LUMBAGO / BACKACHE/ SLIP DISC - Overview
Are you the type who has difficulty in getting up from a seat due to pain and stiffness in the back?.Having difficulty in turning sides in bed due to pain in the back? you could be suffering from Lumbago...
What is lumbago/back ache:-
Our spine comprises of mainly the bones (vertebrae), the disks and the spinal cord .Bones (vertebrae) are stacked one on top of each other to form the backbone. Through these vertebrae passes the spinal cord .Discs are a kind of cushions that are positioned between two vertebrae. They act as shock absorber in the spine. These disks are round and flat in shape and are made up of tough outer covering which surrounds a jelly like material called nucleus.
Although the slipping of the disc can be triggered due to a trauma like over stretching or lifting weight etc. It is difficult to pinpoint one single cause for this kind of disc problem. This problem often occurs out of gradual degeneration of the disk and is related to the aging process. Gradually over a period of time, as we age, the discs loose their water content and both the outer shell as well as the inner nucleus becomes stiffer and brittle.
As the discs wear out, their outer covering becomes more prone to getting torn. It is when the outer covering of the discs that get torn and the nucleus moves out to irritate the nerve passing by, that the pain occurs. The pain can occur in back, hips or even legs. In severe cases relentless pain can occur even with simple movements causing one to lie down in one position for hours and days at a time. pain can sometimes radiate down the legs and this is called sciatica. Although the slipped disk can occur anywhere in the backbone, the lumbar (lower back area) is more prone for this kind of disk.
Lumbago? Is Backache, Low Back Pain and Lumbago same
In today's scenario almost 80 percent of adults are affected by back pain at some point in their lives. Almost every family has one or more people suffered with this some time or the other. Lumbago is defined as mild to severe pain or discomfort in the area of the lower back. Weak muscles in the Back & Stomach increase the risk of Backaches . A variety of problems in the muscles, tendons, bones, ligaments, or an underlying organ, such as the kidney, may also cause backaches. The pain can be Acute (sudden and severe) or Chronic if it has lasted more than three months. Lumbago often occurs in younger people whose work involves physical effort though is not uncommon in elder people of retirement age also. Lumbago is a term for muscle pain in the lower back, near the pelvis & affected region with pain is Lumbo -Sacral region of spine hence it is termed as Lumbago.
Why is back pain so common :-
The curvature of the normal spine is such that, the bony column is weakest at two points. The cervical spine (the nape of the neck) and the dorsal spine are the weakest points. The lower back bears at least one half of the body weight. Hence, these points bear the brunt of repeated stresses and strains
Every joint has an optimum position of function, departures from which increase the likelihood of strains and pains. Over time muscle strains lead to an overall imbalance in the muscle structure. There is constant strain on the muscles, bones, tendons, discs etc. The most common cause of back pain is poor posture
The real pain might be triggered by sudden lifting of
weights, a sudden turn or a wrench, a fall on the back, sitting in a cramped
position for a long time, horse-riding, riding a tractor etc. Occasionally, it
won't be one event alone which triggers your backache. You may have been doing
things improperly for a long time standing, sitting or walking, until suddenly
one simple movement might trigger your pains.
These so-called last straws to the already overburdened back are some of the following
- Trauma: acute or chronic unusual lifting, sudden wrenches, fall etc
- Psychic factors like depression ' can cause lowered (poor) muscle tone and cause backache
- Any acute illnesses can cause poor muscle tone
- Obesity causes increased lordosis
- General poor health
- Localized, focal infections
- Faulty structure of feet
What makes backache worse is that once the pain starts, in order to avoid stressing the painful parts, we tend to perform actions ( walk, stand, lift etc.) with the use of other muscles which are not used to moving in that pattern. This further increases the stress on the muscles
Apart from the above mentioned triggers, backache can be caused by a number of other conditions
- Osteoarthritis (OA): with increasing age, the joints of the backbones undergo degeneration. OA of the joints that link one vertebra to its neighboring ones (called the facet joints) causes back pains
- Herniated Discs (disc prolapse): any heavy strain or increased pressure in the back can displace the round, resilient discs which act as shock absorbers for the back bones. They cushion every impact on the back such as when jogging, weight lifting, horse-riding etc. injuries, normal wear and tear, and diseases that affect the backbones can cause minor tears on the disc surfaces as well as make them bulge out from their places. Displaced discs can press on surrounding nerves and cause pain, tingling & numbness in the legs
- Injuries and fractures of the vertebrae (backbone): conditions that cause nerve, bone and tissue injury can cause back pain ' vehicular accidents, fall from a bike, fall on the back compressing the structures in the back
- Compression of the spinal cord itself (Spinal stenosis): the spinal cord travels through a narrow, hollow shaped bony canal called the 'spinal canal'. With aging, the lumen of this canal tends to become narrow, compressing the contents within it. Back pain is a common symptom of spinal stenosis
- Deformities: often the backbone curvature is damaged secondary to other diseases. The alignment which is usually straight tends to deviate either to the sides (scoliosis) or appear bent forwards (kyphosis). Long-term mal-alignment of the vertebral column can cause tremendous stress and strain on the supportive muscles that surround it. This usually gives rise to backache
- Occupational: many occupations can take a toll on your back. If your work requires long hours of standing, lifting of heavy weights or sitting in an uncomfortable position, your back will possibly suffer
There can be many precipitating causes for backache. In
the majority of cases, it is impossible to identify the exact cause of backache.
