Back Pain and Your Brain: William S. Marras at TEDxOhioStateUniversity

afternoon I'm here to talk about low back pain how many people here have ever had an episode of low back pain lots yeah that's what I thought if you look at the instance of low back pain about 80% of you are going to have low back pain at some point during your life it's a second most common reason for seeing a physician it's the second most common reason for a disability with over a hundred million lost work days a year and it's also tremendously expensive it's in the neighborhood of a hundred billion dollars a year we spend on excuse me I'm low back pain you know I forgot I don't I do have a clicker there's also you know if you have low back pain chances are it'll go away in about three weeks however if a last more than six week then it then it becomes chronic and at that point that's when we worry that's when you can have chronic problems to last more than six weeks and you have surgery the chances of a surgery working to make you better are about 50% and as a matter of fact if you have an MRI or CT scan to try and figure out what's wrong it's about a 10 to 15 percent chance they even know what's wrong with you so the odds are not in your favor if you have that problems so we've been talking about the physical aspects of bat pain what about the emotional aspects of back pain poor doggy right we know that emotion could actually influence what happens in your brain as a matter of fact emotion could present and overlay on top of the physical pain you're feeling and it can actually change the way your brain works so if you look at the brain on the left here that's somebody who's got what we call central sensitization compared to a normal person on the right what this means is even after the stimulus is gone even after the back the root of the back pain is gone you could still be experiencing low back pain so there seems to be an interaction between the mind and the body there now let me talk a little bit about how those works so you know we're typically concerned about the disk if you look at the spine you have 24 vertebrae and in between each one of these vertebrae is is a little disc which is sort of like a shock absorber and if we look at this in close-up we can see that there's good space in between those vertebral bodies that is offered by the disc and we also see that you have these little tubes or cables that come out of the spinal cord and these go down to serve different parts of your body and if you put pressure on that that's when you have a problem sort of like you see at the bottom right here so as a matter of fact here's somebody who had a rupture of the disc it's pushing against that nerve root and that's when you get things like sciatica going down your leg and but you don't get there just from doing one event for example you know you're in the top left there before you lift something you're to bottom right after you lift something it's really kind of a gradual process so the first thing that happens is you start to lose disc height then the next thing that happens is you start to get a little instability between those vertebrae and so at that point they could slide over and start problems and if very lucky then you could get to that point where you have the vertebral where you have the rupture of the disc and that's when things are bad that's when you need surgery so how does this all occur in order to understand how this occurs we have to understand something about the anatomy of the disc and how it gets its nutrition if you look at the disc it's almost like a tire that you lay on his side okay so it's got lots of crosshatch fibers which are like plies of that tire and in the center you've got a gelatinous core and it also has this tiny cap on the top called an end plate and that end plate it's only about a millimeter thick and its purpose in life is to diffuse nutrients into that disc the disc itself has no blood supply like most parts of your body so how does it get its nutrition well it gets them from the vertebrae above and below and basically what happens is these nutrients go through that end plate and nourish those fibers and make the discs happy now we also get 40 blend plates how many people hair a head over tea blend plate microfracture okay how many people here have ever lifted anything heavier okay you've probably had a ver tea blimp and plate microfracture but you just don't know it because we don't have any nerve sensors or what we call nociceptors in that part of the body it's okay if you get one of those that'll heal but what if your job requires you to get lots of these things well these things will heal but they heal in the form of scar tissue and one of the things we know about scar tissue is it's thicker and denser than most other types of tissues in the body and so what do you think happens to those nutrients when they try and pass through this end plate well some of them make it through some of them don't and subsequently we get atrophy of the dis fibers parts of the disc die off that's how we get weak discs and that's how things get bad in terms of ruptures so as engineers what we try and do is figure out when you're going to have this so as an engineer what we do is look at the load imposed on those tissues of the body compared to the tolerance and so here's typically the way to look at things here's the tolerance of a tissue here's the the load of a tissue and if you exceed the if the load exceeds that tolerance then you're going to feel pain so what we try and do is design jobs so those loads are well below there now here's the way we analyze this in the laboratory if you can see in the little window there you see somebody doing a physical task and we have markers on his body we have electrodes on his body to look at muscle activities you see the little contrails of the motion we could precisely understand what somebody does and this accuracy is tremendously accurate it's down to about a third of a millimeter of accuracy so what we did we do with that information is we build a physical model or a computer model of this person and these things are proportioned relative to the size shape proportions of the individual and you can see there we have the forces going in out of the hands we have the muscles that we're getting from the electromyography we have motion and we could do something with these models that you can never do in real life which is you could look inside there and measure exactly what's going on so every one of these little red arrows is basically a vector of force that