Dr Kumar's BASIC HEALTHCARE FOR ALL
BACK PAIN & LOW BACK PAIN (LUMBAGO)
Back pain & low pack pain (lumbago) are perhaps the most widespread of orthopedic maladies, suffered by people of all demographic areas across the world. Lower back is in fact the most versatile, work-load bearing, multi-joint part of the body that is almost constantly at work. It is fully at work when you stand, you bend forwards or backwards, or even sideways, if you stoop low to pick up anything, or to lift anything. It is at work when you sit down, or get up from a sitting position. If you lie flat in the bed, it sure gets some much-needed rest, but if you turn sides in the bed, the low back again comes into play, it comes into action every time you sit and getup from bed, chair, sofa, or your toilet seat. Bad posture when you are standing, walking, sleeping, or just sitting slouched in sofa watching TV, or working at the desk. Low back is under certain stress when you lift loads, or reach out in the front, back or sideways to pick-up anything. You trying getting in/out of your car, or any other vehicle, your lower back is majorly involved in all such movements. Mechanical injury to the spine, or maintenance of wrong posuture for long durations of times damage the spine in a variety of ways - lumbar spondylosis, ankylosing spondylitis, lumbar spondylitis, piriformis syndrome, lumbar rediculaopthy, lumbar lardosis, lumbar spondylolisthesis, slipped-discs, vertebral disc compression etc. Such a huge variety of maladies suffered by the lower spine is simply because of the huge range of movements our lower spine is involved in, and the varying degree if consequent impacts it is subject to as a result of all these variety of active & passive movements, and also the load-involving movements. Imagine, all that is stated above is for the lower spine of people indulging in normal day-t-day activities. The possibility of the trauma to the spines of sportspersons and dancers, and active body-show performers may be far more than what a normal person usually experiences.
In the urban population occupational stress (long hours of sitting) and added strain for posture maintenance on the back muscles owing to the weakened and rather flaccid abdominal muscles (owing to obesity, mild or acute) is the main causative reason for most lower back problems. At least 80% of all Americans suffer an occasional backache, and for about 13% the problem is chronic. The majority of backaches originate in the small lumbar spine, between the waist and tailbone; the cervical spine (neck) is the second most importance source of back pain. Depending upon the cause, the pain may be constant, dull, and centered in one area, or it may be acute or stabbing, and spread from the lower back to the buttocks and legs, or from the neck to the jaw and down the arm.
Over the years it has been considered that the broad term 'back pain' includes the pain that strikes the lower back (perhaps the commonest), middle back, upper back and lower back pain with sciatic + the rarer piriformis syndrome. The pains of these various segments in the back may be classified based on the duration of occurrence as acute (< 6 weeks), sub-chronic (6-12 weeks) or finally chronic (>12 weeks). Of all these pain types perhaps the 'lower back pain' with or without sciatica is the most common & widespread variety. If it becomes chronic (it does so indeed many a times) it may in fact become a gross functional barrier as one ages. And, then, the prognosis for its total elimination becomes that much more improbable 'coz of the limitations on activity (several maladies combined at the same time) with advancing age. Such age-related pains may be perceived as a dull or sharp types caused by degenerative changes in the muscle, or it may just remain a nagging mechanical pain, or chronic arthritis, or even a consequence of some spine deformity etc.
Lower back pain has several factors owing to which its treatment may become that much more difficult, but a right diagnosis and proper line of drug & physiotherapy and exercise regimen may prove quite successful at times. The two most common causes of lower back pain are : (i) mechanical lower back pain, a condition where the pain is in thigh, buttocks & lower back itself, and (ii) sciatica.
Most back pain is due to muscle muscle strains & spasms, often the result of improper lifting or abrupt twisting and/or stretching. Poor posture, obesity and pregnancy are common contributing factors, as is the sedentary lifestyle so characteristic or urban population, confined for long hours in TV watching and/or working at their desk/bed in an overly stressful slouched posture. The vertebral discs in the spine act as a shock absorber between adjacent vertebrae. Spinal discs also act as ligaments that hold the vertebrae of the spine together and as cartilaginous joints that allow for slight mobility in the spine. There are a total of twenty-three vertebral discs in the spinal column. Specific problems with any of these discs may prompt different symptoms, including back pain, neck pain, and sciatica. A slipped (prolapsed) or ruptured spinal disc also causes a lot of discomfort or pain, especially if the disk pinches a nerve in the neck or lower back. So can a structural abnormality, such as a curved spine (scoliosis). One should consult his orthopedic surgeon if the back pain persists for more than two weeks despite rest, or if it recurs soon enough. Don't ever delay if the pain is accompanied by other symptoms, such as numbness in the arms or legs, or loss of bowel or bladder control.
Cervical spondylitis (the common neck pain) has been a fairly common malaise in both young and older subjects. Depending upon the severity of symptoms, it is treated with either NSAIDs or with with NSAIDs + cervical traction in an orthopedic clinic.