Still in 25% of cases, however, it is possible to identify the cause. Often,
these patients are suffering from conditions like a Slipped Disc, Osteoporosis
(brittle bones), deformation of natural spine curvature (Scoliosis) or more
rarely, skeletal damage due to tumours or infection. It is believed that back
pain is usually the result of spinal degeneration or injury, especially damage
to intervertebral discs, These are structures located between the vertebrae that
act as cushions. Each disc consists of a tough, fibrous outer layer surrounding
a soft interior, which is what provides the cushioning. With the ordinary wear
and tear of living, the discs show signs of aging and may be injured. When a
disc begins to degenerate, a strain - even something as small as a sneeze - can
cause the disc to rupture, or herniate, allowing the soft interior material to
protrude out of the disc and press against the spinal cord. This situation is
sometimes erroneously referred to as a "Slipped Disc"or Disc Prolapse . A
herniated disk can indeed cause severe intermittent or constant back pain..
Though the main cause of back pain is simple muscle spasm or strain . Although
symptoms may come on suddenly and can be acutely painful, this is actually a
problem that develops over a long period of time. When muscles contract, Lactic
acid and Pyruvic acid are produced as byproducts of muscular activity. It is the
presence of lactic acid in the muscles that produces the familiar sensation of
muscle fatigue following strenous activity. If high levels of these acidic
byproducts accumulate in the muscles, they cause irritation that can eventually
turn into pain and interfere with the normal conduction of electrical impulses
in the muscle tissue. This results in a condition called delayed-onset muscle
soreness (DOMS). Problems with acidic build-up are often made worse by
dehydration. Precipitating Facors :- - Wrong or Poor posture. - Wearing Improper
footwear. - Walking habits. - Improper lifting & Bending. - Straining. -
Slouching when sitting. - Sleeping on a very soft mattresses. - Calcium
deficiency. - Intravertebral disc damage, injury, wear & tear . - Herniation
or prolapse or rupture of intervertebral disc. - Bone disease specially
Osteoporosis. - Abnormal curvature of the spine or Scoliosis. - Fractures can
also rarely cause the backache. - Arthritis. - Rheumatism. - Constipation. -
Kidney, bladder, prostate problems and female pelvic disorders. - Female
reproductive disorders or problems. Premenstrual Pain. - Pregnancy and labor.
(Baby is head down, facing toward mother's pubic bone instead of her backbone),
back labor is a frequent occurance. It can be very intense back pain due to the
pressure of the baby's skull pressing against the tailbone. - Psychological,
emotional or stress-related problem.
Athletes are very prone to low back aches
Back pain might also originate from the nerves, spine
and muscles of the back. Conditions affecting structures present in the abdomen
and pelvis - (kidneys, ovaries, intestines, prostate etc.) can cause a backache.
In general backache is never really serious. It is self-resolving and lasts only
for some days.
