Doctors @ IHC: Lower Back Pain

Posted by on Sep 18, 2013 in Doctors @ Ivory | Comments Off

Low back pain is a discomfort felt around the lower region of the back, just above the waist and buttocks. It is estimated that about 50% of people worldwide will suffer from low back pain at some point in their lifetime.

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It may be classified by duration as:

  1. Acute:  It is usually caused by an activity placing stress on the back which leads to muscle soreness. Back pain in this case often resolves within 6 weeks. Management is conservative and may include taking a rest which does not mean lying on the bed for the whole day or taking a vacation but abstaining from any activity that will place a strain on your back or supporting your back as you work during the day, taking analgesics, getting a massage and ultimately seeing your Physiotherapist.
  2. Sub-chronic: Back pain in this case persists beyond 6 weeks but less than 12 weeks. It may be an acute case which is not being properly managed therefore prolongs or an early indication of a more serious condition. Home therapies or self-care may not be appropriate in this case and seeing your Physiotherapist for pain management and exercise prescription may be necessary.
  3. Chronic:  This is back pain which persists beyond 12 weeks, it is indicative of a more serious condition often with the lumbar joint or the structures around it. It may be due to aging of the lumbar joint or a damaged intervertebral disc or a nerve compression. It may lead to pain radiating down the legs or weakness in the lower limbs or both. It is often caused by prolong poor posture in standing, sitting or walking. Managing conservatively by seeing a Physiotherapist for treatment and advice on lifestyle modification may be appropriate, in more severe cases, surgical intervention may be warranted.

Signs and Symptoms

Pain is felt at the lower back upon activities that involve lifting, twisting or bending forward. Pain is also felt while sitting or standing and can disturb sleep in certain cases. Episodes of back pain may recur from time to time and increase in intensity. The first episode of low back pain often starts between 20-40 years.

Causes

  • Poor posture: This is perhaps the biggest factor that leads to low back pain. Poor sitting posture which may be due to sitting on a chair that doesn’t adequately support the lower back or slouching while sitting or sitting or standing for too long often lead to low back pain.

Professionals whose jobs require prolong sitting or standing such as Nurses, Doctors, Bankers, I.T experts or other sedentary jobs are big predisposing factors to low back pain.

Jobs that involve frequent lifting or working with machines that vibrate fall victims of low back pain at some point during or after their careers.

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  • Poor Lifting technique: Between the vertebra bones of the back is a gel like disc which prevents direct contact of bones on each other. As humans age, especially from 30 years on, this disc also begins to degenerate. Lifting a heavy object alone and with the poor technique could place excessive force on this disc which leads to a tear of the disc and the gel like substance in the disc protrudes. This is called disc herniation and it can be likened to when a jam doughnut is squeezed and the jam protrudes. This gel could impinge on the spinal cord or its nerve which leads to a pain at that spot or a pain that radiates down the legs which is called sciatica.

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  • Age:  Like every other part of the body, the joints age too and as we age, the probability of having low back pain increases. The aging in this case leads to certain structural changes such as osteoporosis (reduction in bone calcium, making the bone brittle), degeneration of intervertebral disc, reduction in joint space etc.
  • Pregnancy: Pregnancy comes with changes in a woman’s posture and centre of gravity which leads to muscle and ligament strain leading to low back pain. It is estimated that nearly half of pregnant women will experience low back pain during pregnancy.
  • Obesity: This comes with more strain on the joints including the lumbar joint. A protruding tummy has the same effect as in pregnancy where the centre of gravity is altered which could lead to muscle imbalance.

RED FLAGS

These are signs which when accompany low back pain means there is a more serious medical condition that needs immediate attention:

  1. Unexplained weight loss
  2. Loss of bladder or bowel control
  3. Loss of sensation in the buttocks
  4. Fever
  5. Urinary tract infection

PREVENTION AND MANAGEMENT

Depending on the cause of the back pain, management differs from case to case but the following are general advice on prevention and management for low back pain

  • Proper Posturing:

Sitting -with the back straight and not slouching.

Standing- with the shoulders aligned and not tilted at one side. Reducing how long you stand on High heeled shoes by wearing flat shoes also helps.

Lifting- bending at the knees with the back straight to lift objects and asking for help to lift heavy objects reduce the weight transferred to the back.

Stretching after prolong sitting, taking a sit after prolong standing are simple steps to prevent and manage low back pain.

  • Using the correct furniture:

This is especially important for professions that predispose to low back pain. Using ergonomically correct chairs with adequate lumbar support or using a lumbar roll may be of benefit.

A medium firm mattress as against a soft mattress is necessary.

  • Exercise:

An exercise regimen which involves aerobic exercises, strengthening and stretching exercises as prescribed by a Physiotherapist helps to reduce pain and increase function for low back pain sufferers

  • Supportive gadgets:

A lumbar brace or support is often useful for moderate to severe cases of back pain but must only be used after assessment and prescription by a Physiotherapist.

Lumbar rolls to support the back in a chair could be useful too if the chair cannot be changed.

  • Weight management:

The less weight the joint has to bear, the better for the joint and the less tummy protrusion, the less muscle imbalance.

  • Physiotherapy:

This involves a comprehensive assessment to decipher the cause of the back pain. Management may include a combination of back care education, pain management by heat or cold therapy or a massage and an exercise regimen which involves aerobic exercises, strengthening exercises and stretching exercises.

 

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