Back Pain Treatment and Myths!!

Myths & Facts About Back Pain

Back pain is one of the commonest causes that lead us to doctors’ outpatient clinic. Three out of four adults will experience back pain during their lifetime. The intensity of pain may vary from person to person. Most acute episodes of back pain are quite benign and self-limiting, however, chronic back pain is quite disabling physically, psychologically as well as economically!

Lower back pain is the commonest amongst various pain patterns affecting the human back. Back pain can occur in all age groups from pediatric to geriatric. The most surprising fact remains that our knowledge and awareness about probably one of most disabling diseases is very shallow. Low back, per se, is a non-life threatening condition unlike heart disease but it can make a life miserable.

Although awareness about back pain is lacking, we doctors consider back pain mostly either a condition associated with faulty lifestyle or a disease related to age- wear & tear. We shall try today to understand the basic facts about back pain in general.

What is back?

Back is an area of body spanning from the base of the head to the buttocks, on the backside. We, in medical term, mean back as a part of the body made up of the vertebral column, muscles supporting vertebral column, ligaments binding vertebral column and associated structures.

What is vertebral column?

The vertebral column is like a tower made up of small pieces of bones stacked one over the other, separated by cushion like structure called discs. The column supports the head (skull) and connects with the hip bone below. It gives a shape to our torso, transfers load and protects the spinal cord.

What causes back pain?

There are numerous factors responsible for back pain.  The commonest cause of back pain is a muscle strain.  It could be because of repeated insult to back mechanics due to our faulty lifestyle. However, there are other pathological causes also like an injury to disc and joints (facet joints) of the spine, infection of the spine, fracture of vertebrae, tumors of spine etc.

Does all back pain need treatment?

Fortunately, No. Most back pain subsides on its own with the rest of few days. Most back pains become mild or disappear in a week or two. Those pathological back pains may need disease-specific treatment.

What is the role of physiotherapy in the management of back pain?

Majority of muscle sprain or back pain are as a result of either disturbed posture or due to muscle losing its inherent tone. By physiotherapy, one can strengthen their musculature and make the spine biomechanically more in line with its physiological requirements. But, short duration of physiotherapy has no place in the treatment. It has to be practiced for a longer duration to get the maximum benefits.

Does obesity or weight be related to back pain?

Yes, larger the weight of a person more loads back has to bear. Not only that, the curvature of the lower spine (lumbar spine) changes as the mechanical axis shifts due to increased weight in front. Reduction in weight helps to reduce chronic back pain. It is very important to maintain a right weight for a healthy back. When one tries to reduce weight by dieting, one must take care of protein and other important nutrients. As for healthy muscles, nutrient deficiencies are deleterious.

Is back pain related to work?

We generally carry a myth that those who are in laborious activities tend to have more back pain. They are at higher risk of having muscle sprains but back pain is found also in similar proportion in persons who have sedentary work habits. However, back injuries and pain are more commonly found in workers who use vibrating tools quite often. Other than that there is no scientifically proven work style that leads to back pain.

Any relation to back pain with age?

Yes, there is a gross relation between back pain and age. It is not that incidence of back pain will be more in certain age groups. But age will lead us to the cause of back pain. In young, it is the muscle strain that is the commonest cause of back pain, while in older people, the effects of age-related wear and tear will give rise to a chronic back pain.

If I have back pain, can belts help me?

There is no scientific evidence to say that lumbar belts can help to reduce or cure back pain. So, personally, I don’t advise belts for back pain. What we need even with a belt is rest to muscles, which we can get just by lying in bed and avoiding certain activities.

I have back pain; do I need to use a specific type of mattress?

Once again, we do not have any scientific evidence that any specific type of mattress either prevents or help in reducing back pain.  Any routine relatively firm mattress is all that we need for a good sleep and good back.  Ideally, the height of the bed should be adjusted to such level that our knees maintain an angle of 90 degrees while we are sitting on it. The height of bed must not be less than that. For older people who have knee arthritis, more height is beneficial.

Is there any relation to smoking with back pain?

Smoking generally does not cause back pain. But evidencesuggestst that use of tobacco or smoking can disturb the circulation of blood at a small capillary level and it may lead to weakness of muscles. If one has back pain, smoking or tobacco can surely hamper the healing of damaged back.

What lifestyle change I should be doing to try to avoid back pain?

Many back pains are lifestyle diseases. A healthy lifestyle will surely prevent the back pain or will help to reduce the pain.  Try to maintain good lifestyle habits as mentioned below:

• Maintain a proper BMI (Body Mass Index). In other words, maintain your weight in accordance with your height.
• See to it that you are taking enough protein for good muscle health.
• Do aerobic exercises like walking, jogging, cycling, swimming etc. at least 3-4 days a week to maintain the good tone of muscles.
• Good night sleep has no substitute.
• Try to avoid stress or learn to manage the stress.

When do I consult a doctor if I have back pain?

As I told you before, most back pain should subside in a day or two. At least they will become mild in the intensity of pain. However, even after two to three days of good rest, back pain still persists, it is better to consult a doctor. It goes without saying; if intensity increases, medical consultation is imperative. Back pain associated with throbbing pain, fever, weakness and/or numbness in legs, any s/o paralysis of leg or legs, the doctor has to be consulted.

Does physiotherapy help in the management of back pain?

Physiotherapy is a very integral part of back pain management.  Generally, we do not advocate active exercises during an ongoing episode of back pain. We recommend heating modalities like IFT, SWD. Once the back pain starts coming down, passive physiotherapy should be started. As soon as the patient is able to tolerate the active physiotherapy, muscle-strengthening physiotherapy must be started.  Any episode of muscle spasm, sprain or back injury leads to loss of muscle tone. If we do not focus on physiotherapy rehabilitation, there are chances that one can have recurrent episodes of back pain.

It is, however, important to note that there is no role of a very short term physiotherapy protocol. Toning up of muscle takes longer time than one would expect. Ideally, one should be on 6-8 weeks of physiotherapy to regain the muscle strength.

BY

Dr. Niraj Vasavada

Head of Department- Spine

Shalby Hospitals

Contact: +91 98240 99953