LOW BACK PAIN

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75 percent of all people get an episode of low back pain. It is the second most cited reason for being absent from work in the US. Low back pain can sometimes be intolerable. It might be acute that is, sudden and chronic or prolonged and recurring.  Low back pain is not something that you can explain in an article. It would require a full volume of book for understanding even the basics. However my aim here is for the common man to understand what to do if they develop low back pain.

COMMON CAUSES OF LOW BACK PAIN

  • The most common cause is a muscular strain in the low back 
  • A lumbar disc prolapse 
  •  Lumbar spondylosis
  •  Spondylolisthesis
  •  A compression fracture
  •  Lumbar canal stenosis etc.

 Some other diseases can also present itself as lower back pain like kidney disorder. Most of the low back pain that people experience goes away with rest and analgesics within a few weeks. 

 Sciatica is a symptom associated with low back pain, which is a radiating pain that goes down from the back of the thigh to the leg. It also presents itself as numbness of the foot, due to irritation of the exiting nerve root in the spine. It is a false belief that once sciatica develops it will never go away. Acute low back pain will usually have history of lifting weight or pushing objects which might be due to a low back muscle strain or a disc prolapse. This is followed by sudden low back pain and muscle spasm. Lumbar Spondylosis will be usually associated with early morning stiffness or stiffness after a period of rest. In the case of Spinal Canal Stenosis, patients will have difficulty in standing up. Low back muscle spasm is just a protective mechanism of the body to avoid excessive movement and the cause could be just about anything.

  Few occasions when you have to take low back pain seriously:-

One of the emergencies to watch out for  is the Cauda Equina Syndrome when the lower back pain is accompanied by uncontrollable bowel and bladder disturbance with the persistent urge to urinate or defecate. It could also present itself as Saddle Area Anaesthesia when your buttocks have no sensation.

Weakness of the lower limbs either one side or both sides, have to be taken seriously. If the above symptoms develop do not waste time, you should right away go to a spine surgeon or a neuro-surgeon at the earliest to be assessed and treated. 

DIAGNOSIS AND TREATMENT

  •  The first step is to get it assessed by a specialist, clinically.
  • An X-ray is a basic investigation along with few blood test. 
  • CT is helpful especially in the case of fractures
  • MRI is the investigation of choice. One thing you should understand is that you should not be treating on the basis of an MRI. You should be guided by the clinical symptoms which will eventually lead to the proper treatment modality. In my many years of experience, even the MRI of normal people with no back pain whatsoever, will display the images similar to the case of disc prolapse. 
  • In the initial phase complete bed rest with analgesics and nuclear relaxants can do wonders followed by Physiotherapy .
  •  Do not go for exercises if the back is painful.
  • Rest and medication are important initially. 
  • Do not go for massages, it might fell good at the moment but might worsen the condition.
  • Local application of gel and hot fomentation is allowed.
  • Do not expose your back to cold or AC especially after shot shower , cover your back well.

HOW LIFE STYLE MODIFICATIONS CAN HELP RELIEVE LOW BACK PAIN

 Life style modification is something that I have to highlight in the long term treatment plan. Medications can only help you temporarily but ultimately it all depends on how you adapt and take care of your back. If you take proper care of yourself, you can enjoy a better quality of life.

The first step in life style modification is to read and learn as much as you can, from authentic sites or authors or registered practitioners. However, the ideal thing to do would be to go to a good Physiotherapist. Change your mattress to an Orthopedic mattress preferably without spring (beware of fake ortho-mattresses which gives away in a few months). You should learn how to maintain good posture while sitting and standing. If you suffer from low back pain, it is best advised not to do strenuous exercises which includes pushing or the lifting of heavy weights. If you have to lift weights then there are ways you should consider to lift the weight by keeping your back straight. Lower back strengthening exercises, keeping your body weight ideal and regular exercise (upon consultation by a specialist) can provide relief or even completely cure your low back pain.

 90 percent of the low back pains are treated conservatively. In case you have to do surgical treatment especially in cases of disc prolapse, there is no need to panic because medical science has advanced greatly. Minimally invasive micro surgeries with very minimal complications and quick recovery period have become very popular. Another commonly held belief is that if you do spinal surgery, you will become paralysed. This is not true unless the surgery involves taking away a part of your brain or spinal cord itself or a botched up surgery/bad surgeon or an undesired complication. It is almost nil in the hands of an experienced spine surgeon.

LOW BACK PAIN IN PREGNANCY

Low back pain in pregnancy is very common and it is more during the second and third or later pregnancies. All soft tissues swell up during pregnancy as the muscles relax and prepare for birth. This is more prevalent in the last trimester and the hormonal changes adds to the low back pain. Another commonly held myth is that the epidural administered during delivery causes chronic low back pain. Rather it is the pregnancy and delivery itself that instigates the pain. There are only very few chances of the low back pain being caused due to bad epidural technique.

One has to understand that nerves are tissues. If they are injured or if there is pressure exerted on them by a disc or some other factor, recovery would take long if not diagnosed and treated at the correct time. It is impossible for anybody to manipulate and put your prolapsed disc back in its place since the disc is almost a gel-like material. You have to modify your lifestyle and this will ultimately determine the result of your treatment in the longer run. 

Image Courtesy: Dr.Tiju Abdul Kadir

 

 

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