Brudzinski's Sign = Neck flexion causes hip/knee flexion; indicates meningeal irritation.
Suboccipital Tenderness = Pain upon pressure below skull base; tension or cervicogenic headache.

CERVICAL

Soto-Hall Test = Neck flexion supine; detects cervical injury or irritation.
Spurling’s Test = Extend, rotate, compress head; nerve root compression.
Lhermitte’s Sign = Flex neck causes shock sensation; spinal cord issue.
Bakody’s Sign = Arm overhead relieves pain; cervical radiculopathy.

THORACIC

Adam’s Forward Bend = Forward bending reveals rib hump; indicates scoliosis.
Thoracic Flexion Test = Forward bend, thoracic pain indicates facet or muscular issue.

LUMBAR

Straight Leg Raise (SLR) = Elevating leg causes sciatic pain; lumbar radiculopathy.
Bragard’s Test = SLR plus foot dorsiflexion increases pain; nerve root irritation.
Slump Test = Seated spinal flexion causes sciatic pain; neural tension.
Kemp’s Test = Extend, rotate, compress lumbar spine; facet joint irritation.

SI JOINT

Gaenslen’s Test = Leg drop off table stresses SI joint; identifies SI dysfunction.
FABER (Patrick’s) Test = Hip flexion/abduction/external rotation; pain suggests SI pathology.

SHOULDER

Neer’s Test = Passive forward flexion of shoulder; identifies impingement.
Hawkins-Kennedy Test = Shoulder internal rotation at 90° flexion; impingement syndrome.

ELBOW

Cozen’s Test = Resist wrist extension; lateral epicondylitis ("tennis elbow").
Golfer’s Elbow Test = Resist wrist flexion; medial epicondylitis ("golfer’s elbow").
Lateral Epicondyle Tenderness = Pain at outer elbow; lateral epicondylitis confirmed.
Medial Epicondyle Tenderness = Pain at inner elbow; medial epicondylitis confirmed.

WRIST

Phalen’s Test = Wrists flexed, backs together; tingling indicates carpal tunnel.
Tinel’s Sign (Wrist) = Tap median nerve; tingling suggests carpal tunnel syndrome.

HIP

Trendelenburg Test = Single-leg stand; pelvis drops indicating weak abductors.
Thomas Test = Supine knee flexion; lifted thigh reveals hip flexor tightness.
Piriformis Sign = Hip rotation with flexed knee causes pain; piriformis syndrome.
Trochanteric Bursa Pressure = Painful pressure over trochanter; bursitis confirmed.

KNEE

McMurray’s Test = Rotate knee flexed; clicking indicates meniscal tear.
Anterior Drawer Test = Tibia moves forward; ACL injury suspected.

ANKLE

Anterior Drawer (Ankle) = Forward foot displacement; tests anterior talofibular ligament integrity.
Thompson Test = Squeeze calf, no plantarflexion; Achilles tendon rupture.

INJECTIONS

Cervical/HA: TPI ONB FACET MEDIAL BB -> CFA CERVICAL EPIDURAL

Lumbar /SIJ: FACET MEDIAL BB ->RFA EPIDURAL TFESI SIJ / HIP / KNEE

ASA PHYSICAL STATUS I-VI [ASA READ]

NITRONOX PLUS - Training (5 min) Training 20 min ,

https://pubmed.ncbi.nlm.nih.gov/

Anxiolysis|Sedation|Anesthesia Overview - go to conscious sedation (New!)

SPINE:

CERVICAL- FACET MBB RFA | ESI (CESI w/o ctr) |ONB | TPI |TH-ESI

LUMBAR - FACET MBB RFA | ESI (LESI w/o ctr) |TFESI |SACROILIAC JOINT|CAUDAL

NEVRO - Nevro channel SCS TRIAL [ download print 4 pages] - Detailed/40min

NERVE BLOCKS | TRIGGER POINT:

