Dr M K Mam
Low back pain is extremely common and somehow its prevalence is increasing. It has been reported that about 80% of the population experiences an episode of low back pain (LBP) at some point of time in their lives; however its symptoms and severity may vary.
It is certainly one of the leading causes of absenteeism, sick leave, loss of work days and the workplace productivity, thus affecting the economy of the person, the family and the nation as a whole. It is also associated with disability and restriction of social activities. The good thing is that most of the cases get better by themselves or with minimal treatment within a couple of weeks or so. The vast majority of episodes of back pain are self-limiting and non-progressive; however the bad thing is that it recurs in large number of cases.
Causes of LBP: Pain in the lower back can arise as a result of conditions affecting the structures forming the back i.e. bony lumbar spine (vertebrae), discs between the vertebrae, facet joints, spinal cord and nerves, ligaments and the muscles of the low back and the skin covering the lumbar area. The conditions affecting can be since birth -i.e. congenital or it can happen later in life because of injury, infection, degeneration, arthritis or tumor etc. It can be also non-spinal in origin i.e. any problem involving internal organs of the pelvis and abdomen like kidneys, uterus and ovaries in females and prostrate in males. As such there are numerous causes of low back pain and often we can easily pin point the problem.
What are the risk factors which make a person prone to get back ache: Anyone can have back pain, but some things that increase the risk are:
Obesity- over weight: Extra weight certainly puts additional load and stress on the ligaments, the discs and the muscles of the back and causes LBP.
Abnormal postures: Sitting or standing in abnormal postures puts strain on our back. People especially the youngsters often sit in abnormal postures for long time while studying, using mobile phones or the laptops, thus invite trouble for their back and neck.
Old age: As one grows older, the muscles, ligaments and the bones like all other tissues tend to become weaker and worn out (degenerated) thus making a person vulnerable to back stress and pain.
Jobs having strenuous physical activity: People doing strenuous activities repeatedly that require bending at the back are prone to back ache as there is constant wear and tear of the back. Again people involved in lifting heavy weight are at a higher risk and it is mainly because of improper lifting of the weight.
Anxiety & depression: It has been reported that people with depression, mental stress and anxiety have more incidences of back pain; however the exact reasons are not known. It is well known that mental stress affects the whole body, brings unrest in all the systems of the body.
Smoking: We all know that smoking is very injurious for the most of our organs. It is now well recognized that the smokers are more prone to back ache, have more frequent episodes of back pain and often it stays longer, however its main cause is still not clear.
Poor physical fitness: Back pain like any other illness is more common in people who are not physically active and fit.
Pregnancy: It has been reported that about 50% of women experience LBP during pregnancy. The normal lumbar curvature is increased and the centre of weight bearing is shifted forward in pregnancy thus stressing the lumbar spine. The women who do not do exercise during pregnancy are certainly prone to get LBP than the ones who do it regularly.
Prevention of LBP:
At times diagnosis and treatment of LBP is difficult and it challenges the diagnostic and treatment skills of the doctor.
What all can be done to prevent low back pain: Exercise: We all know that exercise is very essential for the overall well being of the body and mind, so is the case with back. Exercise programme has to be started after seeing a doctor as some of the exercises may worsen the back pain. Again we must not start the exercise when there is acute back pain. Any exercise we do should be well within our comfort zone. Simple thing to remember is that one should do it as long the body allows it. Start has to be slow and we must stop doing it if it hurts or there is increase in the pain. There is no need to do strenuous exercises. Simple walking, swimming and stationary cycling are good to keep fit our body and the back. Exercise also keeps the joints supple – prevents stiffness of back.
Yoga: Role of yoga in physical and mental wellbeing of a person is being very well recognized all over the world. Lot many studies are going on Yoga as a treatment and preventive strategy for LBP and certainly there is evidence to suggest that yoga benefits people with non-specific LBP.
Managing your weight : Keeping the weight under control helps not only the back but the whole body to keep it fit and fine. As mentioned earlier extra weight certainly puts additional load and stress on the ligaments, discs and muscles and as such the back muscles have to work harder. Again protruded or potbellied abdomen shifts the centre of weight forward and increases the lumbar lordosis i.e. normal posterior concavity of the lumbar spine, so the back muscles have to put an extra effort to keep the proper alignment of the back. Losing extra weight certainly is good for the back, it also helps to take the strain off the hips, knees and feet and thus improves overall physical health and mobility.
Maintaining a correct posture: Improper posture puts stress on the back and can cause LBP. It can also make already existing backache more painful. Often it is said that we should always try to keep our back straight when we are standing. It is fine; however the most important thing is that we should just stand naturally with our feet slightly apart and not tense up on standing up straight.
Careful lifting of heavy objects: Most often back injuries are caused by lifting heavy objects improperly. Right way of lifting an object is that we do not bend our back, just keep it upright and instead bend our knees to lift the object. We always need to remember that we have to bend our knees and not the back. This way we will be using our thigh muscles to lift the object rather than the muscles of the back. The object must be held close to the body while lifting and carrying. Holding the objects away from the body puts lot of stress on the lower back.
Staying fit and active: It is always good to be physically fit and active, as the active people in general suffer less of the back pain than the people who are not active. Staying active keeps body especially the muscles and joints in good shape so that stress can be well taken care of. Anything we can do to improve our overall physical fitness and general health will certainly benefit our back as well.
Sleeping well: We should have a bed that is comfortable, it must not to be very hard or very soft. A firm bed is ideal for the most of the people with back pain. We must also make sure that the pillow is not too high. Sleeping on sides with knees bent and the hips bent forwards with a pillow in between your knees is appropriate for a painful back. When sleeping on the back, we should keep a pillow under the knees and legs.
Healthy food: Eating healthy food with enough of calcium, vitamin D is essential just to keep the bones strong. A diet high in calories and fat has to be avoided as it will increase the weight, which is not good.
Shoe wear : It has been observed that a patient with LBP prefers using soft sole shoes as they might be acting as shock absorbers especially when we walk on hard surface. We should avoid shoes with high heels. Many patients with LBP are advised and use shoe insoles and they may be effective for the people who have to stand for long periods of time, however there is insufficient evidence to support the use of insoles in the prevention of LBP.
(The author is Consultant orthopaedics. Jammu Formely, Vice Principal, Professor. & Head Deptt. of Orthpaedics, Christian Medical College, Ludhiana)
Dr M K Mam