Back Pain

Back pain is most common ailments counting around 70% of population and is a work related problem. The anatomical structure of the spinal curvature at the cervical and lumbar region where a mobile segment meets an immobile part (sacrum), and where the lumbar lordosis merges into sacral kyphotic spine, makes it more susceptible to damage.

Back ache/pain is a very common problem and has a ubiquitous distribution, accounting for about 60 percent of population at some point in their lives.

Back pain may be:

• Acute: Lasts for 3 months and gets relief within 4-6 weeks of home treatment.

• Recurrent: Acute back pain symptoms get repeated.

• Chronic: Lasts longer than 3 months and relief may also be very slow.

Causes:

• Improper postural habits, Sitting/Standing long hours in same posture.

• Trauma/Injury- Lumbosacral strain, Fracture of vertebrae.

• Degenerative diseases- Spondylosis, Disc prolapsed, Tumors.

• Structural deformities- Scoliosis, Spondylolisthesis (slippage of one vertebra on other), Spinal canal stenosis (compression of nerve roots), Spina bifida.

• Metabolic- Osteoporosis, Kidney improper functions, Constipation.

• Inflammatory- Ankylosing spondylitis, Arthritis.

• Obesity, Greater number of pregnancies, Anxiety, Depression, Carrying heavy weights especially in wrong way.

• Wearing high heels, Lack of balanced diet, Irregular menstrual cycle in women, People with no physical activity.

Symptoms:

• Acute/Sever pain in middle of the back or lower back.

• Persistent back pain while movements like Forward bending, Backward bending, Turning the lower back, Straight leg raising in lying position.

• Increased back pain while Sneezing, Coughing, Stretching.

• Radiation of pain may occur to Buttocks, Back of thigh and leg and decreases by rest.

• Spasm, Swelling, Tenderness in the back is also felt.

Diagnosis:

• Nerve testing by NCV (nerve conduction velocity), EMG (electromyogram) done to lower extremities to detect nerve irritation.

• Disc herniation, Spinal stenosis, Ankylosing spondylitis can be detected with imaging tests like CAT/MRI scan.

• Discography, Radiography.

Treatment:

• R I C E treatment program is to be followed for pain reduction.

  1. Rest should be taken for few days. Use of Lumbar corset/brace can be done to reduce stress on the back as they support the back.

        Resting positions:

      • Semi folicular positions(here both hip and knees are to be flexed)

      • Supine lying/Lying on the back with pillows under knees.

      • Side lying with hip and knee flexed (fetal position).

      • Bed rest on firm mattresses gives better relief.

      • Prone lying is hazardous and should be avoided.

  2. Cryotherapy: Ice application to the pain area is to be done for 15-20 min with certain gap. This reduces inflammation, swelling, muscle spasm, numbs soft tissue, and slows nerve impulses in the injured area.

  3. Thermotherapy:

      • Superficial heat given through

          - Hydro collator packs (wrapped in two towels and placed on painful back for 30 min),

          - Infrared rays.

          - Heating pads.

      • Deep heat given through Electrotherapy modalities.

          - Short wave diathermy (Continuous mode in chronic, Pulsed mode in acute pain).

          - Ultrasound (20 min at 3 times for 3-4 weeks). Analgesic creams can be used as lubricant while taking ultrasound treatment.

      • TENS (effective in relieving both acute and chronic pains)

• Analgesics, Anti-inflammatory drugs, Cortisone injections given under doctor’s supervision.

• Joint mobilization, Soft tissue massage, Electrotherapy modalities, Lumbar traction done by the physiotherapist.

Note: Talk to your doctor before you start an exercise program, and only do exercises that do not increase your symptoms.

• Flexion exercises- These exercises strengthen the abdominal muscles and stretch the back muscles and ligaments. Flexion exercises are good for people whose pain decreases with sitting.

  1. Pelvic tilt- Lie on back, knees flexed and slowly lift your hip and pelvis off the floor by pressing the upper back to the floor.

