My aching back
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Your Health - Dr. Gita Mathai
One of the commonest problems for which patients consult doctors is back pain. It can occur at all ages but there is a spurt of patients in their thirties and forties because of the weight gain in middle age, the large abdomen of pregnancy and the gradual weakness and degeneration of under-exercised back muscles. We were meant to walk on all four limbs like other animals but we chose to defy the laws of gravity and stand upright. This places a great deal of strain on the bones (vertebrae) of the lower back.
Backache can be due to congenital defects in the structure of the spine such as scoliosis (bent backbone) or spina bifida (absence of the supporting spinous processes). Usually though, the person remembers a sudden "give" in the back while lifting an object or a fall. In older persons with osteoporotic bones, the injury may be so trivial as to pass unnoticed till the pain sets in. Sometimes backache is part of a generalised disease process like ankylosing spondylitis, psoriasis or inflammatory bowel disease. It can also be due to problems in the kidney, ovary or uterus.
The person usually complains of persistent pain, stiffness and difficulty in standing and movement. The pain can be anywhere from the neck to the buttocks, but is usually nearer the lower back. This is called lumbago. The pain may remain fixed in that area or radiate down one or both legs, when it is called sciatica. (These are just descriptive terms and not a diagnosis).
Pain in the lower back can be treated at home with the application of a capsaicin containing gel, followed by alternating cold and hot fomentations. This can be repeated several times a day. Mild analgesics like paracetemol or ibuprofen can also be taken. Bed rest does not really help. It may delay long-term recovery by weakening supporting muscles further.
You need to see a doctor if the pain lasts for more than two weeks, interferes with sleep at night, there is weakness in either leg, fever, bowel and bladder functions are affected or cancer has been diagnosed or treated in the past.
A complete examination and blood work is required, including evaluation of the vitamin D3 status. X-rays can reveal gross abnormalities, but usually CT and MRI scans are also needed to make a definitive diagnosis.
If there is an underlying disease, that needs to be tackled and treated. Otherwise, physiotherapy involving applications of heat, ultrasound and electrical stimulation is usually recommended. Once the pain is better, exercises to improve posture, increase flexibility and strengthen back and abdominal muscles are taught. It is imperative to do them regularly as otherwise the benefits accrued disappear rapidly.
Usually, most patients improve within a month or two.
To prevent backache:
- Exercise regularly by jogging, walking or swimming.
- Do “core strengthening” exercises for your back so that the muscles hold your bones firmly in place.
- Do flexion exercises like yoga or pilates.
- Keep your weight in the desired range for your height. To calculate this multiply your height in metre squared by 23.
- Stand erect. Teach children correct posture. If your work involves standing for long periods of time keep a stool under one foot and alternate legs every 10-15 minutes.
- Use ergonomically designed chairs, of the correct height with back supports.
