ouc my aching back

Ouch, my back!

Your Health
DR GITA MATHAI

Regular exercise helps overcome backache
Lumbago or backache affects 80 per cent of the population at some time in their lives and 50 per cent of the working population every year. It accounts for 20 per cent of medical consultations. The resultant loss of working days has enormous economic implications.

Why do we have backaches? As man evolved, he gradually became two-legged from four-legged. This change occurred at a price. The lower back bones (vertebrae) have to bear the weight of the ones above and cope with the additional effect of gravitational pull. This makes them prone to strain, misalignment and dislocation. Also, vertebrae are separated by water filled gelatinous discs held in place by ligaments and muscles.

With age, the discs become brittle and less flexible. They can bulge out, get displaced or dislocated and impinge on nearby structures. Nerves to the legs and arms come out of the little spaces between the vertebrae. This means that any misalignment presses on the nerves and causes pain.

Backaches cannot be attributed to any particular reason in 98 per cent of the people. X-rays are rarely useful in the evaluation of those with acute-onset low back pain. About 75 per cent will show non-specific, inconclusive, age-related changes. Magnetic resonance imaging (MRI) or computed tomography (CT) studies are more likely to reveal a diagnosis.

There might be a history of trauma, an area of weakness, loss of sensation, persistent fever, intractable pain, weight loss, an underlying cancer or it might be a side-effect of corticosteroid medication.

Conservative management should be tried for four to six weeks before proceeding for tests. Some things should be kept in mind —

• Backaches require bed rest. This means lying down for two-three days. However, rest for longer periods may weaken the back muscles further. Rest in the “sitting” position can worsen disc pain as it raises intradiscal pressures.

• Painkillers like paracetamol and non-steroidal anti-inflammatory agents (NSAIDs) should be used. Narcotics should be avoided as they are habit forming.

• Superficial heat, ultrasound, cold packs and massage can relieve pain

• The usefulness of lumbar traction is questionable.

Our changing lifestyles also increase the propensity to develop backaches. School children begin to complain of backache and shoulder pain around the time they attend middle school. Very rarely is it due to an actual back pathology. A heavy school bag, asymmetrically balanced on one sagging shoulder, with an accompanying water bottle, skews the centre of gravity and causes muscle and ligament strain. Moreover, school hours are long and involve prolonged seating. And the furniture is also often not ergonomically designed. The height of the seat may be improper or back support inadequate. At home too, homework may be done sprawled on the floor or across a sofa, with no attention paid to posture.

Women are at particular risk. Fashionable footwear (block heels, stilettos, platforms) shifts the centre of gravity. Balance then requires abnormal adjustments on part of the spine. Pregnancy exaggerates the normal shallow “S” bend (lordosis) of the lumbar spine. Hormonal laxity allows the alignment to “slip”. The resultant backache sometimes persists through life.

Sedentary individuals develop backache if they lift weights. This is because their unconditioned muscles and ligaments cannot respond efficiently to the sudden physical stress.

Weight gain too places additional stress on the spine, with each extra kilo resembling a permanently attached knapsack, to be carried during all waking hours.

As age advances, the water content of the intervertebral discs naturally decreases, causing shrinkage, fragility and decreased pliability. This in itself causes older people to “pull” their backs and injure themselves. Bones too become weaker as their calcium content decreases with increasing age.

Backaches can be prevented with a little care, effort and attention to correctable reversible factors, like posture, footwear and furniture.

The school bag should not be more than 10 per cent of the weight of the child. It should have padded straps and be placed over both shoulders. Any other weights like a water bottle (a litre of water weighs a kilo) should be consciously alternated between the two shoulders.

Seating and lighting arrangements at schools and at home should be reviewed and improved. At all ages, any weight carried should be alternated between the two arms.

Children under the age of 16 years should not wear heels. Footwear should be supportive, well designed, comfortable, practical and without heels.

A conscious effort should be made to shed excess weight and maintain the BMI (body mass index, which is weight in kilogram divided by height in metre squared) below 25.

Calcium supplements should be taken regularly.

Back exercises should be started early and continued through life. They can be learnt from yoga instructors, physiotherapists, books or television. If done regularly, back injury and pain may never occur.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in