Lower Back Pain
“Burlington Lower Back Pain Is The Most Common Cause of Missed Work Days As Well As Job Related Disability”
Most times when people get back pain is usually of only a few days duration, but it can be much longer or sometimes lead to much more serious problems.
Acute – or short term duration can last from a few days to a few weeks. Most of this type of a problem is mechanical in nature, which means the cause of it may be old unresolved injuries, from sports to gardening, work around the house, a car accident. Symptoms are usually stiffness, muscle aching or sharp, stabbing pain. You may stand ‘crooked’. You may also have ‘shooting’ pain down a leg.
Chronic – or longer term duration. If it lasts more then 3 months, it is considered chronic. If it is chronic it will have a degree of disability or at least an inability to do what you want. It can range from mild to severe. From a nuisance to where even walking or moving around is difficult.
What is the back? – The back is an intricate structure of bones, muscles, ligaments, tendons etc. that form the back of the trunk. The main part is the spinal column and its main role is housing the spinal cord. The spinal cord connects the brain to the rest of the body. Meaning, to every single cell of the body. The spine is made up of 24 movable vertebrae, which stack on top of each other. When in that position, vertebrae form a channel thro which the spinal cord sits. The spinal cord has a pair of nerve roots which exit the spinal cord at each level between the vertebrae and connect to the rest of the body. The spaces between vertebrae which make room for the nerve roots to exit the spinal cord are maintained by discs. Discs are soft pads made up of cartilage which allow for shock absorption and movement.
Why does low back pain happen? – Low back pain can occur at any age and any body type. Pain can occur as a result of too much strain due to lifting heavy objects or twisting forcibly. What strains is the muscles, ligaments, tendons or joints. If strain happens habitually, it may weaken one of the discs. In time that disc may rupture and compress a nerve root. This results in pain. It sometimes goes into the leg, its called sciatica. Pain can also happen as a result of degenerative conditions such as arthritis, osteoporosis or other bone or disc related problems. In addition, any of the following can cause back pain: obesity, weight gain during pregnancy, stress, poor physical shape, bad posture, poor sleeping habits etc.
In about 2% of all cases, low back pain can indicate a serious condition which may require surgery. Some of these cases will result in permanent disability.
Who gets back pain? – As I mentioned earlier anybody at any age can develop back pain. The most common culprits are old unresolved injuries. We hurt our back as a result of, say, playing with friends or kids. What do we do? Most often we take a pain killer and wait it out. So in several days our pain is gone and we continue with our lives. In the meantime the injury we had has resulted in some scar formation or weakening of one of the supporting spinal structures. With repeated re-injuries we get more scar formation, weakening the spine even more. Eventually, we hurt the back frequently, resulting in longer and longer recovery times.
The same mechanism is at work with bad postures. Here, every time we stand, walk or sit we strain the back as a result of a bad posture. So 30-40 years of a bad posture results in chronic back pain. Incidentally, sleeping posture is also part of this scenario.
A third reason is that most of us in very poor physical shape. Yes, that probably includes you. The stats are that only 10-20% of population regularly exercises, which means the rest of us can routinely be found sitting in front of the TV. Over the years our core muscles weaken, because of not being used, and that by far, predisposes us to an easy low back injury.
All that is necessary is something unusual and strenuous, like shoveling snow, lifting groceries out of the trunk of car, throwing a football at a picnic, helping a friend move etc. There are hundreds of ways to injure your back when the core and leg muscles are weak and out of shape.
What conditions can also cause low back pain? – A herniated disc, also called, bulging disc, protruding or ruptured disc. As a disc goes through a lot of mechanical pressure, it can tear at a place near the spinal cord. The situation can develop where some of the disc material presses on the cord, resulting in pain.
Sciatica is a very common condition in which a herniated disc presses on the sciatic nerves. Sciatic nerves exit the column at low back and wind their way down the leg. So sciatica may cause numerous problems, the most common of which is pain in the leg. If more severe, there may be numbness and loss of muscular control in the leg. Needless to say but sciatica can be very disabling.
