CAUSES AND UNDERSTANDING OF BACK PAIN
Back pain is one of the most common health problems encountered which can reduce work capacity, productivity and quality of life.
CAUSES OF BACK PAIN
Strain of the back can be due to short term and long-term causes.
Short term strain is commonly caused by:
- – working/sitting in a faulty posture for prolonged periods
- – sudden twisting, bending, overstretching
- – heavy exercise
- – lifting weights
- – sleeping in an abnormal posture
- – fall/injury on the back
Long term strain is seen due to faulty lifestyle-
- – prolonged working hours
- – improper posture
- – occupational strain
- – extensive use of gadgets like mobile phones and laptops.
- – Aging (accentuates strain)
Short term strain is usually due to muscle tension, spasm or injury. Long term strain increases wear and tear of muscles, vertebrae and the discs, while aging reduces the body’s capacity to repair and regenerate effectively.
Arthritis of the Backbone (Spondylitis)
Increased wear and tear lead to degenerative changes in the bones and joints of the cervical or lumbar backbone causing Spondylosis (Spondylo-arthrosis). When this progresses to inflammation, it manifests as constant/frequent back pain and reduced flexibility and mobility. The condition is then said to be Spondylitis (Spondylo-arthritis).
Cervical Spondylitis causes neck and shoulder pain, while Lumbar Spondylitis causes lower back pain.
The Intervertebral disc can degenerate, or bulge out (called a slipped disc, herniated disc or disc prolapse) and exert pressure on the adjoining nerves of the spinal cord, causing a shooting pain along the line of the nerve supply. Sciatica is such a sharp, shooting pain going from the lower back through the buttock and down the back of the leg, due to a L4-L5 or L5-S1 disc prolapse.
Other Rarer Spine related causes
- Fracture of the vertebrashould be ruled out especially if a history of injury is present, or in aging people with thin, weak bones (Osteoporosis).
- Spinal curvature abnormalities like scoliosis(side curve) and lordosis (inward curve) Spinal infections (usually accompanied by fever), herpes (shingles) of the spinal nerves
- Spinal tumors.
- Autoimmune arthritis causes damage and inflammation by the body’s own immune system of the intervertebral discs and adjoining vertebra. The spine appear fused like a ‘bamboo’ on X-ray, a condition called Ankylosing Spondylitis (AS) which causes a stiff and painful back. Sometimes this may be associated with arthritis of other joints as well.
Diseases of organs in the vicinity can also manifest as back pain like in certain abdominal conditions (pancreatitis, kidney stones, pelvic inflammatory disease, etc) and chest conditions (some diseases or tumors of lung and aorta) causing lower and upper back pain respectively.
Obesity, lack of physical exercise, dietary deficiencies (decreased Vitamin D and calcium), and smoking increase the overall risk of back pain. Pregnancy is also a common cause of back pain due to the pressure of the growing uterus. Stress, lack of sleep, and anxiety also aggravate back pain.
MANAGEMENT OF BACK PAIN
Short term back strain and pain are managed by:
- – adequate rest
- – relaxing exercises or stretches to relieve muscle tension
- – using warm compress/pads
- – taking analgesic-muscle relaxant medicines when required.
Strenuous exercises like weights and push-ups should be started or undertaken only under the guidance of a qualified trainer.
To avoid long term back strain, the following lifestyle modifications are helpful:
- – maintaining a nutritious diet and appropriate weight. Diet should be rich in proteins, vegetables, fruits, whole grains, yogurt and water.
- – regular physical exercise, with specific back stretches
- – correcting posture, taking precautions during gadget use and ensuring workplace ergonomics
- – testing for Vitamin D and Calcium deficiency
- – ensuring adequate rest and sleep, with appropriate pillow and mattress
In the case of long term back pain, it is prudent to meet a doctor who would examine and advise required investigations according to history and examination. Disc prolapse is indicated by the Slow Straight Leg Raising Test on medical examination. While lying flat, one leg is raised without bending the knee, and a pain radiating from back down the back of the leg is indicative of Sciatica.
Investigations required can include blood tests, X rays, CT, MRI or Ultrasound to establish the diagnosis. Special tests may also be recommended like Nerve Conduction tests, Muscle function test (EMG- Electromyography) and Myelogram (X-ray post dye injection into the spinal fluid to show nerve pressure due to prolapsed disc).
