Medicosnext
Lower back pain is one of the most common universal disorders. The pain is associated with reduction in quality of life, sometimes leading to major depressive illnesses. Treatment of low back pain is simple. You just need to understand the cause. More than 95% of the low back pain is related to bad posture, over-weight, level and type of the working activities / habits, and age.
The spine is the pillar of our body. It helps to maintain upright posture and bear body weight. At the same time, it is flexible, providing different range of movements to the body. Maintaining the proper shape of the spine takes care of majority of the low back pain.
Normally, we tend to slouch while sitting on the chair. Our daily activities involve squatting or cross-leg sitting on the floor. Sitting on the chair in front of computers for protracted periods of time, or postures attained while using mobile phones, would put our spine under constant strain. These postures / positions deviate the normal shape of the spine. These deviations put lots of stress on muscles supporting the back. The elasticity of muscles becomes loose, providing poor support to the back bones. The muscles thus have to put in lots of effort to keep our spine straight, eventually leading to early fatigue. This fatigue is then manifested as pain. Likewise, excess weight and working habits that include lifting heavy loads, prolonged standing, or forward-bending lead to early muscle fatigue, resulting in back pain.
There is a general concept that most of the back pain is associated with nerve entrapment, bony erosion, etc., and this will lead to serious complications affecting activities of daily living. It should be emphasized that degeneration is a naturally occurring process in all living beings. Bone and joint degeneration is just like growing gray hairs, passing through a phase of menopause, diminished vision and hearing, etc. These processes are unavoidable and not preventable. When you get your x-rays done, you might see some degenerative changes depending upon your age. Your MRI might show slip disc (disc is a cartilage that intervenes two vertebrae and acts as a shock absorber) compressing on to the nerve roots. These changes are all expected with aging. Degeneration of back bone also causes nerve entrapment. But, these changes should not be the reason to worry about. These changes will not cause paralysis or cancer or require surgical intervention in majority of cases. Psychological factors play major roles in pain generation, referred to as psychosomatic pain.
So, understanding the problem and its causes is of primary importance in treatment of low back pain. It is worth reiterating that majority of the back pain is not to be worried about. Maintaining good posture, optimum body weight, optimum working environment, and frequently changing postures are all you need to be aware of to take care of your low back pain.
If you could include some physiotherapy exercises targeting spinal flexibility and improving back muscle tone in your daily routine, it will surely help to alleviate pain and improve quality of your life. These types of the pain are called mechanical back pain and accounts for about 95% of all low back pain. Most of these pains are localized around lower part of spine, buttocks, and upper part of back of thighs.
If you have pain radiating to one or both of the legs (mainly goes on one side all the way down from the buttock to the calf in a shooting manner) severe enough to incapacitate you from your regular activities, it indicates significant nerve root compression due to slippage of the intervertebral disc at the back (commonly known as sciatica). Initial treatment of this condition is medications and physical therapies. If not, getting better steroid injection targeting the specific nerve root or epidural space may give significant pain relief. Majority of people get better with these simple non-operative measures in due course of time and usually will never require surgery. After exhausting all these conservative measures, if it is not improving then you might have to consider for surgical decompression. Or, sometimes you may have significant weakness in lower limbs, numbness around the perineal area, inability to pass or control urine, and very severe pain in limbs more than the back (a condition known as Cauda Equina Syndrome), then it indicates an emergency situation when you will absolutely have to undergo surgery as soon as possible.
There are conditions when you need to worry about your back pain. These are called red flag signs, which consist of night pain (pain that wakes you up from your sleep), fever, weight loss, loss of appetite, weaknesses in the lower limbs, and dysfunction in bowel, bladder, and sexual activities. If you have these features, then you must go through thorough investigations and more aggressive treatment. Investigations may include blood tests, X-rays, MRI, and CTscans, depending upon indications.
There are pathological conditions that affect the spine, resulting in severe back pain, neurological deficits (weakness in the lower limbs – a kind of paralysis), deformity of the back, etc. The most common conditions are infections (tuberculosis of the spine is very common in our context), tumors (metastatic or primary), fractures (due to injury or osteoporosis), arthritis, etc. These are the serious issues accounting for about less than 1 % of population having low back pain.
In about 3 to 4 % of people, the pain may be originating from other regions or organs of the body. It may come from gastritis, kidney stones, gall stones, pancreatitis, aortic dissection, uterus, ovaries, or other pelvic conditions. These conditions will have their own specific signs and symptoms and can be defined precisely with thorough clinical evaluation and some routine investigations.
There is also a general belief that spine surgery is fraught with serious complications, so we should never go for surgical treatment. This is a myth. We need to analyze risk / benefit ratio in surgical versus non-surgical treatment. Trial of non-surgical treatment, if available, for that particular condition is always preferred over surgical treatments. However, there are some specific indications when you must undergo surgery on time, otherwise the condition would get worse. If appropriately indicated, then the surgical treatment does have the best result as compared to non-surgical treatment. Decompression of nerve roots and stabilization of the spine will definitely alleviate pain leading to improved quality of life and early return to work. Any surgical treatment is aimed towards eradicating the disease, freeing the spinal cord and nerve roots from compression, thus restoring its function, stabilizing the spine in optimum anatomical position, and preventing the spine from getting deformed.
Finally, most of the low back pains are managed with posture care, reducing body weight, some minor alterations and adjustments in working place, and performing some exercises on regular basis. Addition of some analgesics and muscle relaxants may help you do physical activities. In some circumstances, steroid injections around the compressed nerve will help in relieving pain and avoiding surgery. Surgery does have a role if indicated appropriately, and it is usually considered to be the last resort.
Whatever may be the modality of treatment, the whole idea is targeted towards restoring your normal life. Most of the joints and bone can be replaced today, except the spine. If you take care of your spine, then spine will take care of you. Irrespective of age, your life has to be better tomorrow than today.
