Most people suffer from mild back pain from time to time and the exact cause of which may be difficult to diagnose. It is usually a sign that one or more muscles, joints, ligaments or discs are over-stretched or twisted by movement of the back in an awkward position. Severe pain may be the result of pressure on nerves from the misalignment of the bones in the back and warrants immediate medical attention.

Low back pain afflicts some 80 % of the adult population some time or other in their lives.

Many episodes of pain last only several hours or a day or two. By and large, 90% of patients should have recovered from their initial attack of pain by 6 weeks from the onset.

Symptoms

Early medical attention is necessary if certain symptoms (“red flags”) are present:

  • Constant pain with no significant relief at rest
  • Aggravated by bending in all directions
  • Localisable severe pain to a single spot on the back
  • Progressively severe pain over days/weeks
  • Persistent nerve pains, pain or sensation of numbness, pins & needles aching in one or both legs
  • Weakness of legs, difficulty in walking, unsteady walking
  • Bladder/bowel problems associated with back pain (difficulty in passing urine – incontinence)
  • General symptoms of poor health, loss of appetite, weight loss, lethargy, fever and chills
  • Previous history of cancer

Treatment

Rest is very crucial for patients with episodic attacks of back pain. Rest here may involve going home and lying down for a few hours, or it may be as simple as keeping the back straight and avoiding further stress to the back in the form of bending, lifting and sitting. In severe attacks, lying down for a day or two may significantly reduce the severity of the pain. If it does not, further bed -rest is not helpful.

Physical therapy is very important in the treatment and prevention of low back pain. In the initial period of acute back pain, combinations of heat, traction, manual treatment, and other techniques may help to rapidly reduce the severity of pain and stiffness. As pain subsides, exercises, to relieve stress and strengthen the back ,are gradually introduced. Regularity of such exercises can help to further reduce the pain, as well as protect the back from unhealthy stress and recurrent attacks of pain.

Different types of medications may be prescribed for different types of back pain.

In acute sciatica or leg pain associated with back disorders, the acute irritation of the nerve may be reduced by taking NSAIDS regularly for a short period of time. NSAIDS are often prescribed purely for pain relief rather than for anti-inflammatory effects. It is based on an as-required basis. These drugs are to be avoided if there is a history of allergy and kidney problems. In most cases, NSAIDS are well-tolerated, though most of them provoke gastric symptoms. The doctor must always be consulted.

Muscle relaxants help to reduce muscle spasm and stiffness that occurs during a pain attack. Sedatives and tranquilisers may be taken at night to ensure a restful sleep.

Ice packs, hot packs or heating lamps, ointments that usually contain methyl -salicylate and medicated plasters of various kinds may help.

30 – 40 % of patients suffer a relapse during the first few months following the attack. It is important to identify the factors that aggravated the pain.

I have severe back pain and sciatica that has not improved even with treatment. What should I do?

X-rays of the low-back should be obtained. Conditions like spondylolisthesis, infection and tumour should be excluded. Sophisticated imaging techniques such as MRI ( magnetic resonance imaging) may be required . MRI scans can show the severity of a prolapsed disc and more importantly , the degree of the nerve compression, if any. Other investigations such as bone scan, CT scans or myelograms may be performed in certain conditions.

Prevention

Recommendations for prevention of low back pain:

  • Try to modify the activity so that it is less likely to strain the back
  • Interrupt a repetitive task frequently by standing and stretching. This helps to reduce the stress on the back from building up to critical levels
  • Exercise programmes must be balanced to exercise all parts of the body, including the back.
  • Exercises should be done frequently in measured doses.

Slipped Disc

As a person gets older, a process called degeneration, the nucleus in the lower few discs of the low back . As a result , the discs are less capable of cushioning the spine , especially during repeated stressful activities. The capsule or annulus can then tear and cause pain. This is known as a slipped disc.

In a slipped disc, the annulus tears with different degrees of severity. Small tears heal quickly. Large tears can cause a small portion of the nucleus herniating through the tear to lie outside the wall of the disc. If this herniation is close to a nerve, intense irritation of the nerve can occur. “Sciatica “or feelings of pain, aching, numbness, “coldness ‘, paraesthesia or pins and needles of the thigh and calf may occur. This can involve one or both legs. Properly performed manual treatment using massage, mobilisation and manipulation may often be helpful in reducing the severity of low back pain.

Most cases recover without the need for surgery. As mentioned earlier, 90 % patients recover within 6 weeks. However a small group of patients have a significant portion of the nucleus that has herniated out of the annulus of the disc to compress the nerve and removal of the herniated fragment of disc will result in more rapid recovery of symptoms than without.

Frequently Asked Questions

Aside from a prolapsed disc, what other causes of recurrent back and leg pains are there?

Spinal canal stenosis and spondylolisthesis are 2 other common causes of recurrent back and leg pains . In older people, a condition termed as lumbar spondylosis, ( the facet joints of the spine can wear out ) can result in episodic back pains. Osteoporosis or softening of the bones can occur in the elderly, resulting in back pains. Patients who have had a previous history of cancer elsewhere, and having persistent back pains, should seek a medical opinion. Less commonly conditions such as rheumatoid arthritis, ankylosing spondylosis and various types of infections can also afflict the spine.

My back is often sore at the end of a day’s work. How can I prevent this?

Modification of activity or the work environment may be required. It is often how the person does that results in unnecessary stress to the back. Such instruction can be provided by the doctor or the therapist , either as an individual or in groups of patients attending “Back Care ” classes.

I am already doing a full day’s work. I also jog and play tennis Why do I need other exercises?

Work, no matter how strenous, is not exercise. In fact, some jobs especially those that involve repeated lifting or bending, or prolonged standing or sitting, add to the stress over the spine. Jogging, racquet games, golf, etc. may be good for general health and fitness but do not significantly exercise or strengthen the back. A balanced programme which includes improving the flexibility and strength of the back will help to prevent recurrent injuries.

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