  2. Single Knee to chest- Lie on the back, knees flexed to 90 degrees and feet flat on the floor. Then slowly raise one of your legs off the floor bringing it towards your chest within pain free limit. Keep your back intact to the floor.

  3. Double knee to chest

  4. Hamstring stretch

  5. Curl-ups

Lie on the back, knees flexed at 90 degrees and feet flat on the floor. Keep your arms across your chest. Tighten your abdominal muscles and lift your shoulders off the floor. Do not touch your chin to your chest.

  6. Hip rolling- Lie on your back, knees flexed at 90 degrees and feet flat on the floor. Keep your arms across your chest. Turn your head and upper body to one side (right) and hip and knees to other side(left). Allow your knees to relax and go down towards the floor and repeat the same in reverse directions.

  7. Heel dig bridging- Lie on back, knees and ankles flexed so that your ankles should seem to be digging into the floor. At this point, knees should be at 90 degree flexion. Squeeze your buttocks and slowly lift the hip off the floor until your shoulders, hips, and knees are all in a straight line.

• Extension exercises – These exercises stretch front tissues of spine and strengthen back muscles. Extension exercises are good for people whose pain decreases with standing and walking.

  1. Prone lying on elbows

  2. Prone press-up back extension- Lie on your stomach with support of forearms, and then press your elbows down to the floor and raise the upper back relaxing the stomach muscles. Allow the back muscles to arch lifting hip and pelvis off the floor.

  3. Alternate arm and leg exercise- Start on the floor, on your hands and knees. Slowly raise your leg straight without bending the knee and tilting your hip. If you are comfortable doing this then raise your opposite arm forward without bending elbow.

  4.Tail wagging- Start on the floor, on your hands and knees. Slowly move your hip right towards your right shoulders and come back to normal position and vice versa.

  5. Cat and camel pose- Start on the floor, on your hands and knees. Slowly allow your trunk/lower back to sag and arch.

  6. Wall sit- Stand and rest your back to the wall making back flat against the wall. Then slowly slide down slightly bending the knees.

• Aerobic exercises – Walking, Swimming, Water aerobics, and Bicycling. Running and dancing should be avoided.

• Yoga

  1. Bhujang asana

  2. Shalab asana

  3. Hala asana

  4. Uttarapad asana

  5. Shabva asana

Prevention of Back pain:

• Regular exercise and brisk walk with active daily activities help to strengthen the back muscles preventing back ache.

• Sedentary life style should be avoided. If you have prolonged sitting job hours, then always stretch your whole body for every one hour.

• Avoid sitting/standing long in one posture. Avoid well cushioned seats.

• Preventing back pain at work place:

  1. Avoid high heels wearing to office.

  2. Work by sitting in a comfortable chair.

  3. Practice relaxation positions while sitting.

• Proper postural habits:

  1. Lifting objects –

     - Bend your knees while bending not at your waist.

     - Hold the lifting object close to your body not higher than your chest.

  2. Walking

    - Walk well with your head high chin tucked in, toes pointing straight in front.

    - Wear comfortable foot wear. Take natural, comfortable steps and swing your arms comfortably.

  3. Standing

    - While standing upright, keep one foot in the front and bend it slightly.

    - If you stand for a longtime, keep one foot slightly higher than the other (on a low stool) and change position often.

  4. Sitting

   - Make sure your back touches the back of the chair firmly and the knees should be higher than the hips.

   - Sit close to the desk/table to avoid forward bending. Do not sit too long.

   - While driving move the front seat close to the steering wheel and keep both the hands on the steering.

  5. Turning and reaching out

   - When you move, use your feet rather than twisting your waist. To reach high objects use stool.

  6. Sleeping

   - If you are sleeping to your side, keep knees and lower body slightly bent.

   - If you sleep on your back, put a pillow under knees.

   - If you sleep on stomach, put a pillow under your waist not under your head. Mostly avoid this pattern of sleeping.

   - The mattress should be pliant/firm so as to adapt itself to the shape of the body. The underlying frame should be rigid to support the body.