By Patrick Namwambah
Most of us experience some form of back pain in our adulthood. This is the most common cause of job related disability and a contributor to work absenteeism. Lower back pain range in intensity and is contributed by various factors ranging from accidents, lifting heavy things, age related, congenital and sedentary lifestyles.
Lower back occurs in the lumbar region (L1-L5) which supports much of the weight of the upper body. 31 pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.
CAUSES OF LOWER BACK PAIN
Majority of the lower back pain is caused by natural degeneration of the spine associated with normal wear and tear, occurring in the joints, discs and bones of the spine as people age. Examples of causes include:
- Sprains and strains: Sprains are caused by over stretching or tearing ligaments. Strains are tears in tendon muscles. They may occur during twisting, lifting something heavy or overstretching.
- Intervertebral disc degeneration: Occurs when the discs lose integrity as a result of aging.
- Herniated or ruptured discs: Occurs when the intervertebral discs become compressed and bulge outward or rapture.
- Radiculopathy: A condition caused by compression, inflammation and or injury to a spinal nerve root. Pressure on the nerve root results in pain numbness or tingling sensation that radiates to other areas of the body served by that nerve.
- Sciatica: A form of radiculopathy that occurs as a result of compression of the sciatic nerve, the large nerve that travels through the buttocks and extends down the back of the leg. A shock – life low back pain is felt through the buttocks and down one leg. This condition can also be caused by tumor/cyst that presses on the sciatic nerve or its roots.
- Spondylolisthesis: A condition in which a vertebra of the lower spine splits out of the place pinching the spinal nerves.
- Traumatic injury: This happens as a result of sports, car accidents, or falls, hence injuring the back tendons, ligaments and muscles.
- Skeletal injuries: As a result of irregulars such as scoliosis (a curvature of the spine), lordsosis (abnormally accentuated arch of the lower back) of other congenital anomalies of the spine.
- Facet joint osteoarthritis: Also known as degenerative arthritis or osteoarthritis of the spine. This is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. Lower back pain may initially be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.
COMMON FACTORS LEADING TO LOWER BACK PAIN
- Age: As people age, they experience loss of bone strength and, muscle elasticity and tone decrease. Lower back pain is common between ages 30 and 50. The risk of spinal cord narrowing (spinal stenosis) increases with age.
- Fitness level: Back pain is common amongst people who live a sedentary lifestyle because of weaker back and abdominal muscles which cannot support the spine properly. It’s important to maintain a steady training schedule within the week in order to maintain the integrity of intervebral discs.
- Pregnancy: Results in pelvic changes and alterations in weight loading. However this symptoms resolve post-partum
- Weight gain: Being overweight, obese or a significant increase in weight can put stress on the back leading to low back pain.
- Genetics: Some congenital leads to immobility of the spine.
- Occupational risk factors: Such as heavy lifting, pushing or pulling can lead to back injuries.
- Mental health: Such as depression and anxiety can affect the body in various ways including muscle tension.
- Backpack overloading in children: Backpack overload with books and supplies can cause back strains and muscle fatigue. Kids backpack should weigh no more than 15-20% of the child’s body weight.
DIAGNOSIS OF LOWER BACK PAIN
A thorough back examination including neurological tests is recommended to determine the cause of pain and appropriate treatment. Imaging may be required to rule out specific causes of the pain.
- X-ray: Shows bone structures and any vertebra misalignment and fractures.
- Computerized Tomography (CT): Is used to see spinal structures that cannot be seen on conventional X-Rays such as disc rapture, tumors or spinal stenosis.
- Myelograms: A contrast dye is injected into the spinal cord and nerve compression caused by herniated discs on an x-ray or CT scan
- Discography – Injecting contrast dye into a spinal disc though to be causing low back pain.
- Magnetic Resonance Imaging (MRI) – Use a magnetic force to produce images of soft tissues such as tendons, ligaments and blood vessels. May be used to identify infections, tumor, inflammation, disc herniation or rapture.
- Electrodiagnotics: Are procedures used to determine whether a person has lumbar radiculopathy.
- Bone scans – Used to detect and monitor infections, fracture or bone disorders.
- Ultra sound imaging (Sonography) – Used to identify tears in ligaments, muscles, tendons and soft tissue masses in the back.
- Blood tests – Used to identify indications of inflammations and presence of arthritis.
BACK PAIN TREATMENT
Treatment of the low back pain depends on proper prognosis. Conventional methods used for treatment of back pain includes:
- Hot/ cold packs: Help ease pain and reduce inflammation.
- Strengthening exercises: Maintaining and building muscle strength is important for persons with skeletal irregularities. Mild training in the gym and yoga helps ease chronic back pain.
- Physical therapy: To improve mobility, flexibility and promote proper positioning and posture.
- Medications: Over the counter prescriptions by physicians.
- Spinal manipulations and mobilizations: Done by chiropractors who use their hands to mobilize, adjust, massage or manipulate the spine and surrounding tissues.
- Traction: Involves use of weights and pulleys to gradually adjust the skeletal structure in to better alignment.
- Acupuncture: Involves insertion of him needles into praise points throughout the body.
- Epidural steroid injections: Used for treating low back pain and sciatica associated inflammations. It’s usually a temporary measure.
- Surgery: May be considered when all other therapies fail. Examples of surgeries include spinal fusion, artificial disc replacement, and foraminotomy among others.
RECOMMENDATIONS FOR KEEPING ONES BACK HEALTHY
- A regimen of low impact exercises is advised, this includes, swimming, speed walking indoor bike (spin bike) riding and yoga. Exercise is important since it will enhance muscle strength, flexibility and improve posture.
- Avoid slouching when standing/ sitting.
- Sit on a chair with good lumbar support and proper positioning and height keeping your shoulders back.
- Switch sitting positions often gently stretching muscles
- Wear comfortable low heeled shoes.
- Avoid /limit lifting heavy objects to the body.
- Maintain proper nutrition and diet to reduce exercise weight.
- Quit smoking since it reduces blood flow to the lower back which can contribute to spine disc degeneration.
The writer is the Proprietor of The Saints Health Club, located within The All Saints Cathedral Church Opposite Nairobi Serena Hotel.