When Low Back Pain can be Prevented
What are the bodily structures involved when one has a low back ache?
All structures of the lumber spine can contribute to significant back pain, including the paraspinal muscles, ligaments, facetal joints, disc and nerve roots. Skin, muscles and joints of lower limb are involved due to referred pain. Sacroiliac joints and coccyx can be a source of pain in some cases, explains Dr Saleh Mohammed Kagzi, Orthopaedics Specialist, Zulekha Hospital, Sharjah.
Why is low back pain common? What is its general incidence?
Low back is in existence probably due to evolution of human being as an animal of four legged stance to two legged. Changed posture of human beings, having the body which is not meant originally for the various purpose like what we have now, results in undue stresses. For e.g. during activities like prolonged sitting (as at work or long trip), repetitive bending forward and lifting, poor posture at work and during sleep, involvement in sudden activity like reaching out for object or sports without proper warming up lead to the problem.
About 50-70% of the population suffers from the backache in their life time. 80-90% of these get better with conservative and short period of treatment of about ten days. 15-40% suffers from sciatica-compression of nerve roots, 10% of which do not improve with any type of conservative treatment and they ultimately need spinal surgery, reveals Dr.Kagzi.
Is there a gender bias to the problem?
Probably yes, says Dr.Kagzi. The incidence is slight more in females due to the fact that they do additional physical work, bear children, take care of infants, and carry them around. All these activities can cause ligamental strain on the back and can cause backache. Ligamental stress during pregnancy and labour can initiate backache. 50% of women suffer from backache during this period. Besides, intra uterine contraceptive device and pelvic inflammatory disease increases the incidence of low backache in females. Male usually suffer from backache if their job involves lifting heavy weight items, working with heavy machinery and vibrating tools, long driving or trip etc.
What age group of people may be affected by it?
Although there is no age bar, people of 30 years and above suffer most from low backache. However, age wise incidence depends on the cause of the backache.
What are the common causes?
Risk factors include jobs that require heavy and repetitive lifting, use of jackhammers and machinery tools, and operation of motor vehicles and job dissatisfaction or work compensation issue. Smokers are at greater risk and so are the Obese. Overweight, Obesity and big belly puts additional stress on the lower lumber spine and its associated structures like ligaments, muscles, disc etc and causes or exaggerates existing pain. About fifty percent of the body weight is transferred to the lumber spine. Smoking and alcohol exaggerate the existing problems and should be avoided at all cost, emphasizes Dr.Kagzi.
Other common causes include spinal disorders like disc prolapse, spondylolisthesis, spinal stenosis, and osteoarthritis. Rheumatologic disorders like rheumatoid arthritis, ankylosing spondylitis etc, tumors and infection of the spine, sickle cell disease, gynaecological causes like ovarian cyst and tumors, other diseases like aortic aneurysm, peptic ulcer, gall bladder disease and pancreatic disease. Faulty posture, Sport injury, Osteoporosis, Pregnancy, Trauma, Musculoskeletal defect etc. may alone or in association with existing disease can cause and exaggerate the problem. In 20% cases, cause of the backache is related to pathology elsewhere like Atherosclerosis of the Aorta or Iliac arteries leading to ischaemia, Peptic ulcer, Gall bladder disease, Chronic pancreatitis, Herpes infection, Gynaecological causes like Ovarian –Uterus cancer, Myeloma-blood cancer and other diseases as mentioned before in common causes, reveals Dr.Kagzi.
What are the manifest symptoms of low back pain?
Mild and moderate to severe continuous or intermittent pain of aching or stabbing variety along with or without radiation to the one or both lower limbs is the hall mark of low backache. Sometimes pain may be of burning or throbbing type in case of neuropathy or infection respectively. It may be associated with loss of sensation and weakness in the lower limb in case of severe compression of the nerve roots. Pain may be relieved by rest and exaggerated by the spinal movements. Sometimes pain radiates to the front of the abdomen giving the false impression of its origin from the abdominal pathology.
Do the symptoms of other systemic disease, especially kidneys or pelvic region, manifest with low back pain? Yes, any infection, tumor or malignancy-cancer in this region and causes as mentioned above can manifest with low back pain, says Dr.Kagzi.