Ankylosing spondylitis is a type of arthritic disease with chronic inflammation of the spine and the sacroiliac joints. It is alleged to be associated with the HLA-B27 gene, and hence a genetically inherited disease. It affect males far more commonly than females, and may be a common cause of back pain in adolescents and young adults. Treatment for this malady involves drugs that reduce inflammation and/or suppress immunity, plus, of course physiotherapy and exercises either at home or in an orthopedic clinic. Early signs and symptoms of ankylosing spondylitis might include pain and stiffness in your lower back and hips, especially in the morning and after periods of inactivity. Neck pain and fatigue also are common. Over time, symptoms might worsen, improve or stop at irregular intervals. The most commonly affected areas are - the sacroiliac joint between the base of the spine and the pelvis; the vertebrae in the lower back; the spinal locations (fibrous & fibrocartilaginous entheses) where the tendons and ligaments attach to bones; at times also along the back of the heel; the cartilage between the breastbone and ribs; the hip and the shoulder joints. In severe ankylosing spondylitis, new bone forms as part of the body's attempt to heal. This new bone gradually bridges the gap between vertebrae and eventually fuses sections of vertebrae. The parts of the spine so affected become stiff and inflexible. Such fusion can also stiffen the rib cage somewhat - directly affecting one's lung function. One of the most common complications can be uveitis (eye inflammation) with severe inflammation and blurred vision. In some subjects bones can thin out and the weakened vertebrae can degenerate, affecting mobilty & posture to varying degree. The implication of consequent vertebral fractures putting pressure on the spinal cord and the emanating nerves must be well understood and discussed with your orthopedic surgeon. The disease can also pose problems for the aorta emerging from the heart. Aortic inflammation can be severe enough to affect effective heart functioning.
DIAGNOSTIC STUDIES & PROCEDURES
After examining your back and testing nerve reflexes, the doctor wil probably order X-rays of the affected region of the back. If a ruptured disk is suspected, imaging studies as computerized tomography (CT) scans or magnetic resonance imaging (MRI) can probably pinpoint the exact problem. Other tests may include bone density studies and nerve-muscle evaluations.
All people with traumatic, chronic, acute or degenerative diseases of spine must rest sufficiently during pain flare-ups. Even people with relatively severe pain do respond positively to conservative measureslike physiotherapy with an easy exercise regimen to be follows at home. It sufficient relief is not obtained by these conservative measures, and depending upon the severity of symptoms, NSAIDs, muscle relaxants, epidural injections of corticosteroids and even surgery (if at all necessary) are used (individually, or in combination) for effective treatment of several spinal arthritic conditons. Most simple backaches can be managed with aspirin (or stronger NSAIDs) and rest. If this conservative course proves inadequate, a muscle relaxant and perhaps a cortisone injection may be tried. At times immobilizing the back with a brace, neck collar, or even cervical or lumbar traction may be needed, especially if the problem is suspected to stem from a back injury. Persistent back pain caused by a ruptured (herniated) disk may require surgery to manipulate/remove the disk. Back pain due to any structural abnormality or disease requires treatment of the underlying condition. Because so many backaches are caused by muscle spasms, massage designed to relax the tensed muscle is a natural remedy. Techniques may range from the relatively gentle Swedish (classic) massage to rolling - a deep massage that calls for considerable pummeling - CAUTION, rolling may in fact be dangerous for people with osteoporosis, spinal arthritis, and any other degenerative bone disorders. Epidural injections of corticosteroids are often used in painful nerve compression spinal conditions like cervical radiculopathy & lumbar radiculopathy - a radiating pain caused by an irritated spinal nerve. Such irritation of a spinal nerve low back area causes pain the leg.
self-care is indeed the key to overcoming and preventing back pain.
Although most simple backaches are easily self-treated, one should usually
consult a doctor to rule out any serious underlying problem before
embarking on a self-treatment regimen for back pain. During an acute
flare-up, back pain due to a muscle strain or any injury requires rest in
order to heal completely. One should lie on a firm surface, such as a hard
mattress or floor mat. Don't lie on your stomach, instead, position
yourself on your back with your knees slightly bent and supported by a
pillow, or on your side with the knees bent. For extra relief, try using a
heating pad, an ice-pack, or alternating applications of heat and ice. As
soon as the pain eases perceptibly, start exercises designated to
strengthen your back. CAUTION : If an exercise produces pain, STOP it
immediately. Pain is more often than not a warning that something is
definitely wrong, or not completely healed still.
1. Avoid bending your back while picking something from lower levels, or from a table in front. Rather bend your knees, hold the object, and straighten yourself up - using only the knew and hip joints. Do it slowly and smoothly, and never in any jerky manner.
2. Do some basic stretching exercises before starting any major physical activity.
3. While getting up from the bed, turn to one side and use your elbows and forearns to get up. Do not get straight up as it is likely to put up quite some strain on your already bad back.
4. Do some light to moderate physical activity like walking, brisk walking, and even mild jogging as you start getting better.
Flexing exercises using knees and lower torso. McKenzie exercises (press ups), Sitting exercises, using a chair, and, most importantly Bridging exercises in lying down position, exercises for strengthening the abdominal & hip muscles, exercises involving stretching the back muscles & hip muscles. In severe and chronic cases of back pain these exercises should be performed only after consulting a specialist.
OTHER POSSIBLE CAUSES OF BACK PAIN
Severe osteoporosis, or thinning of the bones, often results in compression of the spinal column, spontaneous fractures of the vertebrae, and almost chronic back pain. Arthritis can also cause chronic back pain. A less common cause is a cancer that has spread to the bones.