Abdominal and low back muscles, together with ligaments, are the major stabilizers of the vertebral column. People may go to the gym, or play golf, squash, or some sport. It is here that injuries sustained result in back pain. Most of them do not consider reinforcing their back and stomach or their core muscles to support these stresses.
Low back pain, or lumbago, can be either acute, sub acute or chronic in duration, according to Dr. Manzoor S. Qazi, consultant orthopedic surgeon and sports injury specialist in Jeddah. In fact, abdominal and low back muscles, together with ligaments, are the major stabilizers of your vertebral column. “What I often find is that most of my patients going to the gym, or playing golf, squash, or some sport do not consider reinforcing their back and stomach or their core muscles to support these stresses,” says a Dubai-based chiropractor.
The lumbar region, or lower back region, is made up of five vertebrae. In between these vertebrae lie fibrocartilage discs, or intervertebral discs, which act as cushions, preventing the vertebrae from rubbing together while at the same time protecting the spinal cord.
Most cases of lower back pain are due to benign musculoskeletal problems and are referred to as non-specific low back pain. They are generally believed to be due to a sprain or strain in the muscles of the back and the soft tissues, especially if the pain arises suddenly during physical load. The rate of serious causes is quite less.
“Over activity of the muscles of the back can lead to an injured or torn ligament in the back, which in turn leads to pain,” Qazi explains. An injury can also occur to one of the intervertebral discs (disc tear, disc herniation). As the body ages, the spine does as well. Due to aging, discs begin to diminish and shrink in size, resulting in vertebrae and facet joints rubbing against one another. Ligament and joint functionality also diminishes as one ages, leading to spondylolisthesis, which causes the vertebrae to move much more than they should. Pain is also generated through spinal stenosis, sciatica and scoliosis.
At the lowest end of the spine, some patients may have tailbone pain, also called coccyx pain or coccydynia. Others may have pain from their sacroiliac joint, where the spinal column attaches to the pelvis, called sacroiliac joint dysfunction. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, a vertebral fracture from osteoporosis, for example, or rarely, from an infection or tumor. Determination of the underlying cause is usually made through a combination of a medical history, physical examination, and, when necessary, diagnostic testing, such as an x-ray, CT scan, or MRI.
“Osteoporosis does not cause low back pain, however bone fractures may occur due to osteoporosis, resulting in low back pain. Although specific back exercises may not relieve existing low back pain, exercise can help to prevent it from occurring in the first place or recurring after it has eased. An ideal exercise routine combines stretching and strength-building exercises with endurance training,” Dr. Qazi said.
For the vast majority of patients, low back pain can be treated conservatively. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.
Applying heat to the lower back provides temporary relief of acute low back pain. Physical therapy is beneficial in recovering from a low back injury or low back pain. It includes electromyography, stretching, strength conditioning and cardiovascular exercise. Firm mattresses are said to be less likely to lead to improvement when compared with a medium-firm mattress.
Short-term use of pain and anti-inflammatory medications can help with the symptoms of lower back pain. However, these medications are not without risk. Muscle relaxants for acute and chronic pain have some benefit, however, there are concerns with side effects, and their routine use should be discouraged.
Staying physically active as much as possible is recommended by most guidelines. Bed rest is discouraged as not being helpful. Even when the pain is severe, some activity is still preferable to prolonged sitting or lying down, as long as it does not involve movements such as heavy lifting that would further strain the back. “Structured exercise in acute low back pain, however, leads to neither improvement nor harm,” Dr. Qazi said.
Most reviews and guidelines have found that spinal manipulation therapy for low back pain of unknown cause is of no benefit beyond standard conservative management.
Low back pain is more likely to be persistent among people who previously required time off from work because of low back pain, those who expect passive treatments to help, those who believe that back pain is harmful or disabling or fear that any movement whatever will increase their pain, and people who have depression or anxiety.
Therapeutic massage is proven to be affective for chronic back pain. Traditional Chinese Medical acupuncture was found to be relatively ineffective in chronic cases. Massage therapy may benefit some patients. Heat application may have a modest benefit. The evidence for cold therapy is limited. Yoga is found beneficial. Correcting leg length difference may help by inserting a heel lift or building up the shoe. A 2008 review found antidepressants ineffective in the treatment of chronic back pain.
Surgery may be indicated when conservative treatment is not effective in reducing pain or when the patient develops progressive and functionally limiting neurologic symptoms such as leg weakness, bladder or bowel incontinence. Spinal fusion has been shown not to improve outcomes in those with simple chronic low back pain.
The most common types of low back surgery, according to Dr. Qazi, include microdiscectomy, discectomy, laminectomy, foraminotomy, or spinal fusion. Another less invasive surgical technique consists of an implantation of a spinal cord stimulator and is typically used for symptoms of chronic radiculopathy (sciatica). Lumbar artificial disc replacement is a newer surgical technique for treatment of degenerative disc disease, as are a variety of surgical procedures aimed at preserving motion in the spine. According to studies, benefits of spinal surgery are limited when dealing with degenerative discs.
All in all, low back pain is treatable and can be avoided. When you don’t take any breaks at work, you strain the vital postural muscles that are responsible for giving stability to your spine. Over a period of weeks and months, this causes stress in ligaments and discs of your vertebral columns, causing back pain. All you need to do is to get up every 35 or 40 minutes, walk around the office or workplace and drink water.