Is there something like acute and chronic low back pain? Yes, responds Dr.Kagzi. Acute backache results from sudden causes like trauma, strains, sprain etc. Chronic pain is due to slow and continuous ongoing process which means pain persists for more than three months. It can be due to variety of reasons and needs proper investigations to rule out the pathology. In chronic backache one should take into account psychosocial factors like depression, narcotic, alcohol addictions, litigation and compensation issues, job dissatisfaction etc.
How is low back pain diagnosed?
Diagnosis is by careful history and clinical checkup, blood investigations to rule out other causes in case of prolonged illness and X-rays of lumbosacral spine. In case of chronic pain one has to undergo CT Scan / MRI / Dopplers study / bone scan/Nerve conduction studies as the situation demands. Investigations are directed towards finding out the real pathology and /or to rule out the other potentially dangerous pathology like tumors, infection etc.
Once diagnosed, what is the treatment for the condition?
Treatment depends on the cause of the pain. It is conservative in case of backache arising from orthopaedics causes, initially in most instances. This includes, reassurance, rest, analgesics, supervised exercise, modification of life style, control of diet and weight, preventive measures like abstinence from alcohol, smoking etc.. Benefit has been shown with biofeedback, muscle relaxation, functional restoration programme, reconditioning etc. Surgery is needed in case of organic causes not helped by conservative management like severe disc prolapse, spinal canal stenosis or spinal instability or intraspinal tumor etc and last but not least it is essential to treat the primary pathology if present, like diabetes, hypertension, rheumatoid arthritis, infection etc.
When is surgery necessary and what is the type of surgery done?
If low backache is severe, does not respond to conservative treatment and is associated with neurological damage or jeopardized neurology, then surgery is needed. Only 10 percent of patient with symptoms require surgery. Surgery includes laminectomy, discectomy, fusion, correction of deformity. In 4-10 yrs follow up comparisons of the results between conservative treatment and surgery, no significant difference in final outcome was revealed. Surgery, therefore provides more rapid relief of pain, but the ultimate endpoint is approximately the same, regardless of either treatment, chosen, reveals Dr.Kagzi.
What are the risks of the surgery?
Besides the general risk of anaesthesia, risks are very low if surgery is done for indicated cases, on time, and by expert surgeons, says Dr.Kagzi. In cases where surgery is the only answer then one has to take the risk for the sake of preventing further complications and bring out relief in pain. Complication of the surgery includes- neurological damage, wound infection, postoperative disc infection, cerebral spinal fluid fistula and thrombo-embolism.
What is the role of physiotherapy in low back pain, with or without surgery?
Physiotherapy is helpful in relieving pain in many cases, says Dr. Kagzi. It helps in relaxation of muscular spasm and increases the blood circulation in the muscles and ligaments resulting in pain relief. It is also useful in post –operative cases. However one should be careful in selecting the type of physiotherapy as inappropriate treatment can result in further damage and valuable time is lost if surgery as the only resort possible, is indicated.
Can low back pain be prevented?
Low back pain arising from the preventable causes can be prevented for example by proper posture of the body, exercise, nutritious diet, control of body weight, awareness, abstinence from the risk factors. Sitting posture increases the disc pressure 400%; it reduces to 200% in standing and to zero in recumbent position. So proper sitting posture- sitting straight with back fully extended, using back conforming support of the swivel chair etc is helpful. Standing and walking for a while is advisable in between the long periods of sitting. While sitting one should make sure that knees lie at higher level than hips’ – foot can be put on some foot rest.
Correct posture, healthy diet, optimum body weight and daily exercise to strengthen and relax the spasm or stiffness of the back muscle, are very important in warding off such problems. Stretching and muscle strengthening exercise of the back, regular jogging, swimming, cycling can be beneficial. Lying down on one side with legs curls up and pillow in between the knees or lying straight on back with pillow underneath the knees can help relax the back and give relief from the stress on back. Bed should be of firm mattress and there should be unyielding strong flat surface support underneath. Big belly or paunch is not good for back, emphasizes Dr.Kagzi.
********
No comments:
Post a Comment