OCCIPITAL |TRIGGER POINT |

MIGRAINE NERVE BLOCKS: ONB |SPG block | Botox

UE NERVE BLOCKS | JOINT INJECTIONS

| SHOULDER | ELBOW | WRIST

LE NERVE BLOCKS | INJECTIONS

LATERAL FEMORAL CUT. NERVE

https://www.nysora.com/topics/regional-anesthesia-for-specific-surgical-procedures/lower-extremity-regional-anesthesia-for-specific-surgical-procedures/ultrasound-guided-lateral-femoral-cutaneous-nerve-block/

https://thepainsource.com/procedure-lateral-femoral-cutaneous-nerve-block/

KNEE PAIN:

PRP | KNEE | G-BLOCK |GN-RFA

Surgeries - Mobi-c Minimally Invasive TLIF TLIF

Sample info on Artificial Discs

DASH = https://www.healthvermont.gov/sites/default/files/documents/pdf/HPDP-Diabetes_dash%20eating%20plan.pdf

TYPES OF PAIN

Overall Pain Burden

= Chronic pain affects ~20% adults worldwide (~1.5B people) and ~50M US adults (20M high-impact).

1. Nociceptive Pain = Pain from actual/potential tissue damage via intact somatosensory system.

Prevalence: ~30–40% adults worldwide | ~100M US Subtypes: Somatic (skin, muscle, bone) vs Visceral (organs).
Mediators: Prostaglandins, bradykinin, substance P. Examples: Osteoarthritis, appendicitis, fractures.

2. Neuropathic Pain = Pain from lesion or disease of somatosensory nervous system.

Prevalence: ~7–10% worldwide | 8–10% US Mechanisms: Ectopic discharges, maladaptive plasticity, central sensitization.
Biomarkers: NaV1.7/NaV1.8 sodium channel mutations, glial activation.
Examples: Diabetic neuropathy, post-herpetic neuralgia, radiculopathy.

3. Nociplastic Pain = Pain from altered nociception without clear tissue damage or nerve lesion.

Prevalence: ~20% worldwide | ~10–15% US Mechanisms: Central sensitization, impaired descending inhibition, abnormal pain modulation. Associated Syndromes: Fibromyalgia, irritable bowel syndrome, tension-type headache. Neuroimaging: Abnormal thalamic–cortical connectivity, altered μ-opioid receptor binding.

4. Mixed Pain = Overlap of nociceptive, neuropathic, and/or nociplastic processes.

Prevalence: ~30–50% of chronic pain cases | ~40% US
Examples: Low back pain (mechanical + nerve compression), cancer pain, post-surgical pain.

5. Other Specialized Categories =

Inflammatory Pain = Driven by immune mediators (TNF-α, IL-1β, NF-κB). Seen in RA, Crohn’s, gout. (~3–5% worldwide | ~5–7% US)
Functional Pain = Clinical symptom without proportional pathology, overlaps with nociplastic.
Psychogenic/Idiopathic Pain = Pain disproportionate or unexplained by pathology, influenced by psychiatric or biopsychosocial factors (~5–10%).

📌 Key Concept:

Nociceptive = damage signal
Neuropathic = nerve injury
Nociplastic = altered processing
Mixed = overlapping mechanisms

CERVICAL FACET PATTERNS

Disc Bulge vs Herniation vs Extrusion vs Stenosis

Disc Bulge (DB) – Mild <3 mm, Moderate 3-5 mm, Severe >5 mm | ICD-10: M51.26 (L), M50.30 (C), M51.24 (T)

Disc Herniation (DH) – Protrusion 2-6 mm, Extrusion >6 mm | ICD-10: M51.26 (L), M50.20 (C), M51.24 (T)

Central Canal Stenosis (CCS) – C10 ... L12

C-spine <10 mm (severe), 10-13 mm (moderate)

L-spine <12 mm (severe), 12-15 mm (moderate) | ICD-10: M48.02 (C), M48.04 (T), M48.06 (L)

Foraminal Stenosis (FS) – Significant narrowing <3 mm | ICD-10: M99.33 (C), M99.34 (T), M99.35 (L)

Facet Hypertrophy (FH) – Thickening >3 mm | ICD-10: M47.812 (C), M47.814 (T), M47.816 (L)

Ligamentum Flavum Hypertrophy (LFH) – Thickening >2-4 mm | ICD-10: M47.12 (C), M47.14 (T), M47.16 (L)

