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Back Pain

LOW BACK PAIN

Introduction:

Most of us suffer from low back pain and stiffness at some time or the other though the severity and frequency may vary. Lower back is a delicate area of muscles, nerves, bones and joints which are working continuously to support the weight of upper body.

Most of the time acute low back pain (pain which goes on for a limited time) will get better by itself, usually in less than 4 weeks. When pain keeps recurring or continues at a mild level, it is referred to as chronic back pain.

What causes low back pain?

The causes of it vary from individual to individual and also according to the age. Low back ache is often triggered by everyday activities such as bending awkwardly, lifting incorrectly, prolonged standing, poor posture and driving continuously. In some cases pain can occur for no reason. Low back pain can be caused by number of factors from injuries to the effects of ageing. Most acute back pains in the early 20’s to late 50’s are caused by muscle or ligament strain.

  1. Muscle or ligament strain : which is often a result of
Poor posture (Both standing & sitting)

Poor muscle tone

Bad lifting technique

Lack of fitness or being overweight

Over stretching or overuse of your back muscles

  1. Injuries: injuries can cause back pain irrespective of age.
  2. Effects of ageing --- LUMBAR SPONDYLOSIS
  3. Infections
  4. Tumors
Risk factors

Obesity

Sedentary occupations,

Wearing high heels,

Smoking

Unaccustomed and infrequent strenuous physical activity

What is spondylosis ?

It is like “wear and tear of the bones, small joints and discs of the back. These changes are seen in 5th and 6th decades of life. Patient usually complains of generalized back pain.

What is slipped disc / disc bulge?

Spinal column is made up building blocks called vertebra and in between supported by Intervertebral discs which act like shock absorbers. When the material from these discs leaks out due to injury, it presses on the regional nerves giving rise to symptoms. You may feel localized pain in the back or radiating pain to the lower limbs.

What is sciatica?

Sciatica is pain that shoots down the leg from your buttock to foot. It may be due to bulging disc in your spine pressing on a nerve (also known as slipped disc) or it could be caused by spasm of the muscle around the nerve in the back, buttock or leg.

Can osteoporosis cause back pain?

Osteoporosis is decreased amount of bone. It is usually associated with reduced strength and elasticity of muscles and ligaments. “wear and tear” in the discs and small joints of the back is also normally present . Osteoporosis can cause back pain due to minor fractures in the spine particularly in postmenopausal women.

Does one need to worry about his/her back pain?

No! but one need to see a doctor immediately if they have the following Warning signs:

  • Feel numb or have pins and needles in one or both legs or around your back passage, genital area, or inside the tops of your thighs.
  • You are incontinent (bowel or bladder) or unable to pass urine.
  • You feel unsteady on your feet or both legs feel weak.
  • You feel generally unwell, such as if you have a high temperature as well as severe back pain.
  • You have weight loss or night sweats.
  • Your back pain is getting worse over a period of time for no apparent reason.

Treatment

What can you do to help yourself?

Keep moving:

If you do not have any of the warning signs, then your pain is likely caused by muscular spasm. In such cases during the first 1-2 days, take it easy. Try not to bend forwards and try not to strain yourself or sit in the chair for long periods of time. If pain lasts longer than 1-2 days “keep active and get moving”. Moving around won’t do your back any harm even if it hurts – in fact it may help pain get better faster. Lying in bed for too long will not help and it may even make it worse. Carry out your normal activities like going to work (non strenuous) or going for short walks and cooking etc. But try not overdo things.

Pain Killers:

If low back pain is severe and interfering with daily activities short course of NSAID’s drugs along with some muscle relaxants may provide sufficient relief.

Hot and cold packs:

Use of corset or back belt

A well fitting corset can provide warmth, comfort and a degree of support to your back. It is best to use a brace only for short periods or during back-straining activities as prolonged use may weaken your back muscles. The best brace you can give yourself is your own muscle corset by building up your muscles with exercises. Strong muscles in the front mean less back pain.

Physiotherapy

Physiotherapy is a good adjuvant treatment and the therapist can advise you on the posture, movements and exercises in addition to using some local pain relief measures.

Tips to reduce the risk of back pain

“keeping your back fit and maintaining a good posture” Regular aerobic activities that don’t strain your back can increase strength and endurance in your lower back. Strengthen your back and abdominal muscles. Flexibility in your hips and upper legs allows for proper pelvic bone alignment, which improves back pain.

  • Walking is usually helpful – start slowly on flat ground, building up to longer walks and gentle slopes.
  • Swimming is an excellent exercise – do back or front crawl instead of breast-stroke which can strain your neck.
  • When your back pain has settled, using an exercise bike is a good way of getting fit. Keep the saddle at correct height to keep the natural curves in your spine.
  • Proper shoes and reduction of weight, if one is obese.

Lift Smart:

Follow correct lifting techniques: Do not bend at your waist, bend at the knees. When lifting luggage, stand along side of the luggage, bend at your knees, grasp the handle and straighten up. To lift a very light object from the floor (a piece of paper), lean over the object, slightly bend one knee and extend the other leg behind you. Hold on to a nearby chair or table support as you reach down to the object.









Sit smart :

Sit up right and try to lift your head and stretch yourself into a tall, relaxed posture in a proper chair. Avoid sitting for longer than 30 minutes at a stretch. Take a break by standing, even if it’s just for few seconds.

Make sure your chair supports your lower back (or place a small pillow at waist level), working surface is at proper height so you don’t have to lean forward. Now and then stand and stretch.









Stand smart

If you have been standing for a long time (e.g. while cooking), keep one leg on a foot rest (at a comfortable height) and alternate the legs after 20 minutes. Try tucking in the abdomen. Try reaching the overhead cabinets slowly not to twist / strain your back.









Drive smart :

While driving car adjust the seat so that your arms are comfortably positioned on the steering wheel. Sit upright and do not hunch over the steering or slouch on the seat. Avoid long drives especially if you already suffer from back pain.