Low back pain. Symptoms, Causes, Investigation,Treatment

In today’s time everyone is troubled by low  back pain. The job of some people is such that they have to sit in the chair all day. Because of this they have to face sever low back pain. 

The problem of low back pain more seen in women because women’s bones weaker then men.

Introduction of Low back pain.

Low back pain is characterized by pain which is present in the lower part of the back region.

As much as 80% of industrial population and 60% of the general population experience acute low back pain at some point of time in their life.

Symptom

Back pain varies. It may be sharp or stabbing. It can be dull, achy, or feel like a “charley horse” type cramp.

The type of pain you have will depend on the underlying cause of your back pain.

Most people find that reclining or lying down will improve low back pain, no matter the underlying cause.

People with low back pain may experience some of the following:

Back pain may be worse with bending and lifting.

Sitting may worsen pain.

Standing and walking may worsen pain

Back pain comes and goes, and often follows an up and down course with good days and bad days.

Pain may extend from the back into the buttock or outer hip area, but not down the leg.

Sciatica is common with a herniated disk. This includes buttock and leg pain, and even numbness, tingling or weakness that goes down to the foot. It is possible to have sciatica without back pain.

Back pain may be worse with bending and lifting.

Sitting may worsen pain.

Standing and walking may worsen pain

Back pain comes and goes, and often follows an up and down course with good days and bad days.

Pain may extend from the back into the buttock or outer hip area, but not down the leg.

Sciatica is common with a herniated disk. This includes buttock and leg pain, and even numbness, tingling or weakness that goes down to the foot. It is possible to have sciatica without back pain.

Causes of Low back pain

In the majority of the patient the common causes of low back pain are:

1-Idiopathic

2- Diskogenic.

However low back pain could result from various other causes. It is therefore necessary to identify and rule out the other causes of low back pain before initiating physiotherapy.

Other common causes of Low back pain

1-Congenital:-Congenital bony malformations of vertebra, sacralization of lumbar vertebra, lumbarization of the sacral vertebra, spondylolisthesis.

2- Traumatic:- InJudicious sudden lifting, fall with indirect or direct injury to the back, compression fracture of the vertebra body or transverse process, subluxation or patial dislocation of lumber vertebra facet joint, spondylosis and spondylolisthesis.

3- Degenerative Diseases:- These include annular tears, herniated nucleus pulposus, spinal stenosis, osteoarthritis, spondylosis and spondylolisthesis.

4- Inflammatory Diseases:- Rheumatoid Arthritis, ankylosing spondylitis, and various type of sacroilitis.

5- Infection Diseases:- Tuberculosis, pyogenic infections of the spine, pelvic or sacroiliac joint infection.

6- Neoplastic Disease:- Benign and malignant tumors involving nerve roots, meninges and pelvic tumors.

7- Metabolic Diseases:- Osteoporosis and other metabolic diseases.

8- Circulatory disorder:- Vascular insufficient like varicose veins, abdominal aortic aneurysm.

9- Toxicity:- Chronic radium poisoning may cause aseptic necrosis of bone and pathological fracture of vertebral bodies.

10-Psychoneuroticproblem:- Psychoneurotic pain also occur due to anxiety, tension or trouble work.

The disk lesion:- If the lesion is due to the disk pathology it is important to identify the type, extent and site of the lesion.

The commonly affected disk in the lumbar region are the fourth and fifth Disks.

The physical examination:- Detailed physical examination is necessary to diagnose the exact site, extent and cause of lesion. It may consist of the following:

Detailed history of episode Examination of the posture E valuation of pain characteristics Palpation Range of spinal movement Neurological examination Diagnostic physical test Evaluation of the functional status

1- L4 and L5 :- Prolapse of the disk between L4 and L5 will compress the L5 nerve root.

There will be diminished sensation in the dorsum of the foot and anterolateral aspect of the leg, weakness of the extensor hallucis longus. Ankle jerk will be normal.

2- L5 and S1:- Prolapse of the L5 and S1 disk compress the S1 nerve root.

There will be diminished sensation over the lateral aspect of the leg and foot, weakness of plantar flexion of big toe and foot. Ankle jerk will be absent.

Investigations

X-Ray of the spine should be done in all cases of Low back pain. There are a number of advance techniques such as computed tomography (CT) scan, magnetic resonance imaging (MRI), bone scan etc.

Treatment

Most back pains fall in the nonspecific category of classification and have almost a set program of treatment.

The following things single or in combination are generally employed in the conservative management of low back pain.

Rest and analgesic

Spinal Extension exercise

Physical agent- Moist heat, short wave diathermy (SWD), Ultrasonic therapy, infrared therapy etc.

Spinal traction

Spinal support or brace

Postural correction

Home instructions

Patient is advised to avoid flexion strains

Advise to avoid weight lifting

Advise to sleep on a firm mattress and not on saggy mattress

Avoid two wheeler

While traveling in bus sit in the middle or front seat

Avoid prolong standing

Prevention

It may not be possible to prevent low back pain. We cannot avoid the normal wear and tear on our spines that goes along with aging. But there are things we can do to lessen the impact of low back problems. Having a healthy lifestyle is a good start.

Exercise

Combine aerobic exercise, like walking or swimming, with specific exercises to keep the muscles in your back and abdomen strong and flexible.

Proper Lifting

Be sure to lift heavy items with your legs, not your back. Do not bend over to pick something up. Keep your back straight and bend at your knees.

Weight

Maintain a healthy weight. Being overweight puts added stress on your lower back.

Avoid Smoking

Both the smoke and the nicotine cause your spine to age faster than normal.

Proper Posture

Good posture is important for avoiding future problems. A therapist can teach you how to safely stand, sit, and lift.

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