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- Chronic Pain
Causes and Prevention of Low back pain
Low back pain is a common musculo-skeletal disorder, described usually as a sharp persistent, or dull pain felt in the part of the back; just above the waist, with in the waist and immediately below the waist. The pain at times radiates to one or both of the lower limbs (Sciatica), typically behind the thigh. It may also be associated with a feeling of numbness, tingling sensation, or heat in the muscles of the lower limbs. It affects 70% of all people at some point in their lives. The condition may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). In the common presentation, pain develops after movements that involve lifting twisting or forward bending. The pain may be localized at a particular point, or may be diffuse. Statistics show the condition to be common starting from age 20, with seemingly equal distribution in gender.
According to Paul W Stratford (associate professor school of rehabilitation science, McMaster University) low back pain is an important public health problem in all industrialized countries as it accounts for more than 60% of all activity limitation disorders in adults aged less than 45 years.
It is important to understand that low back pain is not a specific disease but rather a complaint that may be caused by many underlying problems of varying degrees of seriousness.
Acute pain may come as a result of injury to the structures that provide stability to the spine such as muscles and ligaments.These kinds of injuries are common in athletes, but may also result from motor vehicle accidents or direct blow to the back using heavy objects. They include sprains, fractures to the lumbar vertebrae, injury to the intervertebral discs and subluxations. Following injury, or disease, the makeup of the discs may change: blood vessels and nerves may grow into the disc interior and herniated disc material can push directly on a nerve root. Any of these changes can also cause pain.
The lower back is subjected to a lot of mechanical stress and strain, as it supports all the weight of the upper body. The lumbar region (lower back) is made up of five (bones) vertebrae, named L1 to L5. In between these vertebrae are fibro cartilaginous discs, which act as cushions, preventing the vertebrae from rubbing against each other while at the same time protecting the spinal cord. Nerves come from and go to the spinal cord through specific openings between the vertebrae, providing the skin with sensations and messages to muscles. The vertebrae form small joints with each other called facet joints which are responsible for directing and limiting motion of the spine. It is at the cartilaginous discs and the facet joints that the degenerative processes take place.
The discs are made up of specialized cells that can survive without blood. They are thus not supplied by either the circulatory or the nervous system. Repeated stress can therefore cause the discs to shrink; lose flexibility and the ability to absorb physical forces over time. This increases strain on other parts of the spine. Vertebrae at times may start rubbing over each other, ligaments of the spine thicken and bony growths develop on the vertebrae. As a result, there is reduced space through which, the nerve roots pass as they leave the spinal cord. Reduction in this space results into compression of the nerve root and thus pain.
Medical conditions such as tumors and conditions affecting the female reproductive system may cause acute low back pain. These include endometriosis, ovarian cysts, ovarian cancer, or uterine fibroids, and other pelvic inflammation diseases. Nearly all pregnant women report pain in the lower back during pregnancy due to changes in their posture and center of gravity causing muscle and ligament strain. Low back pain may also be referred pain from diseased internal organs like the gallbladder disease, kidney stones, kidney infections and many others.
Signs that indicate a serious problem include previous history of cancer, unexplained weight loss, impaired bladder or bowel control, significant motor weakness or loss of sensation, association with fever and urinary tract infection.
- Lift objects safely. Avoid bending the back while picking up an object, instead bend at the knees
- When sitting, adjust the chair to support the lower back and keep the spine in neutral position
- While sleeping choose a firm bed and mattress which will prevent the back from loosing the natural curves
- Regular exercise as well as a balanced diet rich in calcium and Vitamin D will keep your back strong and healthy
How to prevent Low back pain
Many of the activities we do knowingly or unknowingly, may cause injury to the back or speed up the process of degenerative changes in the lumbar spine. Basic modification in the way one carries out some of these activities can help a great deal in minimizing low back pain. Here are some tips on how to deal with the commonest offenders.
