Back issues have become one of the most common out-patient diagnosis with patients belonging to adolescents to elderly. The most common. Low back-ache is a common symptom and has been associated with many causes. This has been classically associated with ‘DISC PROLAPSE’ and ‘SCIATICA’ in common terminology. There has been increasing incidence of back pain more so in the young population.
The chief reasons in common day practice are:·
- Long sitting hours·
- Chronic Bad posture·
- Nutritional deficiency·
- Lack of exercises·
- Increasing trends of Smoking and Alcohol consumption
- Indulgence in Improper/Unsupervised weight training at GYM.
The associated Symptoms with back pain may include:·
- Pain radiating to legs.·
- Numbness in hips and thighs.·
- Tingling sensation in the calves and foot.·
- Cold and hot sensations on prolonged sitting/standing.
- Severe backache on sneezing, coughing, deep breathing.
- Severe pain on bending forwards.
- Inability to walk for long distances.
- Rarely, Bowel/Bladder problems.
These are the RED FLAG signs of an impending trouble. One should seek medical attention at or before this stage to conclusively diagnose the source of problem.Low Back ache can have a secondary cause other than Muscle Fatigue and Disuse Atrophy of postural muscle. With age following factors lead to increased incidence of back pain and patient enters a vicious cycle where it becomes difficult to treat without medical intervention:
Low Back Ache: How it starts !!
Several other causes have also been identified. They are:
- Disc prolapse (PIVD): Most common association with back pain.
- Spondylo-listhesis: Slippage of one bone segment over the other.
- Degenerative Arthritis: Like knees, your back has several joints functioning together to perform all the movements and function. The get worn out with age and increasing weight.
- Lumbar canal Stenosis: Refers to the narrowing of the canal in which the Spinal Cord travels and gives branches to all parts of your body.
- Fracture:Bony injury due to Trauma or fall from height can cause severe Back Ache
- Infection:Tuberculosis and other infections can also affect the spine and give similar symptoms.
- Malignancy:Rarely, Neoplastic growth affecting the bones or spinal cord can also be a cause of pain.
The most common cause association still remains “Prolapsed Disc with chronic bad posture and increasing weight.”
The prolapse of a disc has namely four stages:
- Degeneration: Chemical changes associated with aging causes discs to weaken, but without a herniation.
- Prolapse: The form or position of the disc changes with some slight impingement into the spinal canal and/or spinal nerves. This stage is also called a bulging disc or a protruding disc.
- Extrusion: The gel-like nucleus pulposus breaks through the tire-like wall (annulus fibrosus) but remains within the disc.
- Sequestration: The nucleus pulposus breaks through the annulus fibrosus and can then go outside the interver
The diagnosis is usually done by detailed history from the patient. This is supplemented with a clinical examination and confirmed further with radiological examination in the form of X-rays and MR Scan. Most pathologies have been shown to improve with conservative trial. The primary pathology remains lack of exercise and increasing body weight supplemented by a poor prolonged posture. The compliance to Medical and Rehabilitation therapy is must to assess patient response. If conservative trial of 6 weeks fails to bring relief, surgical treatment should be sought.
The components of Conservative Treatment include:·
- Rest on a firm bed.·
- Muscle relaxants and analgesics.·
- Neuro-sedative and Neuro-tonic supplements.·
- Hot fomentation.·
- Electrotherapy – for acute pain.·
- Life-style changes – posture correction, Reduction of weight& training of muscles (Physiotherapy)
Surgical treatment varies as per individual case requirements and may include: ·
- Epidural injections·
- Decompression of spinal cord (Minimally Invasive- endoscopic)·
- Decompression and stabilisation ·
- Discectomy (Minimally Invasive- endoscopic) ·
- Lumbar Fusion·
- Nerve decompression
Surgical procedure is associated with increased risk of Neural deficit post operatively & is considered last resort treatment if conservative trial fails to improve the patient symptoms.We, at Arthosenter are proud to serve you with best in class facilities from physiotherapy to Minimally invasive spine surgeries. The centre is backed up with best equipment for electrotherapy under the able guidance of an Orthopaedic Spine Specialist.
Exercises to prevent low back ache right from the start and to rehabilitate the patient functionally to their routine.
These are essential and should be started only after consultation from your orthopedic surgeon.
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