• What is back pain?

    Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months.

    What causes back pain?

    Below are some common spinal conditions:

    Back strain

    Degenerative Disc disease

    Herniated disc

    Spondylolisthesis

    Spinal stenosis

    Spinal fractures

    How is back pain diagnosed?

    * The first thing is to rule out any other obvious conditions which also cause back pain.

    * There are a number of warning signs, which are factors which lead the doctor to arrange for more rapid investigation and treatment than would otherwise be necessary.

    * Most times an X-Ray is unhelpful, and in fact it gives you a high dose of radiation, so do not be surprised if your doctor does not arrange one.

    * Sometimes your doctor will arrange blood tests to rule out the rarer causes of back pain.

    * When the pain has continued for more than 6weeks your doctor may arrange a CT or MRI scan.

    * MRI and CT generally are not useful during acute LBP or acute sciatica unless surgery, cancer, or infection is considerations.

    WHAT ARE THE MAJOR INDICATIONS TO DO AN MRI?

    MRI Indications:

    * Major or progressive neurological dysfunction such as foot drop or functionally limiting weakness such as hip flexion or knee extension.

    * Cauda Equina syndrome (disease of the nerve roots near the tail bone) (loss of bowel or bladder control or saddle [area around the tail bone] numbness).

    * Progressively severe pain and limitations despite conservative therapy.

    * Severe or incapacitating back or leg pain, such as requiring hospitalization, limiting the ability to walk or significantly limiting the activities of daily living.

    * Clinical or radiological (x-ray images) suspicion of neoplasm (cancerous growth), history of cancer, unexplained weight loss, or systemic (related to the entire body) diseases.

    * Clinical or radiological suspicion of infection, such as endplate (area at the end of bones) destruction, history of drug or alcohol abuse, or systemic diseases.

    How is back pain treated?

    (1) Acute back pain

    Most cases of acute back pain can be treated using self-help techniques

    * Painkillers

    Paracetamol is usually recommended to treat acute lower back pain. If paracetamol proves ineffective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used instead.

    * Stronger painkillers

    If your back pain symptoms are severe, your GP may prescribe a mild opiate-based painkiller, such as codeine, which can be taken in combination with paracetamol or a NSAID.

    * Muscle relaxants

    If your back pain symptoms are very severe, your GP may prescribe a muscle relaxant such as diazepam.

    * Exercise

    It’s important to remain as physically active as possible. While bed rest may provide some temporary relief from your symptoms, prolonged bed rest will make your symptoms worse.

    * Cold and heat therapies

    (2) Chronic back pain

    When back pain does not respond to more conventional approaches, patients may consider the following options:

    * Acupuncture involves the insertion of needles the width of a human hair along precise points throughout the body.

    * Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation.

    * Traction involves the use of weights to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms.

    * Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax.

    * Minimally invasive outpatient treatments to seal fractures of the vertebrae caused by osteoporosis include vertebroplasty and kyphoplasty.

    * In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.

    1-  Discectomy is one of the more common ways to remove pressure on a nerve root from a bulging disc or bone spur. During the procedure the surgeon takes out a small piece of the lamina to remove the obstruction below.

    2- Foraminotomy is an operation that “cleans out” or enlarges the bony hole where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness, and weakness in an arm or leg.

    3- Spinal fusion is used to strengthen the spine and prevent painful movements. The spinal disc(s) between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together.

    WHAT IS THE PROGNOSIS?

    Most patients with back pain recover without residual functional loss, but individuals should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. Engaging in exercises that don’t jolt or strain the back, maintaining correct posture and lifting objects properly can help prevent injuries. Applying ergonomic principles (designing furniture and tools to protect the body from injury) at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.

    WHEN YOU NEED TO CONTACT YOUR DOCTOR IMMEDIATELY?

    Call your doctor right away if you have:

    • Trouble controlling your bladder or bowels
    • Numbness or weakness in the feet legs, groin or rectal area
    • The pain gets worse or extends into your leg and below the knees
    • Pain limits your normal activities for more than 4 weeks
    • Shooting pain down the leg

    Can back pain be prevented?

    Recurring back pain resulting from improper body mechanics or other nontraumatic causes is often preventable. A combination of exercises that don’t jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.

    WHAT KIND OF EXERCISE I CAN DO AT HOME?

    * Lying supine hamstring stretch: Lie on your back with a small rolled towel under your waist. Place your left leg down with knee straight. Bend your right hip so your knee is pointing to the ceiling. Hold your right thigh by locking your fingers. Keep your elbows straight while holding and straighten your right knee and move the foot toward the ceiling. You should feel a stretch on the backside of your thigh. Hold for 30 seconds and repeat 2 times. Repeat the same stretch on your other leg.

    * Camel Stretch: In a hands and knee position, place your hands under the shoulders and the knees under your hips. Raise your head up while at the same time raise your hips up and allow your stomach to fall to the floor. Hold the position for 5 seconds and repeat 10 times.

    * Pelvic tilt: Lie on your back with your knees bent and your feet flat on the floor. Tighten your abdominal muscles and push your lower back into the floor. Hold this position for 5 seconds, and then relax. Do 2 sets of 10.

    * Partial curl: Lie on your back with your knees bent and your feet flat on the floor. Tighten your stomach muscles and flatten your back against the floor. Tuck your chin to your chest. With your hands stretched out in front of you, curl your upper body forward until your shoulders clear the floor. Breathe out as you come up. Hold this position for 3 seconds. Relax. Repeat 10 times. Build to 3 sets of 10. To challenge yourself, clasp your hands behind your head and keep your elbows out to the side.

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