70% of persons approaching a GP are better in 3 weeks while 90 % are better in 6 weeks time, irrespective of the treatment received
Is Lumbago a dangerous condition in any way :-
In case there is suddenly loss of control on bladder or bowel movements with the area of the lower back or legs turns numb, It calls for an immediate medical attention or a consultation with the Specialist. If one suffer from backaches and notice reduced strength or muscle bulk in one or both legs, a Neurologist and Orthopaedic surgeon must be consulted. These warning signs indicate compression of the spinal cord and its branches and early treatment is essential to avoid the permanent damage. To see the exact nature of problem and pressure on the nerve investigations should be carried out. X-Rays are often considered a routine part of back pain diagnosis, yet only a few back conditions show up on X-Rays. If the pain is caused by muscle strain or herniated disc, the X-Ray will do little to aid the diagnosis, since discs, muscles and ligaments are all soft tissues. X-Ray exposure should be avoided in pregnant women patients. CT- Scan and MRI -Scan can show the nature and extent of the discs involved. However, it is noted that 20 to 30 percent of people with back pain have herniated discs that are not the source of their discomfort. If pain comes after lifting something heavy, after coughing, or after unusually heavy exercise, and the pain prevents one from moving or shoots down one leg, one may have a slipped , prolapsed or herniated disc. Smoking aggravates problems in the discs.
Seeking medical help
If you experience one or more of the following symptoms, get in touch with your doctor immediately
- Your back pain spreads down up to your knees
- You feel numb in your groin, rectal area, legs and foot
- You have fever, weakness and sweating
- The pain is so unbearable that you are not able to move
- The pain does not go away even after 2 or 3 weeks
Prevent Back pain ?
The following tips will help you guard yourself from hurting your back
- When you lift heavy objects, keep your knees bent and squat while lifting the object. Do not bend to lift it
- While carrying the object hold it close to your chest, keep your spine erect and straight
- When you lift heavy objects, keep your knees bent and squat while lifting the object. Do not bend to lift it
- While carrying the object hold it close to your chest, keep your spine erect and straight
- When you are lifting the object, do not twist your body
- When you move heavy objects, push it instead of pulling it
- Do not remain seated for long hours. Get up once in a while and stretch your body
- Do not wear high heeled footwear
- Exercise regularly. Lack of it can cause back ache
- Exercise daily. A good exercise will improve your posture
- A complete workout session should include walking/swimming aerobic activity + riding a stationary bike
- Never skip your warm-up exercises, even if you do regular workouts
- Manage your weight. Try maintaining your body weight within the range optimal for your age, sex, and daily routines
- Have foods rich in calcium, Vitamin D, phosphorus and proteins. They both help in building and repairing bones and muscles
- Wear low-heeled shoes. Avoid wearing stilettos for long periods
- Quit smoking. Smoking contributes to osteoporosis. It hardens the arteries supplying blood to our bones and reduces the blood supply to other vital structures that form your backbone
- Relax. Avoid stress from getting at you. Stress
causes the supportive muscles of the back to go into an abnormally contracted
state. Try yoga, tai chi and massages which are known to
How to prevent the occurance and What are Dos and Don'ts for the patients ?
Prevention · Adopt correct & good posture · Exercise regularly - especially swimming · Avoid Jerky movements or rides. · Don't stay in the one position for too long. Stand up and stretch after you have been sitting for a while or crouch for a few moments if you have been reaching up. · Lift correctly with your legs, not your back. Do not bend at the waist to lift. · Support your lower back when sitting. Buy a special cushion if necessary, particularly for driving · Try and sleep on your side - ensure you have a firm mattress. · Get up from the bed by turning to the side and don't get up straight from the bed.
Symptoms usually are: -
Acute or Chronic pain. Muscle fatigue. Stiffness.
Swelling. Spinal subluxation. Pain radiating into legs. Numbness and /or
tingling in limbs.
- Pain across the lower part of the back that sometimes radiates into the buttocks, the back of the thigh or to the groin. The pain is usually worse on movement. - Limitation in movement of the spine - especially bending forward and leaning back. - Tense spasm of the muscles surrounding the spine and causing a stiff back. - With severe pain and spasm, the back may tilt to one side causing a change in the posture. - The pain is sometimes accompanied by a tingling sensation or numbness in the back or buttocks / hips or leg.
When to see doctor:-
Your back pains definitely deserve medical attention in the following situations
- Your pains are accompanied by persistent fever
- You suddenly lose control over your bowel and bladder movements
- There are additional symptoms of numbness in the feet, nausea vomiting etc
- You have had a violent accident involving the back
- There is redness of the skin overlying the backbones
- Pain is elicited even with slight application of pressure
- You have developed weakness in the legs along with or after onset of the back pains
- The pains radiate below the hips to the legs
- Even the slightest movement in intolerable
- You have been on steroid treatment for other conditions
- You have a positive medical history of a tumor in the past
- You are HIV positive or have an addiction to drugs
- You have lost weight in the recent past
- You are above 50 years of age
- You are less than 20 years and feel this is the worst back ache of your life
- Your low grade pains persist for more than two weeks
- In spite of resting your back, the pains do not improve significantly in one or two day's time
How do I prevent backache:-
Some simple measures can help keep back pain at bay !
