HEALTHWATCH
A pain in the back
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DR. UMA KRISHNASWAMY looks at the causes of low back pain and measures to cope with it.
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LOW back pain is a common problem especially for those in the 40-60 age group. While the majority of instances are short-lived and self-limiting, some tend to become chronic and occasionally severe. Chronic back pain can detract greatly from one's quality of life, interfering with both work and play.
The lower back is a crucial part of the body, connecting as it does the upper body to the lower. It consists of five bones called lumbar vertebrae, stacked one on top of the other with shock absorbers called discs between them. The spinal cord and the nerves to the lower part of the body pass through a canal formed by the vertebrae. The whole system is connected by small joints and is supported by muscles and ligaments, which allow movement and flexibility and lend support and strength to this crucial area.
The common causes of simple back pain include: poor posture, lack of exercise, standing or bending down for long periods, sitting in a chair or sleeping on a mattress that does not provide enough back support, lifting loads that are heavy or awkwardly shaped, bending, stooping or lifting weights in the wrong way, falling or even tripping. Aging with its inevitable wear and tear effects on the back, obesity, poorly conditioned muscles and smoking are common background factors. Occasionally psychological factors may be at play. Most back pain sufferers have pain of varying degrees of intensity located in the low back. When a disc protrudes to press on a local nerve root, pain may be felt in the buttock, groin or leg. This is called sciatica. There may be symptoms like "tingling", "pins and needles" or a sense of weakness in the leg muscles. These usually tend to come and go and, in the majority of instances, are short lived. In a small minority of individuals, the pain becomes long-term or chronic. In some, the intensity of the pain may worsen with time. Rarely, in serious instances, there may be a disturbance of bladder or bowel function.
When evaluating back pain, particularly in the initial period, the doctor may need to do nothing more than examine the patient thoroughly. Tests such as x-rays or special investigations such as an MRI scan may be required only in the more severe or persistent instances of pain. In some, a psychological evaluation may also be done. Such an evaluation allows an orthopaedic surgeon to pinpoint the source of pain and tailor treatment effectively.
Simple back pain usually responds to measures such as the use of painkillers (paracetamol, aspirin), used under medical guidance. Research indicates that rest, particularly bed rest, is not helpful in the majority cases and may be suggested by an orthopaedic surgeon only in selected instances. Gentle exercises for the back, particularly done under the supervision of a physiotherapist are a very important aspect of treatment. Rarely is surgery required and is usually reserved for complications such as a "slipped disc" or more serious and complicated pathology capable of jeopardising the nerves to the lower body. The use of local heat or cold pads, alternative and complementary systems of medicine and therapy such as osteopathy, acupuncture, acupressure, massage, yoga, Alexander technique may be of some value, particularly for long-term use. Long-term care involves regular exercise, using a chair with a backrest, sitting with feet resting flat on the floor, sleeping on a firm mattress, lifting and carrying only manageable weights, bending the knees, keeping the back straight and feet apart to bend or lift up weights.
By making these common sense measures lifetime habits, one may not only control back pain but also prevent it.
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