Medical Article

Backache become a Headache

Back pain is not a unique problem.  About 80 per cent of adults experience low back pain at some point of their life. It ranks second to headaches as the most frequent location of pain. It is almost next to common cold in the list of common diseases. 

Symptoms of Back pain
Back pain makes it hard to move or stand up straight. The pain has a stabbing or shooting sensation. Usually acute back pain comes all of a sudden and lasts for few days. If it lasts for months, it will be chronic back pain. In severe back pain, a loss of bowel or bladder control, fever, leg weakness, pain while coughing or urinating could be expected.  Low back pain often gets better on its own.  If the back pain doesn’t improve after three days, seek advice from a healthcare provider.
If back pain occur after injury, medical attention is must. Treatment also depends on the type of pain. It includes hot or cold packs, exercise, medicines, injections, complementary treatments, and sometimes surgery. The most common site of pain is the lower back because it bears the brunt of our weight and hence is more prone to get affected.

Anatomy of low back
Backache is a condition that is usually caused when one or more structures of the back get affected. The back region is made up of 24 small bones called vertebrae. These vertebrae are attached to sacrum and coccyx, from top to down. The sacrum attaches itself in front of the bones of pelvis.
There are discs in between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain.

Causes of Back pain
Back pain related to posture and flexibility
The erect human structure helps our back to withstand the gravitational pull over our lifetime.  Posture also makes this region more vulnerable to wear and tear, strains and fractures.  Flexibility of back is needed to keep us mobile and it depends on joint structure, muscle elasticity and the connective tissue fiber material made up of collagen, elastin and titin.  The discs between vertebrae, give strength, stability and flexibility. It acts as a shock absorber, but limits movement. The spinal cord and spinal nerves pass through the protective tunnel created with vertebrae and discs.  The nerves passing through the vertebrae, branch off to various parts of the body. The collagen fibers help to withstand the tension of the erect posture and weight. Strenuous activities like jumping, running, and lifting put strong force on the spine. The disc help to withstand this pressure.

Causes of back pain

Incorrect body posture is a reason for back pain. It may be due to long standing or sitting in wrong postures. Back injury, heavy physical work, lifting, bending, twisting or awkward positions might act a precursor in triggering back pain.

The sprain or strain due to sudden fall, car crash, or sports injury. When a back injury occurs, muscles, ligaments, and tendons become overstretched and swollen up, causing pain, tenderness, and stiffness.
Muscle strains :  Strained muscles, tendons or ligaments or inflamed joint cause pain along spine.
Osteoarthritis: Everyone past the age of 60 gets affected with degenerative joint condition.  Age and injury lead to deterioration of the cartilage. Cartilages are the protective tissue that covers the surface of the joints of the vertebrae.

Osteoporosis :  Women older than 50 yrs can be affected by osteoporosis.  One in every three women faces painful vertebral compression fractures.

Triggering Factors
Back pain may be the result of a strenuous work or previous history. Factors like stress, distress, anxiety, depression, cognitive functioning, job dissatisfaction and mental stress can play a key role in back pain.

Internal factors
There may be some deep underlying causes of low back pain, like slipped disc, wherein disc bulges out of vertebral joint and puts pressure on spinal nerves. In spinal stenosis, the spinal space narrow down and pressure is induced upon the spinal nerves.  In conditions like spondylolithesis, one of the vertebrae slips forward and goes out of position. In degenerative disc disease, the disc in spinal cord gradually gets worn out. In Osteoarthritis, there is wear and tear of the bones.
Sometimes routine activities, such as gardening, picking up a child, reaching for an object or even coughing, can trigger back ache.
Although back pain often gets triggered suddenly but the causes may have been piling up for quiet some time owing to slouched posture in chairs, driving in a hunched position, standing in an arched manner, lifting without bending knees, sleeping on sagging mattress, being unfit, sleeping prone, getting out of the bed straight from supine lying position.

Back pain diagnosis

Physical examination :  Without inflicting pain, the doctor examines the point of pain and what degrees of movement are possible. Doctors will examine the limb muscle, power and sensation and also nerve reflexes.

X-ray :  It helps to identify the changes in the vertebral bones and any wear and tear in joints. X-ray shows disc spaces, if disc is slipped, the space is diminished between the two vertebrae. X-ray helps to get all basic information about the ache. Two views, one from front and the other from side will be taken.

MRI or magnetic Resonance Imaging :  MRI gives complete picture of spinal cord and the emerging nerves. The patient is requested to lie still on a sliding table. After positioning the patient comfortably the table slides into a cylinder like structure, housing a large magnet. With the patient inside the MRI unit, a two dimensional image of spine is created.

Treatment and exercise for back pain :  In most cases, exercise helps to maintain and strengthen muscles of back. In very few cases will require operative treatment, like surgery for slipped disc to release an entrapped nerve. 

Non-operative treatment :  If pain is localized, one needs to follow rigid exercise regimen, with some precautions. If pain is radiating they have to visit a physiotherapist. If pain doesn’t subside, there must be some cause which requires an immediate medical attention.

Electrical stimulation :  Transcutaneous electrical nerve stimulation(TENS)
It blocks the pain from reaching the brain. The physiotherapist will place electrodes near the area of pain. TENS may relieve pain in your leg due to inflammation or compression of nerves in your back. This treatment involves manipulation and massage of spine and back muscles, which help to relieve from mild-to moderate pain.

Acupuncture :  An acupuncturist inserts a hair thin needle under skin. It stay there for 15 to 30 minutes. This insertion causes little or no pain. Researchers suggest pain relief may cause from release of endorphins, bodies natural pain killers.

Prevention of back pain :  Daily exercise and minor precautions help to prevent back problems from occurrence or recurrence. Back is an integral part of all our body movement and is susceptible to strain or injury due to its configuration. Despite being aware that poor posture is bad for back, everyone ignore it. This aggravates problems of the back.

Lifting posture :  Keep feet an inch apart, then bend hips and knees to an angle of 30 to 45 degrees, keep back straight and lift the object. Hold the object close and avoid twisting the trunk.

Posture :   Stand tall with your chest facing upright, shoulders relaxed, chin tucked in and back relaxed, but upright.

Sitting  :  Don’t sit in the same position for long period and walk around or stretch back regularly. While getting up from the chair, always lean forward and put your body weight on the arms of the chair through palms and push stand up. If suffering from backache use a cushioned back support.

Driving :  Position car seat supporting back and keep legs relaxed. Use cushioned lower back support or acupressure seat-mat covering so as to stimulate the pressure points of your back.
Sleeping, use firm mattress to sleep.

Bed Rest :  When resting on the side, lie straight. Use a pillow or support underneath lower limb which is above and folded in from of the other limb.

Back Brace :  For acute pain a back support belt is recommended. It provides support for the back muscles, but it is recommended only during the time of daily activities and not more than a week.

Bad posture :  Avoid slouched shoulders, head down and knees locked while sitting.

Ignoring the pain :  Start becoming aware about body and the minimal discomfort experienced in any part of the body is an alarming signal for taking an appropriate action.
Minimize stress at the desk :  Don’t lean over the desk or sit too far from the work table also avoid sitting on work table with back unsupported. The height of the chair should be in proportion to the table so much so that the elbows make an angle of 90 degrees with the table.

Avoid sleeping in prone position for very long duration

Avoid wearing very high heels. Appropriate height of shoe heels should range from 1 cm to 3 cm.


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