Back pain is one of the commonest causes that lead us to doctors’ out patient clinic. Three out of four adult will experience back pain during their lifetime. The intensity of pain may vary with person to person. Most acute episodes of back pain are quite benign and self limiting, however, chronic back pain are quite disabling physically, psychologically as well as economically!Lower back pain is commonest amongst various pain patterns affecting human back.
Back pain can occur in all age groups from pediatric to geriatric. The most surprising fact remains that our knowledge and awareness about probably one of most disabling disease is very shallow. Low back, per se, is a non-life threatening condition unlike heart disease but it can make a life miserable.Although awareness about back pain is lacking, we doctors consider back pain mostly either a condition associated with faulty life style or a disease related to age- wear & tear.
We shall try today to understand the basic facts about back pain in general.
What is back?
Back is an area of body spanning from base of head to the buttocks, on backside. In medical term, back is a part of body made up with , vertebral column, muscles supporting vertebral column, ligaments binding vertebral column and associated structures including discs, spinal cord and nerves coming out of the vertebral column.
What is Vertebral Column?
Vertebral column is like a tower made up of small pieces of bones stacked one over another separated by cushion like structure call discs. The column supports the head (skull) and connects with the hipbone below. It gives a shape to our torso, transfers load and protects the spinal cord.
What causes back pain?
There are numerous factors responsible for back pain. The commonest cause of back pain is muscle sprain. It could be because of repeated insult to back mechanics due to our faulty lifestyle. However, there are other pathological causes also like injury to disc and joints (facet joints) of spine, infection of spine, fracture of vertebrae, tumors of spine etc.
Does all back pain need treatment?
Fortunately no. Most back pain subsides on its own with the rest of few days. Most back pain become mild or disappear in a week or two. Those pathological back pains may need disease specific treatment.
What is the role of physiotherapy in the management of back pain?
Majority of muscle sprain or back pain are as a result of either disturbed posture or due to muscle losing its inherent tone. By physiotherapy one can strengthen their musculature and make the spine biomechanically more in line with its physiological requirements. But, short duration of physiotherapy has no place in the treatment. It has to be practiced for a longer duration to get the maximum benefits.
Does obesity or weight is related with back pain?
Yes, larger the weight of a person more loads back has to bear. Not only that, the curvature of the lower spine (lumbar spine) changes as the mechanical axis shifts due to increased weight in front. Reduction in weight helps to reduce chronic back pain. It is very important to maintain a right weight for a healthy back. When one tries to reduce weight by dieting, one must take care about protein and other important nutrients. As for a healthy muscles nutrient deficiencies are deleterious.
Is back pain related with work?
We generally carry a myth that those who are In laborious activities tend to have more back pain. They are at higher risk of having muscle sprains but back pain is found also in similar proportion in persons who have sedentary work habits. However, back injuries and pain are more commonly found in workers who use vibrating tools quite often. Other than that there is no scientifically proven work style that leads to back pain. Wrong postures at the work or even during our day to day life do affect the biomechanics of spine and may lead to back pain.
Any relation of back pain with age?
Yes there is a gross relation of back pain and age. It is not that incidence of back pain will be more in certain age groups. But age will lead us to the cause of back pain. In young, it is the muscle sprain that is the commonest cause of back pain while in older people, the effects of age related wear and tear will give rise to a chronic back pain.
If I have back pain, can belts help me?
There is no scientific evidence to say that lumbar belts can help to reduce or cure back pain. So, personally I don’t advise belts for back pain. What we need even with belt is rest to muscles, which we can get just by lying in bed and avoiding certain activities.
I have back pain; do I need to use a specific type of mattress?
Once again, we do not have any scientific evidence that any specific type of mattress either prevents or help in reducing back pain. Any routine relatively firm mattress is all we need for a good sleep and good back. Ideally height of the bed should be adjusted to such level that our knees maintains an angle of 90 degrees while we are sitting on it. The height of bed must not be less than that. For older people who have knee arthritis, more height is beneficial.
Is there any relation of smoking with back pain?
Smoking generally do not cause back pain. But, but evidences suggest that tobacco or smoking can affect the circulation of blood at a small capillary level, it may lead to weakness of muscles. If one has back pain, smoking or tobacco can surely hamper the healing of damaged back.
What lifestyle change I should be doing to try to avoid back pain?
Many back pain are lifestyle disease. A healthy lifestyle will surely prevent the back pain or will help to reduce the pain. Try to maintain a good lifestyle habits mentioned below…
a) Maintain a proper BMI (Body Mass Index). In other words maintain your weight in proportion to your height
b) See to it that you are taking enough protein for good muscle health.
c) Do aerobic exercises like, walking, jogging, cycling, swimming etc. at least 3-4 days a week to maintain good tone of muscles.
d) Good night sleep has no substitute.
e) Try to avoid stress or learn to manage the stress.
f) avoid smoking or tobacco
When do I consult a doctor if I have back pain?
As I told you before, most back pain should subside in a day or two. At least they will become mild in intensity of pain. However, even after two to three days of good rest back pain still persist it is better to consult a doctor. It goes without saying; if intensity increases medical consultation is imperative. Back pain associated with throbbing pain, fever, weakness and/or numbness in legs, any s/o paralysis of leg or legs, doctor has to be consulted.
What is the role of physiotherapy in the management of back pain?
Physiotherapy is a very integral part of back pain management. Generally, we do not advocate active exercises during an ongoing episode of back pain. We recommend heating modalities like IFT, SWD. Once back pain start coming down , passive physiotherapy should be started. As soon as patient is able to tolerate the active physiotherapy, muscle-strengthening physiotherapy must be started. Any episode of muscle spasm, sprain or back injury leads to loss of muscle tone. If we do not focus on physiotherapy rehabilitation, there are chances that one can have recurrent episodes of back pain. It is, however, important to note that there is no role of a very shot term physiotherapy protocol. Toning up of muscle takes longer time than one would expect. Ideally, one should be on 6-8 weeks of physiotherapy to regain the muscle strength.