Lift objects safely
Poor lifting technique can cause both acute injury, and serious chronic effects. You must avoid being in a hurry while moving a heavy object because it is important to plan ahead before lifting. Take time and examine the object you want to move and ensure that it’s not too heavy for you to lift. If it is, find help, and ensure that you and your lifting partner understand the plan. Stand close to the load, and be as central to it as possible. Lifting the object close to the body will make you more stable. Keep the feet about shoulder width apart because too close or too far apart will hinder movement and may cause instability. Face the direction you want to move the object to so as to avoid twisting movements in the back. Bend the knees keep the back straight and think about the motion before you lift. Focus on keeping the spine as straight as possible. Lower to and rise from the ground only by bending your knees, rather than bending at the waist. Never bend your back to pick something up. You may practice a little before you actually take on the object. Tightening your abdominal muscles may come naturally. It helps in better weight distribution and is good for minimizing excess force on the spine. As you rise, lift through the legs. Remember to keep your eyes slightly upwards as this helps maintain a straight spine.
It is common to assume different postures which seem confortable and convenient while sitting to watch a movie, while doing some work in the kitchen or doing some work on the computer. However most of these convenient postures may in the long run be risky to the back. Whatever you are doing, you need a position that will not compromise the safety of your spine, and this has a lot to do with the choice of chair. Sitting in an office or other places for long periods can cause significant discomfort in the back. You can however minimize this by sitting in the right position. Sit in the chair so that the lower back is supported, keep the spine straight and have your knees level with your hips. If necessary use a footrest. Your chair height should be such that you can use the keyboard (when using a computer) with your wrists and forearm straight and level with the floor while the elbows are by the side of your body. This will help prevent strain injuries to the wrists and elbows as well. Try to avoid crossing your legs which may cause impairment in circulation. Let the screen be directly in front of you preferably at arm’s length, with the screen top at around eye level. If the screen is low or too high, you will have to bend or stretch your neck and end up with neck discomfort. Position objects you need to use frequently such as telephone or stapler within easy reach to avoid unnecessary repeated stretching or twisting.
Proper sleeping posture
When you sleep try to maintain positions that will keep the spine in neutral position and not arched so as to relieve pressure. Because it is not easy to maintain a desirable posture during deep sleep, it is important to use the right kind of bed. A thick soft mattress into which you sink is most likely going to cause your back to curve in undesirable fashion and put extra strain to the back. So will a spring sagging bed. Choose a firm preferably wooden bed with a soft, but firm mattress to allow the weight of the pelvis as well as that of the chest sink only slightly in whichever position you lie. This helps maintain the natural curves of the spine and relive strain from the spine. If you already have back pain, try these positions and you will almost feel immediate relief. When sleeping on the sides place a pillow in between your knees and try to keep your top leg from falling over your bottom leg. When sleeping on your back, place a pillow under your knees. To rise from the bed, roll onto the side of the bed and bend both. Drop your feet over the side as you push with both arms to sit up. Scoot to the edge of the bed and position your feet under your buttocks. Stand up keeping your back in neutral position.
Physical exercises strengthen the muscles of the back and abdomen which are important for stability of the spine .They also help keep a manageable body weight, relieving the spine from excess load. They are also good for the heart and general cardiopulmonary system health. Sporting activities are great. Jogging and bicycle riding are a healthy way to end a stressful day and will usually guarantee quality good night sleep. You may consult your physiotherapist for aerobic exercises which are safe for you. In addition to regular physical exercise, eating a healthy balanced diet rich in calcium and vitamin D will help prevent osteoporosis, which can lead to compression fractures of the vertebral bones.
Smoking increases risk of bone loss and interferes with blood flow because it promotes arthrosclerosis (tightening of arteries) and also increases sensitivity to pain. This interference in blood flow to the bones accelerates the process of degeneration because both bones and intervertebral discs are not receiving sufficient nourishment.
If your back pain is associated with any other symptoms such as those mentioned in the medical section of causes, you need to consult your doctor for proper assessment and management.
- Lumbar Spine Anatomy and Pain
The lumbar spine refers to the lower back, where the spine curves inward toward the abdomen. Learn the several distinguishing characteristics of the lumbar spine and the commom causes of lower back pain.