Temple of Healing



Low Back Pain: A Twenty FIRST Century Enigma

Dr. Prakash Khanchandani, Head of Department, Orthopaedics, SSSIHMS, Prasanthigram

Low Back pain (LBP) is a very common condition; about 95% of people suffer from it at some point in their life. Back pain can affect people of any age for different reasons. As people get older the chances of developing LBP increases due to factors like previous occupation and age related degenerative diseases of spine.

Acquiring basic knowledge of spine anatomy is worthwhile for better understanding the pain and related issues. The human back is composed of a complex structure of muscles, ligaments, tendons, discs and bones, which work together to support the body and enable us to move around. The spinal cord passes through a canal within bony spine and nerve roots exit through neural forminae to supply various parts of the body. The bony segments of the spine are cushioned with cartilage like pad called discs. Pain may originate from bone, discs between the vertebrae, ligaments, muscles, spinal cord and nerve roots arising from the spinal cord.

Common causes of LBP are muscle strain or spasm, damaged disc, nerve root compressions, fractures etc. Occupations that involve weight lifting, bending, prolonged sitting, heavy exertion and driving increase the incidence of LBP.

Risk factors like occupational activities, pregnancy, sedentary lifestyle, poor physical fitness, older age, obesity, smoking, excessive strenuous physical activity and medical conditions like arthritis and cancer is linked to higher incidence of LBP.

The main symptom is pain in the low back and sometimes radiating all the way down to the buttocks and legs. LBP with any of the associated symptoms like weight loss, fever, swelling in the back, persistent back pain, radiating down the legs, associated injury, difficult urination, faecal incontinence or loss of control, numbness over legs warrants a thorough clinical examination, appropriate investigations and treatment.

Initially, patients are advised for conservative management in the form of pain medications, activity modification and physical therapy. Based on the nature of pain and the condition causing it, various physical modalities can be tried for the relief of LBP like hot packs, ultrasound therapy, short wave diathermy, cryotherapy (cold packs) electrotherapy like transcutaneous nerve stimulator (TENS), IFT( Interferential therapy) and muscle release techniques.

After an appropriate period of rest, an exercise schedule follows. It is clear that active exercise is more effective than rest since it decreases the amount of adhesion and muscle atrophy and increases tissue circulation and oxygenation. For specific indications not responding to these measures spinal epidural steroid injections/ nerve Root blocks and different surgical options are available.

Following a healthy lifestyle can reduce the risk of developing LBP. Daily physical exercise helps to strengthen the muscle and reduces obesity. There are two main types of exercises that to reduce the risk of LBP. The first is core-strengthening exercises of the abdominal and back muscles. The second is flexibility training that focuses at improving core flexibility including spine, hips and upper legs. Paraspinal muscle strengthening and balancing is the cornerstone for preventing LBP.

Make sure your diet includes enough calcium and vitamin D, as these are crucial for maintaining bone health. Supplementation of Calcium and Vitamin D should be used with a medical prescription i.e. only when required. A healthy diet also helps to control body weight. A significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height, and weight. Obesity is a definite contributory factor causing backache.

Here are some healthy habits. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet. Keep your legs straight and your head in line with your spine. If you regularly use a computer, it is important to ensure that you have a chair with good back support and adopt a good posture and head position. Make sure your elbows are at right-angles and that your forearms are horizontal. A good seat for working should have good back support, arm rests and a swivel base. When sitting, try to keep your knees and hips level and keep your feet flat on the floor, or use a footstool. We must realize that in many individuals 30 percent or more of time is spent on office chair; hence investing in an ergonomic smart chair is always a good option. Its always good to avoid continuous prolonged sitting and slight stretching and walking in between sitting spells.

When lifting heavy objects, use your legs to do the lifting by bending the knees, rather than your back. While you are lifting keep looking straight ahead, not up or down, so that the back of your neck is like a continuous straight line from your spine. It is better for your back to push things across the floor, using your leg strength, rather than pulling them.

While driving it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks. Get out of the car and walk around. It is always a good practice to sit in the car first and then bring the legs inside for minimizing back strain while sitting in the cars.

While sleeping, you should have a mattress that keeps your spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle. Medium density memory foam mattress is ideal for a good back posture while sleeping. It is worthwhile investing in a good mattress since 6-8 hours are spent daily on the same.

LBP is an avoidable condition at least for most of the people, if they follow a healthy lifestyle. Nowadays, everything is easily available online, pushing humans to sedentary life. Let us break habit it by following simple activities like healthy diet, going for a morning walk, swimming, maintaining good posture and regular exercises.

Let this be our New Year resolution for a healthy and pain free back!