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Backache: Prevention & Cure

 
Back pain

Know Your Back

Vertebrae

• In the neck there are 7 Cervical Vertebrae.
• Supporting the chest there are 12 Thoracic Vertebrae
• Next are 5 Lumbar Vertebrae
• Below them is the Sacrum (which consists of 5 sacral vertebrae)		 Welcare Clinics
Intervertebral Discs

• 23 narrow spongy shock absorbers which fit between the 24 separate bones of your spine. Without the discs these bones would grate and crunch every time you move.

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Each disc has a strong fibrous outer casing - called the Annulus fibrosus - and a soft, squashy, jelly-like interior called the nucleus pulposus - which is reinforced with strands of fibre. Intervertebral discs have very little in the way of nerve supply and contain no blood. They are made up largely of water.

As you get older the amount of fluid in your discs will diminish slightly - and as a result you will get shorter.



What causes back pain?

I. Disc injury

Ruptured Disc: This means an injured or damaged disc that leaks out watery jelly from the centre of the disc. This leakage reduces the shock absorber effect and sometimes the jelly presses against a nerve and causes pain, primarily leg pain.

Prolapsed Disc: The phrase "a slipped disc" is used very commonly and indeed at some time or other this diagnosis has been blamed for producing almost every form of acute back pain. There are two major errors in this.
1. All discs do not and cannot slip.
2. What does goes wrong and may be called a "slipped disc" is much less frequent than previously thought


II. Degenerative disc disease

As discs degenerate, they lose their water content and height, bringing vertebrae closer together. The nerve openings are consequently narrowed and the added pressure from the disk can pinch a nerve causing back or leg pain.


Areas you may suffer backache


• Neck – A slipped or prolapsed disc in the cervical spine could result in a severe pain in your shoulder, arm or hand. Small movements may make the pain worse. Accompanied by numbness or tingling in the fingers

• Mid-Back – Back pain that becomes worse after sitting in one position for a long time may be caused by poor posture or by a badly-designed chair. Stress, anxiety and emotional worries can lead to muscle tension which results in aches and pains in the back. This is one of the MOST COMMON causes of back pain - probably affecting as many as eight out of ten sufferers.

• Lower Back

• Hips

• Base of the Spine


Types of backache

• Sudden onset – If your pain started after a trivial movement - such as tying up your shoe laces or turning over in bed - it may be a result of a slipped disc or a joint problem in your spine. Pain going down one or both legs, or numbness or tingling in one or both legs, then you may be suffering from sciatica.

• Continuous – Radiates round the chest - a fracture caused by osteoporosis of thin bones. Accompanied by discomfort when passing urine and/or blood in your urine - kidney infection/stone. In the middle of the back that is made worse by eating and accompanied by indigestion - stomach ulcer. Low back pains that are accompanied by gynaecological symptoms (discharge, bleeding etc.) may suggest a gynecological cause - such as period pain.

• Exacerbated on – exercise, passing urine, movement/ cold weather.


Investigations

MRI (Magnetic Resonance Imaging) scan is the most common test used to look at the spine. This allows us to view not only the bones of the spine, but also the nerves and discs.

• Slices can also be taken across the spine, giving a cross sectional view.
• The MRI scanner allows us to see the nerves and disc quite clearly. No special dyes or needles are required.

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Management

I. Conservative Management

A. Good posture: The neck has a slight natural curve, which sits on top of the two curves in the middle and lower back. Correct posture maintains all three curves and prevents undue stress and strain by distributing body weight evenly.
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Standing Posture – In correct, fully erect posture, a line dropped from the ear will go through the tip of the shoulder, the middle of the hip, the back of the kneecap and the front of the anklebone.

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Sitting posture – When sitting in any position, the three back curves need to be maintained. If you cannot sit without slouching forward or backward, you need to support yourself with hands and arms or lean against a wall or chair back.

 
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Lying posture – Avoid propping head or upper body up on an arm and hand. Head should remain relaxed. Legs should be together. Bed rest on a hard bed.
 
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B. Exercises
 
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Cat Back
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Foetal Position Arm Exercises
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Alternate Leg Slides Alternate Leg Raises

C. Stress Therapy: Yoga and Meditation


II. Surgery

Surgery is considered only after conservative management fails. Patient develops neurological deficits (weakness, numbness and change in reflexes).

 
Discectomy: The removal of a herniated disk to relieve pressure on a nerve root. Welcare Clinics
Laminectomy: derived from lumber (lower spine), lamina (part of the spinal canal's bony structure) and -ectomy (removal).The operation is performed to relieve pressure on one or more spinal nerve roots Welcare Clinics
 

What to Expect After Surgery:

Pain: It is normal to have pain after your operation. It will be most severe in the lower back area where the surgery was done. Residual leg pain is not unusual; this is caused by swelling of the previously compressed nerve as well as from surgery itself.

Activity: Initially, you are permitted to get out of bed following surgery with the assistance from a nurse. Thereafter, you should be up walking as much as tolerated.

General Attitude

It is normal to feel physically and emotionally let down and tired the second and third day after surgery.
Natural reaction to the stress of surgery and the lingering effects of anaesthesia.
Must not be allowed to get in the way of your positive attitude that is essential for recovery to normal activity.


Pregnancy & Backache

Apply heat.
Wear a support gadget (such as abdominal support straps).
Do strengthening exercises. Pelvic-tilt exercises help strengthen the back and relieve pain.
Take medications cautiously

Dr. Dapinder Singh is an Orthopaedic Specialist at Welcare Clinic Qusais.
Clinic timings – Sat – Thurs 8.00am to 10.30pm; Fri 2.30pm – 10.30pm
Tel – 04 258 6466

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