Back Pain

Almost every individual in his life experiences low back pain.The lower back usuallystarts below the rib cage .Sometimes the pain may be intense or it gets better of its own with passage of time . But each time it recur it becomes worse than the previous one .

Dull aching pain to stabbing pain with or without radiation to lower limb are the usual symptoms . sometimes it becomes progressive and makes some one hardto move or stand straight .

Sometimes the pain may be acute due to sudden exertion like heavy weight lifting , strenuous exercises in gym or working for a longer period in a unaccustomed position . These pain usually due to muscle pool in the back or sometimes due to prolapse (slippage of disc to the spinal canal or nerve root ) of intervertebral disc .

The acute pain is relieved by rest and simple analgesics(pain killer ) in most of the time . Once the pain is settled one should focus on building strength on back muscle.

sometimes the acute low back pain persists and transform into chronic form .5-10% of the back-pain patients present as chronic low back pain (CLBP).The CLBP incidence increases with age and highest in the age group of 50-60 yrs. The females are at more risk of CLBP.Obesity , nature of job , job satisfaction, psychosocial factor , family history are also important factor contributing to CLBP .

How Does Back Pain Presents

The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis.

Osteoarthritis. This is an age-related “wear and tear” type of arthritis. It usually occurs in people 50 years of age and older, but may occur in younger people, too. The cartilage that cushions the bones of the knee softens and wears away. The bones then rub against one another, causing knee pain and stiffness. Rheumatoid arthritis. This is a disease in which the synovial membrane that surrounds the joint becomes inflamed and thickened.

This chronic inflammation can damage the cartilage and eventually cause cartilage loss, pain, and stiffness. Rheumatoid arthritis is the most common form of a group of disorders termed “inflammatory arthritis.” Post-traumatic arthritis. This can follow a serious knee injury. Fractures of the bones surrounding the knee or tears of the knee ligaments may damage the articular cartilage over time, causing knee pain and limiting knee function.

Who’s at Risk

Most people experience back pain first when they’re in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include:

Diagnosis – as a screening tool Xray is the first line investigation to rule out any gross bony abnormality.But when Xray are normal or less informative we adviseMRI whichprovides more details about the spinal cord, the spinal canal, the nerve root compression, the herniated disc and any collection around the vertebrae and spinal cord. CT scan is advised when there is a structural problem and it is essential for bony correction of the vertebralcolumn.

In old age the the vertebrae becomeosteoporotic and and fail to constant load leading to compression fracture.Same thing can happen to pelvis bone also.This canbe confirmed by doing a BMD ( bone marrow density ) or DEXA scan.

TREATMENT

It is always individualised and based upon the signs and symptoms of the patients. The expectation of the patients and nature of job are the two main aspect of the treatment.The mri finding are not considered as an indication for surgery always but MRI helps in planning of the surgery .

Treating the cause is important for relieving back pain like bone forming and remodelling medication (teriparatide,bisphosphonate,danosumab ) in case of osteoporosis .Rest and analgesics in case muscle pull, surgery for mechanical problem like herniated disc, nerve root compression etc .

A majority of the portion of back pain are self limiting . Life style modification and change in posture at job are important modifiable factor for choronic low back pain .

Doctors recommend returning to your normal activities as soon as possible. Studies suggest that , more than a day or two of bed rest can actually make the pain worse and may reduce muscle tone and flexibility. Some times elderly patients are not fit for surgery , at that time epidural injection can be tried . It is done under image guidance and as a day care procedure .

How can we delay onset of low back pain

Most of the time the culprit is inadequate muscle strength so physiotherapy or muscle strengthening exercise has an important role in the prevention of back pain . Two types of strength-training exercises that may benefit the lower back are flexion and extension exercises. In flexion exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.

Back Pain

How Does Back Pain Presents

There’s no sure way to prevent back pain as you age, but there are steps you can take to lower your risk:

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