Spondylolisthesis (SPL) – Grade I: 0-25%, Grade II: 26-50%, Grade III-IV: >50% | ICD-10: M43.12 (C), M43.14 (T), M43.16 (L)

Spondylosis (SP) – Degenerative disc changes with osteophytes (1-3 mm) | ICD-10: M47.812 (C), M47.814 (T), M47.816 (L)

Osteophyte Complex (OC) – Bone spurs contributing to narrowing | ICD-10: M25.78 (C/T/L)

Thoracic Kyphosis (TK) – Hyperkyphosis >40-45° curvature | ICD-10: M40.09

Lumbar Lordosis Abnormality (LLA) – Loss of normal curvature | ICD-10: M40.56

Thoracic/Lumbar Radiculopathy (TR/LR) – Nerve root compression | ICD-10: M54.16 (L), M54.14 (T), M54.12 (C)

Cervical Myelopathy (CM) – Spinal cord compression | ICD-10: M47.12

Medical Topicals | OTC & HOME MADE

OTC Topicals for Hand/Joint Pain

Voltaren® Arthritis Pain Gel – Diclofenac 1% NSAID; ↓ inflammation.
Biofreeze® or Icy Hot® – Menthol/camphor; cooling counter-irritant.
Zostrix® – Capsaicin; depletes substance P.
Aspercreme® Lidocaine – Lidocaine 4%; sodium channel blocker.

4-Ingredient Ginger–Turmeric Salve (Simple Version)

Ingredients

½ cup coconut oil (carrier & base)
2 Tbsp turmeric powder (anti-inflammatory)
2 Tbsp grated fresh ginger (warming, anti-inflammatory)
1 Tbsp beeswax pellets (thickens & stabilizes)

Method

Warm coconut oil with ginger & turmeric on low heat 20–30 min (avoid boiling).
Strain out solids.
Return infused oil to pan; add beeswax and melt fully.
Pour into jar/tin; cool until solid.

Use
Apply to affected joints 2–3×/day.
Shelf life: ~6 months in a cool, dark place.

DISCUSS WITH YOUR DOCTOR 1ST ( Blood thinners | English )

https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/022307s002lbl.pdf

The half-life of Effient (prasugrel) is approximately 7 hours (range 2–15 hours), based on the elimination half-life of its active metabolite.[1] This is substantially shorter than the half-life of warfarin (36–48 hours), and also shorter than the half-lives of the direct oral anticoagulants previously discussed: dabigatran (12–17 hours), apixaban (9–14 hours), rivaroxaban (5–13 hours depending on age), and betrixaban (19–27 hours).[1-6]

**** Important Reminder - FOR REFERENCE ONLY

SEEK INSTRUCTIONS FROM YOUR DOCTORS ****

***For Spine AND HIP INJECTIONS - here are instructions to stop bloodthinners.

For SI joint injections - no need to stop your blood thinner.

Do not stop taking your anticoagulant until you have been cleared to do so by the medical provider prescribing that medication.

Anticoagulants

Coumadin (warfarin): Stop 5 days before procedure; INR must be obtained on the day of the procedure.
Pradaxa (dabigatran): Stop 4 days before procedure.
Eliquis (apixaban): Stop 3 days before procedure.
Xarelto (rivaroxaban): Stop 3 days before procedure.
Bevyxxa (betrixaban): Stop 6 days before procedure.

Antiplatelets / Platelet Inhibitors

Aspirin / Excedrin (any dose “baby” or otherwise): Stop 7 days before procedure.
Plavix (clopidogrel): Stop 7 days before procedure.
Effient (prasugrel): Stop 10 days before procedure.
Ticlid (ticlopidine): Stop 5 days before procedure.
Pletal (cilostazol): Stop 2 days before procedure.

NSAIDs (Nonsteroidal Anti-inflammatory Drugs)

Advil (ibuprofen): Stop 1 day before procedure.
Arthrotec (diclofenac): Stop 1 day before procedure.
Indomethacin: Stop 2 days before procedure.
Lodine (etodolac): Stop 2 days before procedure.
Mobic (meloxicam): Stop 4 days before procedure.
Aleve (naproxen): Stop 4 days before procedure.
Relafen (nabumetone): Stop 6 days before procedure.
Feldene (piroxicam): Stop 10 days before procedure.