Spinal degeneration from discal wear and tear can result in discal narrowing. This in turn decreases the intervertebral foramen, the opening through which the nerves exit the spine, putting pressure on those nerves, causing recurring pain.
Stenosis is related to congenital narrowing of the spinal canal and predisposes some people to low back pain.
Skeletal irregularities produce strain on vertebrae, muscles, tendons and ligaments supported by the spinal column. These irregularities include scoliosis, a curving of the column to one side or the other. Kyphosis, in which a curve of the upper back is severely rounded. Lordosis, an accentuated arch in the lower back.
Back pain treatments
Treatment involves reducing inflammation, restoring proper function and strength and preventing recurrence of the injury.
Ice and heat – Use ice on the most painful area as soon after the injury as possible. I recommend using ice on the back for 10 min. then remove the ice pack for 10 min. allowing the back to warm up in the room temperature, then put ice back on. Switch the pack on and off 5x, then let your back rest for 1-2 hrs. then repeat again. I know a lot of people like to use heat, I think because it’s more comfortable then ice. I have never found heat to produce any significant results, other then rest for the patient.
Bed rest – used to be a standard recommendation, but we know better today. Of course, some rest is necessary but keep moving, even if its only around the living room. When going to sleep it helps to sleep on the side and put a pillow between the knees. Sleeping on the back is good as well, also put a pillow under the knees, to keep them bent.
Exercise – may be the most effective way to speed recovery from low back pain. Proper exercise can keep the muscles stretched and fit. The best all around exercise is swimming. I rarely recommend running/jogging, simply because a lot of peoples bodies are not suited for running. By improper running they risk more injuries to the low back and hips. Whichever way you choose to exercise, keep it a routine and keep it for a lifetime for best results.
Medications – only use in the short term. Medications have no ability to ‘fix’ or repair any injuries. Relying on them long term will surely lead to more back problems.
Spinal manipulation – is very effective. It should be used in conjunction with corrective spinal exercises. Very often, corrective postural exercises are necessary. Other postures, such as during sleeping and work have to be addressed. For patients who decide to keep working on the above mentioned techniques, they can manage their low back condition so that it doesn’t cause undue problems. In many cases, they can completely get rid of their back problems.
Acupuncture – also effective in back pain treatments.
Traction – has been always touted as an effective way to treat back pain. I have never found it to be so. In fact, traction without spinal manipulation has very little chance of success. The main reason is that affected discs, which traction intends to stretch are usually the hardest to stretch, so traction stretches the healthy, unaffected discs the most.
TENS – (transcutaneous electrical nerve stimulation), just plain doesn’t work. The theory is sound but it just doesn’t work that way in a live human. We have to get physically involved in treatment. For back pain sufferers there is no effective way to reduce your back pain by sitting around with a TENS unit or taking medications. Eventually, the muscle weakness, improper posture and bad postural habits have to be addressed and corrected.
And finally there is surgery – spinal fusion, discectomy, discal absorption, discal replacement etc. have very limited clinical results. Some 75% of all surgical patients report being no better after 3.5 years following surgery. As surgery is permanent, one should consider it very carefully.
Tips to a healthier back
Bottom line is: lose weight and get in shape. I know, its easier said then done. It sounds like a tall order. Consider it as a program and chunk it little by little. If you just start paying attention to your posture during working hours and during sleep, you’ll be making significant progress in a short time. None of this stuff is complicated, the difficulty, for most people is to stay consistent until most of the ‘new’ habits become everyday routine.
When you consider that the entire exercise routine for a healthier back lasts only 10-15 min., and you can do it at home, it doesn’t seem like such a difficult thing to keep doing.
As I mentioned the biggest challenge is consistency, to stay with the program until you are actually standing, working, sitting and sleeping with a proper posture.