LOW BACK PAIN

LOW BACK PAIN

Low back pain is neurological disorders occur mostly as a result of injury to muscle or tendons in the back affecting the lower portion of the spine.  Also sudden movements or poor body mechanics while lifting heavy objects can result in low back pain.

Causes of Low Back Pain

Conditions commonly associated to back pain include:

  1. Muscle or ligament strain. Heavy lifting or a sudden inappropriate movement causing injury like strain to the back muscles and spinal ligaments. Consistent straining of the back can cause painful muscle spasms.
  2. Bulging or ruptured disks. Disks are the cushions between the bones in the spine. When the soft material located inside a disk bulge or rupture also press on the nerve. However, a bulging or ruptured disk probably not cause back pain. Disk disease is often discovered on spine X-rays, CT scans or MRIs done for another reason.
  3. Osteoarthritis affects the lower back. In some cases, the narrowing of the space around the spinal cord is caused by presence of arthritis in the spine. This condition is refers to spinal stenosis.
  4. The painful break is developed when the bones become porous and brittle.

 Risk Factors of Low Back Pain

Following factors contribute to the development of back pain:

  1. Age: Back pain is more common with age, starting around age 30 or 40.
  2. Lack of exercise: Weak, unused muscles in the back and abdomen might lead to back pain.
  3. Excess weight: Excess body weight puts extra stress on the back.
  4. Diseases: Arthritis and cancer contribute to low back pain.
  5. Improper lifting: Using the back instead of the legs can lead to back pain.
  6. Psychological conditions: People prone to depression and anxiety appear to have a greater risk of back pain. Muscle tension contributes to back pain which is often caused by stress.
  7. Smoking: The occurrence of low back pain in smoker is high because smoking causes coughing leading herniated disk. Decreased blood flow to the spine causing osteoporosis is most common in smoker.
  8. Occupation

Symptoms of Low Back Pain

Low back pain is associated with the following symptoms

  • Numbness
  • Tingling
  • Weakness
  • Tenderness
  • Limited range of motion
  • Pain radiating down one or both legs
  • Re occurrence of pain
  • Stiffness

Preventions of Low Back Pain

  • Exercise: Regular low-impact aerobic activities can increase strength and endurance in the back and allow the muscles to work better. Physical activities such as walking, bicycling and swimming.
  • Muscle strength and flexibility: Abdominal and back muscle exercises, which strengthen the core, helping the muscle to support the back.
  • Maintain a healthy weight: Being overweight strains back muscles causing pressure on the spine.
  • Quit smoking

Avoiding movements that strain the back, way of using body properly:

  • Stand smart: Maintaining a neutral pelvic position when standing for a longer periods, place one foot on a low footstool which reduce the pressure on lower back. Alternate feet. Good posture can reduce the stress on back muscles.
  • Sit smart: A seat with good lower back support, armrests and a swivel base. Placing a pillow or rolled towel in the small of the back can maintain its normal curve. Keep knees and hips level. Change position frequently, at least every half-hour.
  • Lift smart: Avoid heavy lifting, keep back straight no twisting and bend only at the knees. Hold the load close to body. Find a lifting partner if the object is heavy or awkward

Diagnosis of Low Back Pain

After recurrence of the symptoms, following investigation are suggested to rule out the diseases condition

  1. Medical History: A thorough medical history including any recent injuries, family history of disease, and occupation, activities and other lifestyle considerations
  2. Physical exams: which may include inspecting, palpating  the painful area or reflex or other neurological tests
  3. Electromyography:  which measures muscle and nerve function
  4. Imaging—X-rays: This can show bone spurs and damage to bone, while CT scans and MRIs can depict damage to soft tissue like discs or ligaments

Treatment of Low Back Pain

Treatment of low back pain includes both home remedy and medication treatment

Home Remedy Treatment

  • Avoid bed rest: Bed rest often be a wrong choice of home remedy when low back pain strikes. However, patients who retreated to bed actually experienced more pain and recovered more slowly than patients who stayed fairly active.
  • Use ice and/or heat: The use of ice or cold packs for periods of up to 20 minutes at a time helps reduce pain and swelling. Although, heat such as a heating pad or warm bath, eases pain. Ice is recommended in the first 48 hours after injury; then it can be combination of ice and heat.
  • Over-the-counter (OTC) remedies: Short-term use of OTC pain relievers, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen and naproxen, may ease the low back pain. OTC creams, gels, patches, or sprays applied to the skin can be considered. Which stimulate the nerves in the skin providing feelings of warmth or cold to reduce the sensation of pain.

Medical Treatment

Three main treatments are involves for the management of low back pain:

  • Medications
  • Physical therapy
  • Surgery

Medications used in treatment of low back pain:

  • Muscle relaxants
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Narcotic drugs for pain relief e.g. codeine
  • Steroids to reduce inflammation
  • Corticosteroid injections

Physical therapy use in managing low back pain includes:

  • Massage
  • Stretching
  • Strengthening exercises
  • Back and spinal manipulation

Surgical treatment

For severe cases, surgery may be necessary. Surgery is usually only an option when all other treatments fail. However, if the severity persist causing loss of bowel or bladder control, or a progressive neurological damage

  1. Discectomy: It relieves pressure from a nerve root pressed on by a bulging disc or bone spur. The surgeon will remove a small piece of the lamina, a bony part of the spinal canal.2
  2. Foraminotomy: Is a surgical procedure that opens up the foramen, the bony hole in the spinal canal where the nerve root exits.
  3. Intradiscal electro thermal therapy (IDET): This involves inserting a needle through a catheter into the disc and heating it up for 20 minutes. This procedure enables the disc wall thicker and deeper on the inner disc’s bulging and irritation of the nerve.
  4. Nucleoplasty: It uses a wand-like device inserted through a needle into the disc. It can then remove inner disc material. Radio waves are used  to heat and shrink the tissue.
  5. Radiofrequency lesioning or ablation: Is a way to use radio waves to interrupt the way the nerves communicate with each other. A special needle is inserted into the nerves and heats it, which destroys the nerves.
  6. Spinal fusion: This makes the spine stronger and cuts down on painful motion. Two or more of the vertebrae are removed. However, surgeon then fuses the vertebrae next to each other with bone grafts or special metal screws.
  7. Spinal laminectomy: This is also known as spinal decompression, removes the lamina to make the size of the spinal canal bigger. The pressure on the spinal cord and nerves are suppressed.

Complication of Low Back Pain

In the severe phase of low back pain and there is reduction in the activity affecting the physical health of an individual. Lack of physical activities predisposed to more risk for some very serious problems, such as: Diabetes. Cardiovascular disease, obesity, arthritis

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