Supplements

Fish oil: Stop 6 days before procedure.
Garlic: Stop 7 days before procedure.
Vitamin E: Stop 7 days before procedure.
Turmeric: Stop 7 days before procedure.

Again, confirm these timelines with the provider who prescribed your medication.

HABLE CON SU MÉDICO PRIMERO (Anticoagulantes | Española) [videos]

**** Recordatorio importante - SOLO PARA REFERENCIA

BUSQUE INSTRUCCIONES DE SU MÉDICO ****

Para inyecciones en la columna vertebral Y la cadera – aquí están las instrucciones para suspender anticoagulantes.

Para inyecciones en la articulación sacroilíaca (SI) – no es necesario suspender su anticoagulante.

No deje de tomar su anticoagulante hasta que haya sido autorizado por el proveedor médico que le recetó ese medicamento.

Anticoagulantes

Coumadin (warfarina): Suspenda 5 días antes del procedimiento; el INR debe obtenerse el día del procedimiento.
Pradaxa (dabigatrán): Suspenda 4 días antes del procedimiento.
Eliquis (apixabán): Suspenda 3 días antes del procedimiento.
Xarelto (rivaroxabán): Suspenda 3 días antes del procedimiento.
Bevyxxa (betrixabán): Suspenda 6 días antes del procedimiento.

Antiplaquetarios / Inhibidores de Plaquetas

Aspirina / Excedrin (cualquier dosis “baja” o normal): Suspenda 7 días antes del procedimiento.
Plavix (clopidogrel): Suspenda 7 días antes del procedimiento.
Effient (prasugrel): Suspenda 10 días antes del procedimiento.
Ticlid (ticlopidina): Suspenda 5 días antes del procedimiento.
Pletal (cilostazol): Suspenda 2 días antes del procedimiento.

AINEs (Antiinflamatorios No Esteroides)

Advil (ibuprofeno): Suspenda 1 día antes del procedimiento.
Arthrotec (diclofenaco): Suspenda 1 día antes del procedimiento.
Indometacina: Suspenda 2 días antes del procedimiento.
Lodine (etodolaco): Suspenda 2 días antes del procedimiento.
Mobic (meloxicam): Suspenda 4 días antes del procedimiento.
Aleve (naproxeno): Suspenda 4 días antes del procedimiento.
Relafen (nabumetona): Suspenda 6 días antes del procedimiento.
Feldene (piroxicam): Suspenda 10 días antes del procedimiento.

Suplementos

Aceite de pescado: Suspenda 6 días antes del procedimiento.
Ajo: Suspenda 7 días antes del procedimiento.
Vitamina E: Suspenda 7 días antes del procedimiento.
Cúrcuma: Suspenda 7 días antes del procedimiento.

TYPES OF PAIN -> TESTS -> TREATMENTS

Most Common Types of Pain =

LBP - HAs - Joint - Neuropathic - FBM - Whiplash (acute)

Neck - Abd/Pelvic - Post-Op - CA - Dental/Face | PAIN RESEARCH

XRAY MRI EMG NCV | Cracking Joints | Sciatic N. |

1️⃣ Lower Back Pain (Most Common) | ~30-40% of adults at some point in life | Leading cause of disability worldwide | Causes: Muscle strain, herniated discs, arthritis (Spine | Knee), spinal stenosis.

DX: Spinal Stensosis - Cervical Lumbar

LUMBAR - FACET MBB RFA | ESI (LESI w/o ctr) |TFESI |SACROILIAC JOINT|CAUDAL

CERVICAL- FACET MBB RFA | ESI (CESI w/o ctr) |ONB | TPI |TH-ESI

2️⃣ Headaches & Migraines | ~15-20% of the population regularly [Tension 40% / Migraine 10% ] | Includes tension headaches, migraines, cluster headaches | Causes: Stress, dehydration, neurological disorders, hormonal changes. WHIPLASH (HEADACHE) |

3️⃣ Joint Pain (Arthritis & Osteoarthritis) | ~25% of adults | Common in knees, hips, hands, shoulders | Causes: Aging, wear-and-tear, autoimmune conditions (rheumatoid arthritis).