is being imposed on the disk and you can see these things are straight back when this guy starts to pull and then you see him swinging to the side that's because he's taking a step with one of his legs so it shows how incredibly accurate we could get with these as a matter of fact we also do this for patients so here's a patient this is a patient's particular spine in the in the model with all the way or and tear and degeneration and you can see we see muscles which are the red arrows bone contacts which are blue the green that you'll see here in a minute are going to be ligament forces and you see the disks actually deforming changing colors so we could tell what the stress is there so what do we do with this information well we use it to interpret what happens when people are exposed to various risk factors so the one everybody knows about our physical factors right so physical factors we know the the heavier something is that you lift the more load there's going to be on the spine but it's not quite that simple yes that is true but take a look at the standard deviation these black bars on top of each one of the red bars there's a standard deviation bars which show how much it varies you see those are tremendous so you could have a load that's very high or very low but on average it's going to be one of these we also know of things like where you lift to and from is very important so you can see that actually has more of an influence than the weight of the object what about things like individual factors well these are things like your genetics can't really do much about that other than trying to understand what it means for you but there are things you do have some control over for example here's a little study we did looking at BMI body mass index or how obese a person is and the zero here is if you're of the ideal level which are the green bars and the blue shows what happens if your BMI as increased by five the red shows what happens for grease by ten and you can see these are nonlinear jumps the jump from the green to the blue is moderate the droop the jump from the blue to the red are excessive okay so it's a nonlinear hazard to put on more body weight in terms of your spine we also know that your previous experiences like if you've had low back pain could influence things loads are from thirty to seventy percent more when you've had low back pain before and you're doing a task the last one here is psychosocial and organizational factors what are those things psychosocial factors are basically the way you relate to the social issues around you how you interrelate with your boss how you relate with your spouse or your friends or your co-workers and the literature has shown that all these independently lead to back pain but we couldn't figure out why so we did a couple studies and this is kind of interesting because what we did is we work with a cyclo social expert who trained my experimenters are my graduate students how do how to treat people and be very engaging and have a positive psychosocial environment so they'd bring wood wire up a subject like you just saw have them do some exertions in the laboratory and we'd be very engaging so my graduate students look at them in the eye that whistle they turn on the radio make small talk with them do whatever they can to make them feel comfortable so they went through did some exertions and then halfway through the experiment I walk in the room and I start yelling at the graduate student you know I start saying things like Bob you'll never graduate you don't do it like this you do it like that and I'm not that bad of a guy it's really all sort of a staged event and so we go out of the room we pretend we're having this big argument just leave the subject in the room all wired up to think about what he just saw and all the the negative hostility was directed at the graduate student not the subject and so after about five minutes the graduate student goes back in the room and he proceeds to say we got to do this again it's all he says turns off the radio stops looking at the person in the eye stops the small talk stops the whistling and all he says is we got to do this again so they do the same exact experiment again and here are the results the red diamonds are the stress sessions the blue squares are the unstressed sessions and if you look at this for some people there's a huge jump in stress session being generally more stressful than the unstressed for other people they're light on top of each other why the difference well it turns out it was all due to your personality introverts it it we had a huge jump in terms of the loads on the spine and introverts with the extroverts they couldn't care less same thing with intuitive sensors so what's happening here what's the common thread amongst all these risk factors well the common thread is the way the body in the mind particularly in interprets information so we get the information about the world from what we hear what we see what we feel what the emotions are and our brain processes this and recruits the muscles in the torso and the muscles of what really load the spine and what happens when people are have higher levels of stresses we have more what we call Co contraction so these muscles and your torso are actually playing a little tug of war which is with each other which greatly increases the stress as opposed to what it really takes to perform the task and that's how these increased loads occur and that's how it's - it's tied to the brain so what do you do about this well wellness is a great start what is wellness wellness is taking care of all the different parameters of your life so you know occupation social spiritual physical intellectual medical financial everything's got to be in balance and if all these parts of your life are in balance then the way your mind processes information recruits those muscles and token tracks to load the spine are all in balance - and you minimize the loads on the spine that way and as a matter of fact here at Ohio State we have a huge emphasis right now and wellness and this is part of why we do because we know this is very very important in terms of what it does for the day-in and day-out stress on the body including physical loads so my message then is if you want to balance control your back pain balance your life that's what it's all about thank you for your attention

Channel: TEDx Talks

Views: 128,631

Keywords: ted talk, ted talks, tedx talks, tedx, tedx talk, ted x, ted

Id: u-kJ4XD5xQk

Length: 13min 33sec (813 seconds)

Published: Thu May 16 2013