Back Pain

Almost every individual in his life experiences low back pain. The lower back usually starts below the rib cage on the midline with the surrounding muscles. Sometimes the pain may be intense or it gets better of its own with the passage of time. But each time it recurs it usually becomes worse than the previous one.

Complains – 

Dull aching pain to stabbing pain with or without radiation to lower limbs is the usual symptom. Sometimes it becomes progressive and makes it someone hard to move or stand straight. 

The pain may be acute due to sudden exertion like heavy weight lifting, strenuous exercises in the gym, or working for a longer period in an unaccustomed position. This pain usually due to muscle pool in the back or sometimes due to prolapse (slippage of disc to the spinal canal or nerve root ) of the intervertebral disc. The acute pain is relieved mostly by rest and simple analgesics (pain killer ) with muscle relaxants. Once the pain is settled one should focus on building strength on back muscle under the guidance of an Orthopaedics doctor. 

Many a time the acute low back pain persists and transforms into a chronic form. 5-10% of the back-pain patients present as chronic low back pain (CLBP). The CLBP incidence increases with age and highest in the age group of 50-60 yrs.  Females are at more risk of CLBP. Obesity, odd nature of job, job dissatisfaction, psychosocial factor, family history are also important factors contributing to CLBP. 

When you will know about your back pain-  

A person suffering from CLBP experiences pain in the lower back (lumbar and sacroiliac region). Pain can also radiate in the lower extremities or generalized pain can be there. In higher form, they present with incoordination of movements along with loss of control of bowel and bladder. When the low back pain is progressive it affects the posture and sometimes it makes difficulties in sleeping position also. When it affects daily activities of life one should seek medical advice and should not delay.

Spine disease or spine-related issues not only causes back pain there are several issues can potentially cause back pain like Problems in hip joint, sacroiliitis, gynecological problem like Pelvic Inflammatory diseases, ovarian mass, issues related to kidney and ureter, etc.

A significant portion of the non-spine cause of back pain suffers from a stress fracture in the sacrum or pubic ramus which are mainly due to chronic suffering from osteoporosis and osteomalacia due to Vitamin D deficiency.   If neglected low back pain progress to a severe disabling state due to poor medical attention and patients may need hospitalization. 

Warning signs

Loss of bowel and bladder control, numbness in the groin area, leg weakness, low backache with fever, feeling the impulse of pain while coughing or straining, or increase in pain intensity with rest are the few signs that warrant immediate medical attention. 

Who’s at Risk 

• Genetic predisposition
• Overweight
• Sedentary activities
• Job-related heavy lifting
• Lack of back fitness with aging
• Vitamin D deficiency
• Osteoporosis
• Uncontrolled comorbid like Diabetes and Hypertension.

Diagnosis – 

Xray is the first-line investigation to rule out any gross bony abnormality like a defect in spine spondylolysis and spondylolisthesis (slipping of one vertebra over another) and deformity in spine-like scoliosis or kyphosis as the first screening tool. But when Xray is normal or less informative MRI scan is advised which provides more details about the spinal cord, the spinal canal, the nerve root compression, the herniated disc, and any collection around the vertebrae and spinal cord. CT scan is advised when there is a structural problem or injury and it is essential for bony correction of the vertebral column.

When there is significant motor or sensory weakness the patient is advised to do NCV (NERVE CONDUCTION VELOCITY TEST) to know about the status of the individual nerve.

In old age, the vertebrae become osteoporotic and fail to withstand a constant load of the body leading to a compression fracture. The same thing can happen to the pelvis bone also. This can be confirmed by doing a BMD ( bone mineral density )  or DEXA scan of the spine and hip.

Treatment – 

It is always individualized and based upon the signs and symptoms of the patients.  The expectation of the patients and the nature of the job are the two main aspects to decide on the nature of the treatment. The MRI findings are not considered as an indication for surgery always but it helps in planning the surgery if indicated. 

A majority of the portion of back pain are self-limiting. Lifestyle modification and change in posture at the job are important modifiable factors for chronic low back pain.

Treating the cause is important for relieving back pain like bone-forming and remodelling medications (teriparatide, bisphosphonate, danosumab)  in case of osteoporosis . Rest  and  analgesics with muscle relaxants  in case of muscle pull.  In cases of sacroilitis, low back is treated as a part of spondyloarthropathy with anti-rheumatoid medicines (DMARDs). Surgery is needed for mechanical problems like herniated disc, nerve root compression etc .

Doctors recommend returning to your normal activities as soon as possible. Studies suggest that more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility. Sometimes elderly patients are not fit for surgery, at that time epidural injection can be tried.  It is done under image guidance and as a daycare procedure.

How can we delay the onset of low back pain – 

Most of the time the culprit is inadequate muscle strength so physiotherapy or muscle-strengthening exercise has an important role in the prevention of back pain. Two types of strength-training exercises that may benefit the lower back are flexion and extension exercises. Inflection exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example of extension exercise is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.          

There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:

• Stay at a healthy weight.
• Exercise regularly.
• Lift with your legs, not your back.
• Make sure your workstation position isn’t contributing to your pain.

If you struggle with severe hip pain or back pain, you may need immediate medical attention. To find out what is the appropriate treatment option for you and for a second opinion, contact the team at Top Bone and Joint Clinic. Our highly skilled Doctors will suggest you best treatment option for your back pain. Call us today at 9337431976, 06743567913.