NON-STEROID TREATMENTS

Topical Treatments

CBD/THC Topicals – Apply 2–3 times daily as needed (20–30 mg per dose).
Diclofenac Gel (Voltaren 1%) – Apply 2–4 g up to four times daily.
Capsaicin Cream (0.025–0.1%) – Apply 3–4 times daily (initial burning sensation expected).

Therapies & Physical Treatments

Acupuncture – 1–2 sessions per week (based on response).
TENS Therapy – Use 15–30 min per session, up to 2–3 times daily.
Paraffin Wax Therapy – Heat wax to 125–130°F, dip hands 5–10 times, wrap, and leave for 15–20 min, repeat daily or as needed.
Hand Exercises – 5–10 min, twice daily (stretching, grip strength, and mobility drills).

Supplements & Natural Remedies

CBD - OTC is supplement - buy only at a reviewed, reputable company - usually 25-50 mg per dose 2-3x per day
Omega-3 (Fish Oil, EPA/DHA) – 1,000–3,000 mg daily.
Curcumin (Turmeric w/ Black Pepper Extract) – 500–1,500 mg daily, divided into 2–3 doses.
Collagen Peptides – 5–10 g daily (powder or capsules).
Magnesium Lotion (or Oral Supplement) – Apply 1–2 times daily OR take 200–400 mg magnesium glycinate orally.

LUPUS | LIVING WITH LUPUS | ANTI-INFLAMMATORY DIET | RESEARCH = CANNABIS AND AUTOIMMUNE DZ CANNABIS AND LUPUS

LUPUS AND DIET | LUPUS + NUTRITION |

4️⃣ Neuropathic Pain (Nerve Pain, Sciatica, Neuropathy) | ~10-15% of the population | Includes sciatica, diabetic neuropathy, post-herpetic neuralgia, carpal tunnel syndrome | Causes: Diabetes, nerve compression, injury, chemotherapy.

NEUROPATHY

5️⃣ Musculoskeletal Pain (Fibromyalgia, Myofascial Pain, Chronic Pain Syndrome) | ~10-12% of adults | Widespread pain, often linked to stress or nervous system dysfunction | Causes: Muscle overuse, central nervous system disorders, psychological stress.

6️⃣ Neck Pain | ~10-12% of adults | Often work-related or posture-related | Causes: Poor posture, whiplash, arthritis, disc herniation.

7️⃣ Abdominal & Pelvic Pain (IBS, Endometriosis, Menstrual Pain) | ~10-15% of the population | Common in women and people with digestive disorders | Causes: Inflammatory conditions, hormonal imbalances, digestive disorders.

8️⃣ Post-Surgical & Post-Traumatic Pain | ~10-15% of surgery patients | Can develop into chronic pain | Causes: Nerve damage, scar tissue formation, inflammation.

9️⃣ Cancer Pain | ~30-50% of cancer patients (70-90% in late-stage cases) | Often severe and persistent | Causes: Tumor growth, nerve compression, chemotherapy side effects.

🔟 Facial & Dental Pain (TMJ, Toothache, Trigeminal Neuralgia) | ~5-10% of the population | Often related to nerve disorders or jaw misalignment | Causes: Tooth decay, jaw misalignment, nerve dysfunction (trigeminal neuralgia).

Whiplash Sciatica THORACIC MBB

Disclaimer: Information provided is for reference only and does not imply affiliation or endorsement with the mentioned individuals, companies, products, services, treatments, and websites. For informational purposes only - contact your medical provider for health and medical advice. Content accuracy, completeness, and timeliness are not guaranteed. Inclusion of information and websites does not constitute endorsement. Users should exercise caution when accessing external content. See your medical, legal, finance, tax, spiritual and other professionals for discussion, guidance, planning, recommendations and greater understanding of the risks, benefits, options and ability to apply any information to your situation.

