Coping with Back Pain

Backache is next only to common cold and flu in terms of prevalence

Back painBack pain, one of the most common complaints, affects five out of six people, some time in their life. While most cases of back pain do not have any causative, or underlying factor, the disorder attracts a huge annual cost running into several million rupees.

The onset of back pain is generally related to a host of causes. It may be linked to a muscle strain, back injury, overuse, muscle complaints, pressure on a nerve root, including poor posture, among other things. While people who perform repetitive lifting, including construction workers, have increased risk of back pain, the problem can affect pregnant women and smokers too.

A typical symptom of back pain is often felt in the lower back. This may manifest itself from the spine, muscle, nerve, or other structures in the back. Sometimes, the pain may also radiate from your mid- or upper-back.

Symptoms

A variety of symptoms may be present when your back hurts. Symptoms, in general, may be: tingling or burning sensation, accompanied by a dull, aching and/or sharp pain. This may be accompanied by weakness in the legs or feet. A simple movement gone wrong, suddenly, can lead to back pain.

Many back-related injuries happen at work; it is, therefore, better to be prepared, and change the tide when your back aches. More so, because there are as many things you can do to lower your chances of getting back pain as there are ready-to-make-and-eat foods at the mall.

Common causes

Most often, back pain is felt when you -

  • Lift a heavy object
  • Move suddenly, or hastily
  • Sit in a particular position for very long hours
  • Suffer an injury - a fall, or an accident.

Although the specific structure responsible for your back pain is not generally known, there are several possible "prompts" that lead to low back pain. This may be due to osteoporosis - a bone disorder - or, spasm of the muscles in the lower back, or hernia, including poor alignment of the vertebrae.

Other local factors that may present on evaluation, by the doctor, may include spinal stenosis, or narrowing of the spinal canal, ligamental tear or strain, scoliosis or kyphosis [spine curvature gone haywire due to a genetic defect; this is also seen in children and teenagers]. Another cause may be fibromyalgia - a condition characterised by general muscle pain, stiffness, fatigue, sleeplessness, and numerous sensitive points at the sites where the muscles join the bones.

Technically speaking, low back pain usually involves spasms of the large, supportive muscles alongside the spine, irrespective of the cause. The spasm and stiffness can, at times, be extremely painful.

Risks

Your job could be one of the determining factors - of positions that require heavy lifting, bending and twisting, or truck/lorry/bus driving [whole body vibration] may cause back pain. There are other causative indicators too, viz., bad posture, or pregnancy, if you are over age 30, if you smoke and/or obese. The chances expand if you don't exercise.

Medical conditions may also cause low back pain - these include arthritis [bone joint disease], bladder infection, kidney stone, ovarian cancer or cysts, twisted [torsion] testicles. People with a low pain threshold and/or those who feel stressed or depressed also often present with backache.

Management

It's commonly found that most people with backache feel better within a week's time. It is also often seen that back pain is likely to be completely gone in four to six weeks. It would, of course, do us all a great deal of good, if we get better quickly, because if this does not happen, for whatever reason, back pain may become a difficult customer to handle.

It is not that back pain calls for extreme measures, including complete bed rest. Bed rest does more harm than good — because, the more active you are the better. Besides, if you do not have symptoms of loss of bowel or bladder control, weakness, weight loss, or fever, doctors recommend that you stay as active as possible. There is, of course, no problem if you wish to reduce physical activity for the first two-three days and get on with your usual activities, thereafter.

First remedies

Try to alleviate your symptoms and reduce any inflammation in the area of the pain in the first few days by way of reduced activity, if needed. You may apply ice pack to the painful area, for the first 48-72 hours. Thereafter, you can use heat, or hot water fomentation. You may also use a pain-relief pill, or natural remedy, under the guidance of a therapist [Please remember that some medications, including over-the-counter {OTC} pills should not be used by people who have a stomach ulcer, stomach inflammation, or a liver disorder]. If you do not get relief, in a couple of days, it is time you sought an appointment with your doctor.

Some auxiliary measures can also provide relief in many cases:

  • Try to sleep in the curled-up, foetal position with a pillow between your legs
  • For those who prefer sleeping on their back, a pillow or rolled towel may be placed under their knees.

Prevention best

The best way to prevent backache is, of course, by way of regular exercise - exercise helps you avoid repeat episodes of back pain. More important: it will help you avoid back pain in the first place. However, it is mandatory that you know how to exercise safely. Exercise provides you the means to improve your posture, strengthen your back and improve flexibility, lose weight, and avoid falls.

What makes a complete exercise programme, you may well ask. Answer: any of the aerobic activities, such as walking, swimming, or exercise bicycle, including stretching and strength training.

