It is extremely difficult to find a person aged 45 or above who has never had a significant episode of backache in his/her lifespan. And strangely nearly 80 per cent of the backaches are confined to just two zones of your spine. And would you believe that the actual reason for back pain dates back 20 million years?
Backache is so common that most people adopt coping strategies that aren’t really helpful. But with correct diagnosis and treatment your troubles can be cured in no time. What most patients do not realize is the fact that there are more than a dozen causes for the symptoms. The trick is to identify what you have, rather than prescribing a remedy common for all patients.
When you see a newborn cuddled up in a cot, did you ever observe the shape of their spine? All neonates have a C shaped back. But as they grow old and gain head control, the neck muscles become stronger and pull back the upper part of the spine. Later on when the babies start walking, the lower part of the spine changes its shape. The neck and the lower back are the areas of reverse spinal curvatures. Where the C shape is lost and the spine is angled or reversed backwards.
So, what does all this mean? Human beings became evolutionary superior because of these reverse spinal curvatures. We were able to stand straight and hold our heads up high. The change occurred through a scientific process called a gene mutation, 20 million years ago. But with all this glory came some nasty surprises as well. The neck and the lower back became areas prone to wear and tear.
Types of backache
There are two varieties of back pain. Axial backache is when pain arises from the bones of your spine, called vertebrae. Radicular back ache is when the pain comes from squeezed/compressed nerves.
What will be described today is called nonspecific backache. This is the commonest and affects millions of people on a daily basis. Backache is one of the leading health related causes for economic loss. As it affects work performance of even youngsters.
There are also other types of backaches like inflammatory back pain where pain is felt in the mornings with a bit of stiffness and gets better as the day progresses. This is related to inflammatory arthritis. An infection can sets inside the spine and causes trouble, like in tuberculosis of the spine. Rarely a cancer can spread to the spine and cause very severe pain. Weak bones can fracture and result in backache as well. Sometimes the organs inside the body can cause pain that is felt inside the spine. This is called visceral referred pain. A good example is kidney stones causing backache.
The bones that make up the spine called vertebrae connect with each other through three joints. Out of these, the intervertebral joint is the largest. In between vertebrae we have our own shock absorbers called discs. Discs are gel like structures. In between the bones, nerves spring out through tiny holes called foramina. Within the spine there is a tunnel through which a large nerve bundle called spinal cord travels.
If the junction between the vertebrae undergo a bit of wear and tear, this could cause axial pain. Also wear and tear can cause the bones to press against nerves and again cause radicular pain. Sometimes the discs between the bones split open and then pinch the adjacent nerves. This could cause severe pain.
Non specific backache
The characteristic symptom is pain confined to a particular region of your spine; which worsens during movement and gets better when you lie down. Pressure applied over that area might reproduce your symptoms.
Disc prolapse and pain
When the discs between vertebrae split apart it causes sudden onset of severe backache. This only happens if the disc presses a nerve. From what we observe, disc prolapse is seen in people less than 45 years. The pain can worsen when you carry weights and gets better when lying down. Disc prolapse pain can be felt around a specific part of your body like a belt tightening over the waist.
Muscle / ligament tear
Pain related to this is seen after strenuous activity, and classically presents a few hours or days after the initial incident. Again the body tightens the muscles that surround the area and ‘muscle spasm’ are detected when the patient is examined. People who have muscle/ligament tears prefer to stay immobile.
Facet joints and pain
Facet joints are tiny joints over vertebrae that prevent excess movement of your spine. These joints can undergo arthritis, which in turn causes pain. Facet joint arthritis is seen in the elderly. The symptoms are alleviated when the patient is in the seated position and is slightly leaning forward.
Sciatica is pain which starts at the lower back and shoots like electricity down the back of the leg towards the foot. Certain postures might suddenly cause sciatica and most of my patients are quite distressed about this. Sciatica is caused by pressure against a nerve called the sciatic nerve.
The joint specialist or rheumatologist will initially obtain some details and then examine the patient in lying standing and seated positions. Certain maneuvers like ‘Straight leg raising test’ will be performed. Depending on the findings the specialist will decide on whether to order X-rays or other imaging tests like MRI scans.
Most backaches do not require sophisticated tests if correctly diagnosed. But if there are features of impending danger like pressure against the spinal cord causing incontinence, further investigation is mandatory.
Most backaches if left alone will spontaneously heal in three months. Medication can hasten the process. Drugs like NSAIDS, ointments and muscle relaxants are used for treatment of backache. For radicular (nerve related) pain there are neuromodulator drugs.
Specific gentle exercises can also help patients a lot. The exercises should be taught depending on the condition of each patient, so always seek medical advice beforehand. Some patients are also referred to physiotherapists for specific therapies. TENS therapy (Transcutaneous electrical nerve stimulation is a therapy that uses low-voltage electrical current for pain relief) is also very useful. Resting is best avoided and we prefer if the patients stick to their daily routine.
How to avoid backache
Muscle strengthening meant to stabilize the spine is known to prevent backache. Correct posture when lifting weights, sitting or even lying down helps. Avoid rapid jerky movements when lifting objects and use bended knees as much as possible. Never twist your spine during bending. Regular aerobic exercise like swimming, brisk walking and cycling are good for the stability of the spine.
(The writer is a consultant in Joint Disease and Rehabilitation)