BILLING / CODING OFFICE VISIT TELEHEALTH | Focus for work

New Pt Visits = [ Less than 15min x last # (ex What time duration is 99205? 5x15 = 75; 74-60. ]

99202 │ Strtfrwd │ 15–29 min | 99203 │ Low │ 30–44 min

99204 │ Moderate │ 45–59 min | 99205 │ High │ 60–74 min

Established Patient Visits = [ less than 10 min x last # (ex what time duration is 99214? 4x10 = 40; 39-30.]

99212 │ Strtfrwd │ 10–19 min | 99213 │ Low │ 20–29 min

99214 │ Moderate │ 30–39 min | 99215 │ High │ 40–54 min

Prolonged Services

+99417 │ Add-on │ 75–88 min
G2212 │ Add-on │ 89+ min

NOTES:

99417: A CPT code used by healthcare providers in the United States to bill for extra time spent with a patient beyond the standard duration of the primary E/M service.
Add-on: This refers to the nature of the code itself. It is a secondary code that must be billed in addition to a primary E/M service code, not on its own.
Requirements: To use this code, a provider must have spent at least 15 minutes of documented time beyond the total time required for the highest-level E/M service on the same date.
Use case: A provider might bill a standard E/M code like 99215 for a typical established patient visit, and then add-on 99417 to cover significant extra time spent discussing a complex issue or coordinating care

BILLING / CODING ICD10 CPT

pain source; codes on specific sections - medical , spine, joint, headaches/nerve pain, cancer pain etc

Am Academy of Ortho Surgeons

FREED NOTEMD

Cervical Spine (M50.2- codes) C2–3 → M50.21 (High cervical) C3–4, C4–5, C5–6 → M50.22 (Mid-cervical) C6–7, C7–T1 → M50.23 (Cervicothoracic region)
Thoracic Spine (M51.24) T1–T12 → M51.24 (Other intervertebral disc displacement, thoracic region)
Lumbar Spine (M51.26–M51.27) L1–L5 → M51.26 (Other intervertebral DD, lumbar region) L5–S1 → M51.27 ( DD lumbosacral region)

Spinal Stenosis

Spinal Stenosis – MM Criteria Outline

I. Cervical Spine (Neck)

A. Central Canal (Sagittal Diameter) Normal: 17–18 mm Relative stenosis: <13 mm Absolute stenosis: ≤10 mm

B. Clinical Correlation

Increased risk of cord compression when <13 mm

Strong association with cervical myelopathy when ≤10 mm

Symptoms: hand clumsiness, gait imbalance, weakness, sensory loss, hyperreflexia

C. Functional/Medical Necessity Notes

Document ADL limitations, fall risk, or progressive neuro deficits
Conservative therapy tried ≥6 weeks unless urgent (e.g., rapidly progressive myelopathy)

II. Lumbar Spine (Lower Back)

A. Central Canal (AP Diameter) Normal: 15–25 mm Relative stenosis: 10–12 mm Absolute stenosis: ≤10 mm

B. Clinical Correlation

Neurogenic claudication (leg pain with standing/walking, relieved by sitting/flexion)
Radiculopathy with dermatomal pain, sensory loss, weakness, reflex changes
Functional limits: walking <100–200 feet without rest

C. Functional/Medical Necessity Notes

Failed conservative therapy (PT, meds, injections) ≥6 weeks
Surgery/intervention appropriate if disabling pain ≥3–6 months or progressive deficit
Urgent indication: cauda equina (bowel/bladder dysfunction, saddle anesthesia)

III. Lateral Recess

A. Depth

Normal: ≥4–5 mm Stenosis: <4 mm (diagnostic)

B. Clinical Correlation

Radicular leg pain or neurogenic claudication correlates with recess narrowing Often affects traversing nerve roots

IV. Neural Foramen

A. Foraminal Height

Normal: ~15 mm Mild narrowing: 10–15 mm Moderate: 8–10 mm Severe: ≤8 mm

B. Clinical Correlation

Foraminal stenosis = nerve root impingement, dermatomal pain, paresthesia, weakness
Severe stenosis (≤8 mm) usually associated with compressive radiculopathy

