Know about your Back pain

Back pain is a common problem with an incidence of 50% in life time requiring attention. The source of back pain can be muscles of the back,facet joints, degenerated disc or sacroiliac joint. The treatment of each of them differs so it is very important to establish the cause and source  of back  pain. If the source of your back pain is muscle the you need analgesics, TENS therapy, gentle back extension exercises and some times trigger point injections. If the source of your pain is facet joint then you need facet block and facet rhizotomy with a radiofrequency generator.  If disc is the source of the pain then you may need discography followed by total disc replacement. Some times discprolapse can cause back pain with leg pain. This usually requires microsurgical discectomy. Your back pain can also be due to movement of bones which is known as listhesis. This needs lumbar fixation with pedicle screws and rods. If your source of pain is sacroiliac joint then you need SI joint block and rhizotomy.

How to identify the source of your pain?

You can identify  the source of your pain yourself. If it gets aggravated on extension the it is probably comming   from facets. If the pain is more on flexion and sitting  then probably disc is the source of your pain. If you have multiple joint pain then get your uric acid level checked. If your HLAB27 is positive then sacroiliac joint can be your source of pain. Be carefull of osteoporosis. Get your vitamin D level checked on a regular basis.

 

How to prevent back pain?
Correct posture while sitting, standing  and sleeping is important. Regular back strengthening exercise should be done. Do brisk walking and swimming. Yoga also helps. Correct your Vit D level if it is low. Never let your back pain become chronic as that leads to muscle spasm aggravating your back pain.

What are the common causes of low back pain?

• Mechanical injury
• Herniated disc (slipped disc) may cause irritation to the nerves and cause sciatica, a condition where pain travels down the buttocks or legs.
• Degenerative disease affecting the spine.
• Rare conditions may include spinal tumour, infection and fracture.

 

What are the investigations for low back pain?

1. Clinical examination by the doctor
2. Blood test
3. Radiological investigations e.g. x-ray, CT scan, MRI
4. EMG and NCV
5. Discography

What are the treatment options?

1. Rest  
2. Medications - Pain killers
3. Physical Therapy - Perform the flexibility and strengthening exercise
4. Facet blocks, epidural steroids injections
5. Surgical Management

What should I do to prevent low back pain?
Low back pain can be prevented through lifestyle modifications:

• Maintain good body postures at all times.
• Maintain healthy weight range.
• Use proper body mechanics/ lifting techniques. Avoid bending at waist level.
• Modify workplace/space (workplace ergonomics) to reduce back strain.
• Exercise regularly. Proper exercise can help to strengthen and increase flexibility of back muscles and help to increase bone density. Swimming, brisk walking and cycling are good examples of exercises for back pain sufferers.
• Stop smoking.
• Avoid staying in the same position for a prolonged period of time.
• Sleep on a firm mattress.

LOW BACK PAIN WITH LEG PAIN    '

What is lumbar canal stenosis?
Lumbar canal stenosis most commonly affects the middle-aged and elderly population. It is caused by entrapment of the cauda equina roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal is often associated with incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias.

Why does it happen?                                                           
It is caused by narrowing of the lumbar canal due to bony and soft tissue hypertrophy. Some times it is seen in acquired conditions like fluorosis, hyperparathyroidism, Paget's disease, ankylosing spondylitis, Cushing's disease and acromegaly.

What is the clinical presentation?
It is associated with pain and numbness in both lower limb aggravated by walking and standing.

What do I do if I have lumbar canal stenosis?
Seek advice of a spine surgeon.
Imaging/Diagnostic Studies - Plain films of the spine and MRI of spine is diagnostic. Electromyograms with nerve conduction velocity studies may assist in confirming the multiradicular involvement of cauda equina compression.

Treatment is surgery- Laminotomy and not laminectomy is advocated.

Risks and Complications of Decompressive Surgery
The risks of surgery are minimal and patient can walk a day after his surgery.