Treatment modalities for long term back pain include:
- pain-relieving and anti-inflammatory medicines: usually oral, or local application. (injections in severe cases)
- healthy diet and nutritional supplements (like Vitamin D, Calcium and sometimes Collagen protein supplements)
- appropriate guided exercises and physiotherapy sessions
- traction therapy (in disc prolapse)
- wearing of collar/brace/belts when required
- others: massage, heat/cold and vibration therapies
- NSAIDs(Non-Steroidal Anti-Inflammatory Drugs): Reduce Inflammation, Swelling and Pain. Like Ibuprofen, Naproxen, Diclofenac, Aceclofenac, Piroxicam, Lornoxicam, Ketorolac, Etodolac, Etoricoxib etc
- Analgesics: Provide only pain relief and do not have anti-inflammatory action. They may be prescribed in combination with the NSAID class to enhance the pain-relieving effect during painful phases or episodes. Like Paracetamoland stronger analgesics like Tramadol, Tapentadol, Flupirtine, etc.
- SYSADOA (Symptomatic Slow Acting Drugs for Osteoarthritis): Act slowly on the underlying disease process either by enhancing and strengthening the cartilage (Glucosamine, Chondroitin, Hyaluronate)or modulating the inflammatory mediators (Diacerein). These are initially prescribed in combination with NSAIDs as they take time to exert their effect.
- Immunomodulators: Used mainly for severe inflammation or autoimmune conditions like AS, like Steroids, Methotrexate, Azathioprine, and Cyclosporine.
- Collagen supplements: Proteins which help to rebuild and repair bones and cartilage.
- Herbs: Have anti-inflammatory properties like extracts of Rosehip, Boswellia (Indian frankincense, Sallaki), Curcumin (Turmeric),Devil’s/Cat’s claw, Acacia Catechu (Catechins) + Scuttuleria biacalensis (Biacalins), Morus alba, Soy, Willow bark, Ginger, and Green tea.
- Vitamins-Minerals: These include Vitamin D, Vitamin C, Calcium, Magnesium, Zinc, Boron, and Phosphorus. Sometimes these may be combined with Amino acids
Supplements as the name suggest work best along with appropriate medicines for better symptomatic relief as their effects may be variable and take time to set in.
CREAMS, OINTMENTS, GELS
Some of the NSAID medicines are also available as creams, ointments, and gels (or even sprays) and have the advantage of avoiding the side effects seen in the Gut when given orally.
Agents called Counter Irritants are often added to these preparations, as they produce a sensation of heat, burning, or coolness, which decreases the underlying pain perception like Methylsalicylate (oil of wintergreen), linseed or eucalyptus oil, menthol, capsaicin, and camphor.
Spinal surgery may be needed if conservative treatment is ineffective, especially for releasing pressure on nerves, removing bone overgrowths and tumors, stabilizing fractures or for correcting spinal curvature. Commonly performed back surgeries include discectomy (removing the prolapsed portion of disc), laminectomy (removing a portion of the vertebrae), Fusion (fusing two vertebrae for stability), and putting in an implant (like artificial discs).
HEALTH TIPS FOR LAPTOP/COMPUTER USE
Laptop and Computer use have become an integral part of our lives and the backbone of corporate and professional life. Laptops are also now a part of E-learning in most educational institutes. Back ache is a common result of incorrect postures and long hours of using laptops. Here are a few protective tips:
Sitting distance and height
- – Keep an arm’s length distance from the screen
- – Eyes should be at the level of the top of the screen, so that while working your head is straight and eyes gaze slightly downward.
- – The screen should be tilted slightly backward by about 10-15 degrees.
- The posture should be such that the head, neck, and back are in a straight line. Bending the neck or slouching of the back should be avoided as it can lead to neck pain.
- The thigh should be parallel to the floor and the knee should be comfortable under the table (not crouched up). The legs should be straight perpendicular to the floor while the feet should rest flat on the floor (not dangle).
- If one can’t find the chair or table of right height to attain this posture, appropriate chair cushion, or laptop rest or foot-rest can be used.
- The forearm and hand should be aligned in a straight line.
- If the hand is bent at the wrist it can lead to long term strain and development of the computer wrist(pain in the wrist and fingers, and also a loss in firm grip). If this isn’t achievable naturally, wrist support can be used.
- We are almost 30-40% more sedentary as professionals working on computers/laptops major part of the day, thereby, increasing obesity, stress, back pain and cardiac risk.
- Every 1 hour take a walk, stretch your legs, arms, neck and back. Also, perform wrist rotation and finger exercises.
- Make half to one hour of physical exercise like brisk walking, cycling, yoga, aerobics or jogging part of your daily routine.
EXERCISE AND TIPS TO PREVENT BACK PAIN