]

I wish you can speak my language (arabic) to understand the amount of gratitude and respect I have towards you and the videos you make, you are an inspiring physician and I can’t find any words to thank you enough for the valuable knowledge you share with us

[@angelaoduro7892]

I’m not even joking! I’m only 8 minutes in and this is the BEST presentation I’ve ever seen on back pain. Concise yet very crucial information! Amazing

[@sanam.soltani7434]

Thank you for sharing, in these crazy times when universities in my country are teaching medicine via online classes, your videos are a life saver.

[@Raxorium]

Your videos are ON POINT. They are some of the most logical & comprehensive teaching materials out there, thank you.

[@lukaspreis4736]

Your approach to symptoms videos are just genius!

[@deemadodo1404]

I think we should know how to differentiate between inflammatory vs mechanical back pain in history .. so I recommend adding questions about morning stiffness , pain in other joints , extra articular manifestations , history of rheumatic diseases These questions may help us to detect inflammatory arthritis

[@JaehoonWrestling]

Dr. Strong, I do really enjoy learning from your lecture. Thank you so much for sharing your knowledge, expending to others including myself. Much much appreciated it!!

[@Retruyomyl5]

wonderful way to keep this in mind, a million thanks!

[@nadiaelhani9523]

I appreciate all of your lectures! Thank you

[@SebastianCabanaz]

Excellent stuff! Keep them coming

[@charlottemujuru2699]

I was struggling to find a concise text and boom and I bump into the ultimate best guide

[@sunving]

Thank you Dr Strong. Good lecture as always. You are like a one author textbook already :)

[@sanbetski]

thank you for this! appreciate it!

[@shydragger111]

Thank you for a very informative video. Please continue this series. Your videos are helping a lot of medical students and doctors in all stages of their career.

[@dizzyboy92]

This videos are incredible

[@kouroshahadi339]

Wonderful lecture ! Thank you so much !

[@SKARTHIKSELVAN]

Thanks for putting efforts in making these useful videos.

[@DrAugrajUprety]

it was a holistic approach thank you so much sir!

[@samanthiweeravanni1029]

Very informative, thank you so much.

[@user-rk7zv6ou3l]

so glad I found this video😭 so helpful

[@dailydoseofmedicinee]

Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments👍

[@malemaabbey2316]

You are great

[@nelsonlouis5491]

Amazing

[@gabrieljosetinocoyepes6187]

Thanks! Dr Strong

[@PartsofA]

Wow! God bless you ❤

[@hexfizgamingch]

This is very helpfull for my Clinic daily practice.. thank you doctor

[@apurvbose]

Nice keep up the work. 👍

[@scariathomas1993]

Very useful class Sir. Thanks

[@wangpaul1924]

thanks1!

[@anndhary9714]

Excellent!!!

[@gajanandprajapat3410]

Hindi mein bhi bhejen Hindi mein bhi bhejen Hindi mein bhi bhejen Hindi mein bhi bhejen

[@manarmohammed3178]

الله يعطيك الصحة

[@saifnazir9251]

Thank you sir

[@tayebwaisaac]

Can I get the slides. It's very amazing to hear that explaination

[@seanswann1143]

Thanks

[@drhenker1]

Thank you for this excellent lecture. Is it possible to upload the pdf files of your most recent approaches to your google drive?

[@SarkisKlinik]

hi,can tens be used for back pain without certain diagnosis or MRI >?what if there is cancer?

[@shahad5490]

very appreciated!. I wish if there was a written material attached under the video

[@mihirhiremath]

Hello Sir! This is absolutely awesome! You are such a wonderful teacher😄 An approach to Muscular weakness & also to Dysphagia would be much appreciated. Love from India💓

[@Somaye40]

Thank you so much. Very comprehensive and helpful. I just wonder if we should consider age over 50 as a red flag? I know that it is mentioned in all textbooks but is it soley a red flag by itself considering high rate of spondylosis in aged patient? I mean I have many patients over 50 without any other red flag sign and symptoms, should I go for imaging then for all?

[@user-wz6oo9bq5j]

Thanks for this super wonderful approach. This 'approach seies' is particularly helping me with less effort and I listen to them sometimes using before going to hospital while in public transport with earphones. Are there any planned approaches for arthritis/ arthralgia , altered level of consciousness?

[@StrongMed]

Thanks for the suggestions! I've actually started outlines on both those topics, but wasn't happy with their frameworks yet, so put them on hold. They're on the short-list to return to though!

[@xDomglmao]

arthralgia would be awesome!

[@nasreddinekhayati2121]

Hello Doc ! I like too much your holistic and systematized approach. Although I would humbly add to all these etiologies: the TB-spine and the psychogenic back-pain as a manifestation of stress syndrome. thank you so much for your valuable lectures

[@StrongMed]

Thanks, agree with your suggestions!