V. Key Documentation Elements (Insurance MM Style)

Imaging: MRI/CT shows narrowing (with mm measurements) at symptomatic levels
Symptoms: Neurogenic claudication, radicular pain, or myelopathy signs
Neuro Exam: Objective deficits (weakness, sensory loss, reflex changes)
Functional Impact: ADL or ambulation limits, failed conservative therapy
Urgency Criteria: Cauda equina, rapid neuro decline, or severe progressive myelopathy

WORK INSTRUCTIONS - ENGLISH AND SPANISH

🩺 Patient Instructions

English

Use a lumbar brace during work that involves bending or lifting.
Avoid heavy lifting when possible; ask for help with loads over 20–25 lbs.
Bend at the knees, not the waist; keep the back straight when lifting.
Take frequent breaks to stretch your back and legs.
Apply ice or heat as needed for pain relief.
Continue any prescribed exercises or physical therapy.
Report worsening pain, numbness, or weakness to your doctor immediately.

Español

Use un cinturón lumbar durante el trabajo que implique agacharse o levantar objetos.
Evite levantar objetos pesados cuando sea posible; pida ayuda con cargas de más de 9–11 kg.
Doble las rodillas, no la cintura; mantenga la espalda recta al levantar.
Tome descansos frecuentes para estirar la espalda y las piernas.
Aplique hielo o calor según sea necesario para aliviar el dolor.
Continúe con los ejercicios o la fisioterapia indicada.
Informe de inmediato a su médico si el dolor empeora, o si siente adormecimiento o debilidad.

These are medical back braces and spinal support devices designed to help with lower back pain, posture correction, and spinal alignment. They include options for different conditions like herniated discs, scoliosis, and general back support. Consult your doctor to determine which type best suits your specific needs.

Key Points:

Proper fitting essential- wrong size = worsen pain
Start gradually - wear 30-60 minutes initially to avoid muscle weakness
Combine with PT - don't rely on brace alone
Check insurance coverage - may need Rx
Monitor skin - watch for irritation
Get medical evaluation first - wrong type can cause harm

T9 medial branch → T9–10 & T10–11 facets
T10 medial branch → T10–11 & T11–12 facets
T11 medial branch → T11–12 & T12–L1 facets
T12 medial branch → T12–L1 & L1–L2 facets
L1 medial branch → L1–2 & L2–3 facets
L2 medial branch → L2–3 & L3–4 facets
L3 medial branch → L3–4 & L4–5 facets
L4 medial branch → L4–5 & L5–S1 facets
L5 dorsal ramus → L5–S1 facet (via branch to sacral ala/SI capsule)

📚 Reference: Bogduk N, Wilson AS, Tynan W. The human lumbar dorsal rami. J Anat. 1982;134(Pt 2):383–397.
Bogduk N. Clinical Anatomy of the Lumbar Spine and Sacrum, 5th ed. Churchill Livingstone Elsevier, 2012.

T11–12 facet → innervated by T10 and T11 medial branches
T12–L1 facet → innervated by T11 and T12 medial branches

🩺 Key rule: Each thoracic or lumbar facet joint receives dual innervation, from the medial branch at its own level and the level above.

Disclaimer: Information provided is for reference only and does not imply affiliation or endorsement with the mentioned individuals, companies, products, services, treatments, and websites. For informational purposes only - contact your medical provider for health and medical advice. Content accuracy, completeness, and timeliness are not guaranteed. Inclusion of information and websites does not constitute endorsement. Users should exercise caution when accessing external content. The third party links are not under our controlled and we do not monitor them so we cannot be responsible for any damages from using those links. See your medical, legal, finance, tax, spiritual and other professionals for discussion, guidance, planning, recommendations and greater understanding of the risks, benefits, options and ability to apply any information to your situation.

Key resources include American Academy of Pain Medicine (https://www.painmed.org/), International Association for the Study of Pain (https://www.iasp-pain.org/), American Academy of Orthopaedic Surgeons (https://www.aaos.org/), and National Alliance on Mental Illness (https://www.nami.org/) for comprehensive pain management guidance.

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