- Learn to bend and lift objects properly
- Avoid standing for long periods at a stretch. If you stand for a long time, make sure your ears, shoulders, hips and knees are in the same straight line
- If you have long hours of sitting, like a long car drive, try taking stops every one hour and walk around a bit
- When sitting for long, make sure your chair has a high back and supports your back (especially the region between the ribs and hip-bones) curvature properly. You may need the help of a pillow for the same
- Your chair should not be too high or too low either. Again, when sitting on a chair, make sure that both your feet touch ground completely. Your knees should extend beyond the seating provided and they should also be higher than your hips
- Don't slouch when sitting
- Exercise daily. A good exercise will improve
Backache is a symptom, causes for which are numerous. A
sound clinical evaluation often suffices to trace the cause.
Most physical exams will involve an examination of the following
- Palpation: Your doctor will check for any sign of pain produced with application of pressure. He will also need to verify whether you have any outward signs of trauma broken bones, brazed skin etc. your doctor will also assess your reflexes, joint stability and flexibility of the muscles around the joints
- Gait: Check the way you walk. Is pain or stiffness preventing a normal gait ?
- Stance: any abnormal posture adopted when standing
- Range of motion: To check if the range of motion is painless or painful, restricted and stiff
- Straight leg test: this test is done to confirm the affection of the sciatic nerve as it passes through your leg
Doctors may even advice a few tests and laboratory investigations
- A complete blood count along with erythrocyte sedimentation rates this would help in tracing causes like infections
- Other tests depending on presentation of symptoms may be required e.g. the test for tumor markers where malignancies are suspected
- Radiographic evaluation: where the back pains are not relieved by rest or medications and where there is a history of acute trauma to the back, or other symptoms like weakness of legs or numbness, a radiographic evaluation becomes necessary
- Magnetic Resonance Imaging and Computed Tomographic Scanning: both non-invasive tests that provide highly accurate results. These tests can often diagnose the presence of an illness, or herniated discs even in asymptomatic patients
- MRI uses no ionizing radiation and is better at imaging soft tissue (e.g., herniated discs, tumors). CT scanning provides better imaging of cortical bone (e.g., osteoarthritis). Compared with MRI, CT scanning is less sensitive to patient movement and is also less expensive
- Bone scanning: also called Bone Scintigraphy useful when radiographs of the spine are normal but the clinical findings are suspicious for osteomyelitis and bony tumors or hidden fractures
- Needle electromyography and nerve conduction studies: useful in differentiating peripheral nerve damage from disorders of single nerve roots or muscles
Homeopathic medicines offer excellent relief for low
back pains. Homeopathic medications can relieve the spasms of the back muscles
and provide effective pain relief without any side effects and are considered
good for raising the immunity. Homeopathy is of use in eradicating chronic
relapsing conditions. Homoeopathy doesn’t treat the ‘disease in man’ but it
treats the ‘man in disease’. Homoeopathy treats the cause of disease and the
illness will disappear.
Homeopathy is strongly recommended for acute or long lasting chronic back pains
Homeopathic medicines offer excellent relief from low back pains. Homeopathic medications can relieve the spasms of the back muscles and provide effective pain relief without any side effects and good for raising the immunity. Homeopathy is of use in eradicating chronic relapsing conditions. Homoeopathy don’t treat the ‘disease in man’ but it treats the ‘man in disease’. Homoeopathy treats the cause of disease and the illness will disappear. Homeopathy is strongly recommended
Apart from rest followed by physiotherapy homeopathy helps in both acute and chronic backaches. reduces pain and discomfort in acute cases and helps to strengthen the muscles in the back in chronic cases thereby preventing recurrence of back pain.
Pain in the back anywhere below the ribs and up to the hips is called low back pain. It is a condition that affects over 90% of the population at one time or the other. Next to common cold, it remains the most common reason why people seek medical help
Many people who experience low back pain do not meet up with a doctor since it usually resolves on its own. They may suffer from any dull aches to sharp pains or even numbness. The pain characteristically lingers on for a day or two before it gradually subsides. In many, the pains keep recurring in varying intensities