Spine

Backache – History


  • Back ache has been with us since eternity. Backache is the price we pay for our success as specy.
  • Use of only the lower limbs as a mode of locomotion freed our upper limbs to be used for developing tools to lead a
    safer life – catch prey, till the soil, build shelters.


Etiology – Why?


  • With ever increasing comforts came laziness (useless spending of time which we get as a result of securing our physiological needs) and our backs which were made perfectly to walk and run, were abused.
  • The eventual disuse of the muscles which support our spine leads to excessive strain on the spine- which includes bony, ligamentous and the disc in between the two vertebrae causing faster degeneration of these structures.
  • This is felt by us as back ache.


Function – What It Does


  • The purpose of the vertebrae (spine) is to protect the sensitive structures (spinal cord, roots,) and at the same time transmit the weight of the body effectively to the lower limbs. Mind you they are not there to take the weight of the body, which happens when we sit down.





  • Please don’t yawn at this rationalizing, but this is the reason why we develop back ache.


What We Do


  • Once a person comes with back ache, management starts with analyzing the symptoms to see whether it is arising from the back muscles, bone or the disc. To aid our management, various investigations are available.



  • X ray- of the back – will show us if there is any degenerative process involving the vertebral column, or any instability or deformity between the two segments.

 


What We Do – Treatment


  • Based on the symptomatology and the investigations, the treatment for backache depends on which stage you come to us.


Conservative Management


  • Based on the symptomatology and the investigations, the treatment
    for backache depends on which stage you come to us.



Surgical Management


  • If the degeneration process encroaches onto the structures (thecal sac, cord and nerve roots) which it was made to protect, then surgical decompression is indicated to free the nerves.








  • Over time if the dynamic structural stability of the spine is compromised, which again can be felt outwardly as pain, then this can be relieved either by exercises (if the instability is early) or by surgery (if the instability is progressing).


What You Should Do


  • Motivation in sustaining life style modifications is required from the patient.










  • Any organ of the body is in best shape when it is used optimally. The same holds true for your back. Activity – walking should be started as early as possible after your acute pain subsides, along with the exercises we teach you to do.


Life Style Modifications


  • Depending on the type of pain
    – Pain more on bending forward
    – Pain more standing or hyper extending
    – Pain more while walking
    – Pain more while lying down.

  • Pain more on bending – due to the discal disease
    – Avoid bending with knees extended
    – Avoid lifting heavy weights
    – Avoid twisting your body
    – If you are obese, reduce weight by at least 3-4 kg
       to see the difference
    – Once the pain settles down start brisk walking for an hour.

  • Pain more on standing and walking
    due to facetal pain

    – Avoid excessive erect posture( military walk)
    – Always try to flex your back at the hip and the
        knees whenever possible
    – Avoid twisting and turning
    – Reduce weight by 3-4 kgs if you are obese.
    – Once the pain settles down, start brisk walking
       5-6 kms in an hour

  • Pain is coming into the lower limbs
    – Take rest till the pain subsides
    – Do flexion of the hips and knees while
       lying down whenever possible
    – Do stretching of the lower limbs as much as possible
    – Reduce weight by 3-4 kgs
    – Walking to start once pain recovers
    – If pain increasing & developing numbness or weakness
    – surgery (micro lumbar decompression) is a must.

  • Pain more on walking /standing
    – Depending on how far one can walk
    – Flexion exercises of the lower limbs
       ( at the hip and knees)
    – If severe pain starts after a little distance
       then evaluation
       for surgery needs to be done.

  • Pain more on lying down
    – The cause usually will not be mechanical
        (disc or facet related) we should suspect
    – tumor( primary or secondary), inflammatory disorders
        of the spine

  • Non specific pain
    – which doesn’t fit into the above mentioned,
       could be myofascial pain, which usually settles
       with rest and muscle relaxants