Backache? Or Is It Your Spine?

Back pain, more specifically lower back pain (LBP), is perhaps the commonest medical problem worldwide, affecting over 80% of adults at some point in their lives. While in most cases, it isn’t a serious issue and gets better with rest, physical therapy and medication, lower back pain is also a leading cause of disability as per the Global Burden of Disease published in Lancet.

What causes LBP?

It can be precipitated by an injury to back muscles or tendons. Other triggers could include arthritis, structural problems or disk injuries. Of course, one must remember that severe pain doesn’t necessarily mean there’s a serious problem. Here are some common causes for LBP and it’s often a combination of factors:

• Poor posture
• Lack of exercise resulting in stiffening of the spine and weak muscles
• Muscle strains or sprains

Apart from these, there are some specific conditions causing back pain, such as:

Spondylosis: With age,the bones, discs and ligaments in the spine naturally weaken, the discs in the spine become progressively thinner and the spaces between the vertebrae diminish. Little pieces of bone or osteophytes could form at the edges of the vertebrae and facet joints. This condition is spondylosis and is quite similar to changes brought about by osteoarthritis in other joints.

Sciatica: Sometimes,back pain is linked with pain in the legs, and numbness or a tingling sensation. This condition is called sciatica, which is usually caused by a bulging disc pressing on the nerve, causing the pain to travel all the way down to the leg and foot.

Spinal stenosis: In thiscondition, you feel pain in the legs as soon as you start walking, which gets better once you sit down.This could happen if the spinal canal or nerve root canal is squeezed by a bone or ligament, often the consequence of osteoarthritis.

Muscle or ligament strain: Repeated heavy lifting or a sudden jerky movement can strain back muscles and spinal ligaments and cause painful muscle spasms.
Neither sciatica nor spinal stenosis is a serious problem normally. However, if the symptoms are severe and your quality of life is badly affected, you should see a nerve doctor.

Other rarer causes

• Bone problemsoften linked to thinning of the bones or osteoporosis
• An infection
• Atumour
• Inflammation, as in ankylosing spondylitis, a long-term condition in which the spine and other areas of the body become inflamed.

When should you see a doctor?

Back pain often goes away on its own. However, in case you are experiencing any of these symptoms, please seek immediate medical help:

• Difficulty controlling or passing urine
• Loss of control of your bowels
• Numbness around your back passage or genitals
• Considerable weakness in your legs
• Severe and continuous back pain getting worse
• Changes in sexual function like being unable to achieve an erection

In case you are experiencing leg weakness, incontinence, and numbness simultaneously, you could have a serious illness called ‘cauda equina syndrome’, involving spinal cord nerve damage. This is a medical emergency, requiring immediate surgery to decompress the nerves and reduce permanent damage.

In fact, some injuries and conditions do need surgical repair. Fortunately, many of these procedures can be performed through the minimally invasive route.

Diagnosis of back pain

More often than not, it’s a ‘wait-and-watch’ approach with back pains. However, the doctor could advise tests if you’ve had an injury to your back, he/she suspects that there may be an underlying cause for your pain, or the pain refuses to go away.

X-rays are often not very useful since back pain is mostly caused by problems with soft tissues like ligaments and muscles, which don’t show up on X-rays. So the preferred tool is an MRI (magnetic resonance imaging) or a CT (computerised tomography) scan. Spondylosis-induced changes to the spine,however, can be seen on X-rays.

What could be really frustrating for patients is that sometimes even after a thorough investigation, it might not be possible to ascertain the cause for the back pain.

How do I prevent back pain?

A general improvement of your physical condition and proper body mechanics can help prevent back pains. Some cardinal rules are:

Exercise: Simple aerobic exercises can increase strength and endurance in your back, allowingthe muscles to function better. Walking and swimming are very good options.

Build muscle strength: Strengthening core a bdominal and back musclescan help those act like a natural corset for your back.

Watch your weight: Being overweight puts extra stress on your back muscles and can cause pain.

Kick smoking: Smoking is a known risk factor for low back pain. Quitting clearly helps reduce risk of LBP.

Stand straight: You should take care not to slouch and to maintain a neutral pelvic position. Good posture reduces stress on back muscles.

Sit smart: Your seat should have good lower back support, armrests and preferably, a swivel base. To maintain normal curvature, you can try placing a pillow or rolled towel in the small of your back. Change your position at least every half-hour.

Avoid heavy lifting: In case it is unavoidable, let your legs do the work. You must learn to keep your back straight, bend only at the knees and hold the heavy object close to your body.

Just remember that being active and exercising won’t make your back pain worse. You might feel a bit of pain and discomfort in the beginning, but staying active will eventually help you get better.

Our specialized Spine Department is comprehensively equipped to diagnose and treat all spinal injuries and disorders/diseases under the supervision of experienced specialists and surgeons.