LOW BACK PAIN: KEEP YOUR BACK SAFE

The human back is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck and the shoulders. It is the surface opposite to the chest, its height being defined by the spine or backbone and its breadth being supported by the ribcage and shoulders. The spinal canal runs through the spine and provides nerves to the rest of the body.

Contents of the back Spine-

Backbone

Nerves Muscles

Ligaments

Disc

Skin

Functions of the back

The intricate anatomy of the back provides support for the head and trunk of the body, strength in the trunk of the body, as well as a great deal of flexibility and movement. The upper back has the most structural support, with the ribs attached firmly to each level of the thoracic spine and very limited movement. The lower back (lumbar vertebrae) allows for flexibility and movement in back bending (extension) and forward bending (flexion). It does not permit twisting.

Back pain

The back comprises interconnecting nerves, bones, muscles, ligaments and tendons, all of which can be a source of pain. Back pain is one of the most common types of pain in adults. Range from mild, moderate to severe Can be acute(<4 data-blogger-escaped-and="and" data-blogger-escaped-chronic="chronic" data-blogger-escaped-subacute="subacute">12weeks).

Low back pain or lumbago is a common disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is more common.

Causes

The majority of lower back pain stems from benign problems, and are referred to as non specific low back pain; this type may be due to muscle or soft tissues sprain or strain, particularly in instances where pain arose suddenly during physical loading of the back, with the pain lateral to the spine. Over 99% of back pain instances fall within this category.

Mechanical: 

Apophyseal osteoarthritis

Diffuse idiopathic skeletal hyperostosis Degenerative discs Scheuermann's kyphosis

Spinal disc herniation ("slipped disc") Thoracic or lumbar spinal stenosis 

Spondylolisthesis and other congenital abnormalities

Fractures 

Leg length difference

Restricted hip motion

Misaligned pelvis - pelvic obliquity, anteversion or retroversion

Abnormal Foot Pronation

 Inflammatory: Seronegative spondylarthritides (e.g. ankylosing spondylitis) 

 Rheumatoid arthritis

 Infection - epidural abscess or osteomyelitis

 Neoplastic: Bone tumors (primary or metastatic) Intradural spinal tumors 

Metabolic: 

Osteoporotic fractures 

Osteomalacia 

Ochronosis 

Chondrocalcinosis 

Psychosomatic

Tension myositis syndrome

Paget's disease 

Referred pain:

 Pelvic/abdominal disease

 Prostate Cancer 

 Posture 

 Depression

 Oxygen deprivation

Risk factors for back pain

Over weight

Smoking

Operating a machine that vibrates Prolonged use of corticosteroids

Age >50yrs

Prolonged sitting

Weight lifting or twisting while holding a weight

Poor job satisfaction

Excessive alcohol consumption Pregnancy

Symptoms

 Pain of the back is the primary symptom of low back pain. The pain may radiate down to the front, side, or back of your leg, or it may be confined to the low back. The pain may become worse with activity. ​ ​ Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip. ​ ​

You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve. ​ ​ This can cause an inability to plantar flex the foot. This means you would be unable to stand on your toes or bring your foot downward. This occurs when the first sacral nerve is compressed or injured. ​ ​ Another example would be the inability to raise your big toe upward. This results when the fifth lumbar nerve is compromised.

 When to seek medical advice :Red flags .

Presence of any of the following red flags associated with low back pain should prompt a visit to your doctor as soon as possible for complete evaluation.

Recent significant trauma such as a fall from a height, motor vehicle accident, or similar incident ​ ​

Recent mild trauma in those older than 50 years of age:

A fall down a few steps or slipping and landing on the buttocks may be considered mild trauma

History of a recent infection :​ ​Temperature over 100 F ​

​IV drug use: Such behavior markedly increases risk of an infectious cause. ​ ​

Low back pain worse at rest: This is thought to be associated with an infectious or malignant cause of pain but can also occur with ankylosing spondylitis.

History of prolonged steroid use: People with asthma, COPD, and rheumatic disorders, for example, may be given this type of medication. ​

​Anyone with a history of osteoporosis: An elderly woman with a history of a hip fracture, for example, would be considered high risk. ​ ​

Any person older than 70 years of age: There is an increased incidence of cancer, infections, and abdominal causes of the pain. ​

​Prior history of cancer ​ ​

Unexplained weight loss

The presence of any acute nerve dysfunction should also prompt an immediate visit. These would include the inability to walk or inability to raise or lower your foot at the ankle. Also included would be the inability to raise the big toe upward or walk on your heels or stand on your toes. These might indicate an acute nerve injury or compression. Under certain circumstances, this may be an acute neurosurgical emergency. ​ ​

Loss of bowel or bladder control, including difficulty starting or stopping a stream of urine or incontinence, can be a sign of an acute emergency and requires urgent evaluation in an emergency department. ​ ​

If you cannot manage the pain using the medicine you are currently prescribed, this may be an indication for a reevaluation or to go to an emergency department if your doctor is not available. Generally, this problem is best addressed with the doctor writing the prescription who is overseeing your care.

Treatment

General recommendations are to resume normal, or near normal, activity as soon as possible. However, stretching or activities that place additional strain on the back are discouraged. Sleeping with a pillow between the knees while lying on one side may increase comfort. Some doctors recommend lying on your back with a pillow under your knees.

No specific back exercises were found that improved pain or increased functional ability in people with acute back pain. Exercise, however, may be useful for people with chronic back pain to help them return to normal activities and work. These exercises usually involve stretching maneuvers. Nonprescription medications may provide relief from pain. ​ ​Ibuprofen available over the counter, is an excellent medication for the short-term treatment of low back pain. Because of the risk of ulcers and gastrointestinal bleeding, talk with your doctor about using this medication for a long time. ​ ​ Acetaminophen (panadol) has been shown to be as effective as ibuprofen in relieving pain. ​ ​ Topical agents such as deep-heating rubs have not been shown to be effective. 

Most experts agree that prolonged bed rest is associated with a longer recovery period. Further, people on bed rest are more likely to develop depression, blood clots in the leg, and decreased muscle tone. Very few experts recommend more than a 48-hour period of decreased activity or bed rest. In other words, get up and get moving to the extent you can. 

 Prevention 

 The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back.

  Specific exercises: ​ ​

Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease the tendency to suffer back pain. ​ ​ Although not useful to treat back pain, stretching exercises are helpful in alleviating tight back muscles. ​ The pelvic tilt also helps alleviate tight back muscles.

Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Do not wear high heels.

 ​Sitting: Chairs of appropriate height for the task at hand with good lumbar support are preferable. To avoid putting stress on the back, chairs should swivel. Automobile seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support. Sleepin Individual needs vary. If the mattress is too soft, many people will experience backaches