Back Pain

Low back pain is the most common cause of absence from work loss of man hours at work. Back pain affects a younger and active population and happens to 80% population as some point of their life with a high recurrence rate.

Mostly it is due to bad posture or mechanical causes and hence is labelled as mechanical back pain. Such patients are usually treated with short period of rest followed by stretching and strengthening exercises of the lower back. The patient may also need to use ice or heat along with the medications.

If the patient does not improve with conservative means, then they may need to undergo advance imaging. Some patients may also present with radiating pain to the leg called Lumbar radiculopathy or Sciatica. These patients most likely have a disc herniation in the lumbar spine and need an advance imaging to confirm.

Most patients can be treated conservatively using medications, and physical therapy and various modalities, though some may need invasive treatment in the form of injection or surgical procedure. Surgical procedure in lower back may range from microdiscectomy to fusion surgery with use of screws and rods depending on the disease and patient characteristics.

Recovery from lumbar spine surgery usually involves gradual rehabilitation and physical therapy and may take 3 to 4 months or more to return to normal activities of daily living. Bone weakening, or osteoporosis is another cause of back pain in elderly population Other rare causes of back pain can be tumors, disorders of aorta, kidneys, ovaries, prostrate, gastrointestinal system etc.

Risks factors for mechanical back pain include:

  • Age – elder people are more susceptible
  • Behavioral disorders such as anxiety and depression
  • Stress
  • Conditions such as pregnancy
  • Gender – more common in females as compared to males
  • Obesity
  • Poor posture
  • Smoking
  • Arduous physical work
  • Sedentary lifestyle

PREVENTION OF BACK PAIN

Perform relaxation exercises as well as stretching and strengthening exercises
Maintain a good posture
Low back support should be used if needed to avoid slouching
Frequent breaks should be taken from desk jobs allowing stretching of the neck as well as the back.
Sleeping by the side and using pillow between the knees
Wearing of seatbelts and helmets while driving as well as appropriate sporting gear while playing is recommended to avoid injuries.

RED FLAGS

The patients who have back or neck pain with any of these following conditions should seek medical attention as soon as possible.

  • Cancer, neoplasia or malignancy.
  • Unexplained weight loss of more than 10 pounds in the last 6 months.
  • Immunocompromised comorbidities like on chemo or radiotherapy or having disease like HIV or AIDs or being on prolonged corticosteroid therapy.
  • IV drug users.
  • Urinary tract infection.
  • Fever of more than 100 degrees centigrade.
  • Significant trauma from a fall or accident.
  • Bowel or bladder involvement in the form of incontinence or retention.
  • Weakness in the major joint of arm or leg.
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