Seek your doctor's advice if you have had unexplained fever along with your back pain, or your back pain started after a severe blow or fall. Or, if it shows redness, or swelling, on the back, or spine. Or, you have radiating pains, weakness, burning urination, and nightly aggravation of pain. You need to inform your doctor the medications you are taking, or have taken.

As for those who don't have back ache, or have recently recovered, it would make sense to follow a simple "how-to" programme, viz.,

  • When an object is too heavy, summon help; don't resort to foolish bravado
  • If you lift anything at all, make sure that you have spread your feet apart to give a wide base of support
  • Stand as close to the object you are lifting as possible; also, bend at your knees, not at your waist. Keep your breathing on; don't hold your breath
  • When you lift, or lower the object, make sure that you tighten your stomach muscles, and hold the object as close to your body as you can
  • Use your leg muscles, and as you stand with the object do not bend forward
  • Do not stand for long periods of time. If you have to, try using a stool, and rest your left and right foot alternatively on it.

There are also a few more things you can do. Avoid using high-heeled footwear. You may use cushioned soles when walking instead. When working on a computer, make sure your chair has a straight back with adjustable seat and back, arm-rests, and a twirl seat. When you sit for long hours, try to rest your feet on a stool - so that they are higher than your hips. Use a pillow or rolled towel behind your lower back while sitting or driving long-distances. Avoid bending too much at the steering wheel. Also, stop and walk around every hour.

Try to relax. Meditate, and learn yoga or t'ai chi. Also, get a regular therapeutic massage.

Take Care

Avoid lifting objects or twisting of your back for the first six weeks after the pain begins. Do not exercise for the first 6-8 days following backache. Resume regular exercise after four weeks, following recovery, and slowly get back to your original rhythm. Don't try to get back your lost exercise days in a hurry.

When you are ready and confident, you should start easy to begin with. Light cardiovascular training, such as walking, riding a stationary exercise bicycle, and swimming may be resumed two weeks after your symptoms surfaced. The reason is obvious: aerobic activity helps the blood flow to your back and quickens the healing process. It also strengthens the muscles in your stomach and back. Stretching and muscle strengthening exercises may be started slowly; they are useful in the long run. However, stretching exercises are best avoided immediately after an injury. They often aggravate pain. You may, for safety, seek the advice of a physiotherapist before you get back into your fitness/exercise routine, or regimen.

You would also need to avoid playing games like cricket, tennis, football, basketball, and golf. Jogging and weight-lifting too are not suitable soon after injury. Your physiotherapist may recommend some simple exercises like lifting your legs when lying on your stomach [the yogic bow pose], or sit-ups with straight legs, not bent knees.

Alternative Treatment for Back Pain

Besides treatment provided by a doctor and self-care steps taken at home, many people turn to complementary and alternative therapies for relief of back pain.

  • Chiropractic. Back pain is one of the most common reasons that people see a chiropractor. If you're considering chiropractic care, talk to your doctor about the most appropriate specialist for your type of problem. In addition to chiropractors, many osteopathic doctors and physical therapists have had training in spinal manipulation
  • Acupuncture. Some people with low pack pain report that acupuncture helps relieve their symptoms. The National Institutes of Health, US, has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts sterilised stainless steel needles into the skin at specific points on the body. Acupuncture is thought to stimulate your central nervous system to release the body's natural pain-relieving endorphins. Acupuncture may also alter how your blood pressure, blood flow and body temperature are regulated and respond to pain
  • Massage. Massage offers symptomatic relief for back pain caused by muscle spasm. The problem with massage treatment is that the relief seldom lasts beyond the actual treatment. Furthermore, treatments can be quite expensive. That said, if you find relief from massage, there is unlikely any harm caused by the treatment
  • Aromatherapy. Treatment with essential oils can often help relieve the painful muscle spasms that contribute to back pain. Several of these - sage, rosemary, thyme, horsebalm and mountain dittany - are rich in thymol and carvacrol, compounds that help muscles relax. Add a few drops to a couple of tablespoons of any vegetable oil and massage the oil mixture directly into the affected area. Alternately, you can add a few drops of the oil to a hot bath and soak for a while, inhaling the steamy vapours. Essential oils useful for back pain are: 1. Muscular fatigue: lavender, marjoram, rosemary, clary sage; 2. Acute pain: black pepper or ginger, birch. Never ingest an essential oil.
  • Ayurveda and homoeopathy are also just as useful.

- Ashwini Ranade

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Rajgopal Nidamboor
Rajgopal Nidamboor, a trained physician, is a writer, commentator, and author. In a career spanning 25 years, Nidamboor has published over 2,000 articles, on a variety of subjects, two coffee table books, an E-book, and a primer on therapeutics, aside from an encyclopaedic treatise on Indian philosophy.

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