[@xDomglmao]

Please correct me if I am wrong: dorsalgia = either a) any back pain, OR b) upper (non-lumbar back pain) lumbalgia = low back pain, not any more spec., as opposed to lumbago which is an acute form of lumbalgia (sometimes also used just syn.) sciatica = pain originating in lower back, radiating to one leg lumbago with sciatica = acute pain in lower back + pain radiating to one leg (flawed definition of sciatica then?) if neuro Sx: radiculopathy lumbar strain = lumbar mm injury; lumbar sprain = lumbar ligg. injury; often used like they'd be the same, they lead to lumbar back pain (lumbago) and a synonym would be "idiopathic low back pain" Why I am asking: ICD-10 makes a difference between "lumbago" and "lumbar strain" => how do I DD? ICD-10 makes a difference between "sciatica" and "lumbago with sciatica" => I thought sciatica is per definition "pain starting from the lower back radiating to the leg, usually with positive straight leg test", when do I use lumbago with sciatica then? If sciatica is associated with numbness or other neuro Sx, then "radiculopathy"? However, not every radiculopathy has neuro Sx? Very confusing terminology :-/

[@dr.bibaswan]

👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻👏🏻

[@MonaSax-ir6cw]

What about physiological conditions and back pain

[@caterscarrots3407]

Um, any cause of uterine contraction can cause back pain. Not just pregnancy and Braxton Hicks and Labor contractions but also a normal menstrual cycle. In fact, I've even heard that uterine contraction upon menstruation is stronger than that during labor(though that could be down to where it is measured as intrauterine placement of a measurement device is impractical and almost impossible in a woman who is in labor, whereas it's very easy in a menstruating woman, so intrauterine vs surface of the abdomen could be why the menstrual contractions are "stronger", because they are measured at the source). I've also heard of there being an association between pain level in menstrual cramps and pain level during labor. Everything I've read about this association says that worse menstrual cramps = worse labor pains, which is not what you want to hear when you yourself have bad menstrual cramps due to primary dysmenhorhea(I am that person, I've had ultrasound and abdominal CT and all that showed up was a small ovarian mass that turned out to be a simple, clear fluid filled, ovarian cyst, and while ovarian cyst rupture happens to me about once a month, and it does worsen the menstrual cramp onset, I'm pretty certain that I didn't have ovarian cysts at 11 years old(that's when I started having menstrual cramps, long before it got as bad as it is now). I have refused hormone therapy as I don't think it's worth the extra cancer risk just to help with my pain(I've heard of ovarian and even uterine cancer cases being higher in women who take oral contraceptives or hormone therapy in general when it is just for the sake of relieving pain(which a lot of doctors do prescribe hormone therapy for severe menstrual cramps regardless of cause)). Heat therapy works well for my pain and doesn't have that risk that hormone therapy does.

[@xDomglmao]

Didn't know the assoc. btw bad menstrual cramps & bad labor pain, thank you!

[@usamaazhar6237]

Kindly post lectures on how to approach and manage disorders of pulmonary system. Regards.

[@usamaazhar6237]

Kindly make clinical examination videos of systems, especially for exit examination for fellowship. Regards

[@dr.vaibhavsharma]

hello sir, thanks for this video 1 request, kindly upload a video on an approach to vertigo if possible. I'll be looking forward to it

[@StrongMed]

You mean like this one? =) kzbin.info/www/bejne/aGmmi3-an650osU

[@dr.vaibhavsharma]

@@StrongMed oops!! m a recent subscriber, didn't know one video of vertigo already been uploaded. Just finished watching that video. Loved it. Thank u

[@MonaSax-ir6cw]

What about back issues from lack of exercise

[@StrongMed]

Assuming a person has a normal amount of routine activity and doesn't spend 100% of their waking hours on the couch, a lack of exercise should not cause back pain.

[@xBassel92x]

Sir, could you please do an approach to neurologic examination ?

[@StrongMed]

Yep, it's already on the short list of upcoming videos!

[@m.22s15]

I love you

[@angis8505]

Off topic: CONGRATULATIONS !!! 💙🇺🇲💪🏻🙃 I hope that we in Brazil will be able to follow your example and also get rid of our own fascist!!

[@niccoisaiah4171]

Dear Sir (Dr Strong), could you please create a tutorial for approaching vaginal bleeding?

[@khayriahassan8693]

🇸🇴 Somalia

[@mohdumair5650]

Approach to back pain has been presented in a very lucid manner. I think you have missed the gynaecological causes!

[@xDomglmao]

mhmm, fair point

[@StrongMed]

Thanks for the comment! I agree that I left off pregnancy (one of the more causes of back pain in women), but it's not a diagnostic mystery (hopefully!). In retrospect, I should have included an unusually large fibroid, which can cause back pain by compression of adjacent posterior structures. Otherwise, it's very uncommon for back pain to have a gynecological cause (i.e. excluding pure urinary causes like pyelo, or an STI leading to reactive arthritis). Pathology of retroperitoneal structures (e.g. aorta, pancreas, kidneys) is what's usually felt in the back, while intraperitoneal and infraperitoneal structures (including both female and male reproductive organs) are typically felt in the abdomen, pelvis, or groin. While it's certainly possible for conditions such as endometriosis and an ectopic pregnancy to be experienced primarily in the back (based on the anatomic location of the pathology in the specific patient), this is a very unusual presentation. A forthcoming video on the approach to chronic abdominal and chronic pelvic pain will cover the gynecological causes of chronic pain.

[@mohdumair5650]

@@StrongMed Thanks sir.

[@gamaltaher9714]

Thanks