Coping with Low Back Pain

Back ache is peventable

Dr. Goke Akinrounde

Low back pain is a common musculoskeletal disorder estimated to have
affected 4 out of 5 people at some point in their lives. In modern day
work environment, it accounts for a number of work “absenteeism” and
what is now recognized as recurrent “presenteeism”, which is a public
health description of those who managed to come to their places of
work but nevertheless are unable to perform their job schedules in
spite of their presence at work.

Low back pain can either come as acute, subacute or chronic in
duration. Most often, the symptoms of low back pain show significant
improvement within a few weeks from onset with conservative measures.

So, what causes low back pain?
Most cases of lower back pain are due to ordinary musculoskeletal
problems and are generally referred to as “non-specific low back
pain”. These are generally believed to be due to a sprain or strain in
the muscles of the back and the soft tissues, especially if the pain
arose suddenly during physical load to the back, and the pain is to
the side of the spine.
The rate of serious causes is less than one per cent.

The lumbar region (or lower back region) is made up of five back bones 
(vertebrae) (L1-L5); the backbones from top downward house the spinal
cord, which is an extension of the brain. In between these vertebrae
lie fibrocartilage discs (intervertebral discs), which act as
cushions, preventing the back bones from rubbing together while at the
same time protecting the spinal cord. Nerves stem from the spinal cord
through holes within the vertebra, providing muscles with sensations
and movement associated messages. Stability of the spine is provided
through ligaments and muscles of the back and lower back.

The lumbar region is the area of the spine that is also the source of
most movement and flexibility, and is the support structure for much
of a person’s body weight. Both factors often contribute to the onset
of back pain, but the causes of lower back pain are varied. Most cases
are believed to be due to a sprain or strain in the muscles and soft
tissues of the back. Meaning that over activity of the muscles of the
back can lead to an injured or torn ligament in the back which in turn
leads to pain. An injury can also occur to one of the intervertebral
discs (disc tear, disc herniation).

One thing to note also is that as the body ages, the spine also does.
Due to aging, discs begin to diminish and shrink in size, resulting in
vertebrae and facet joints rubbing against one another. Ligament and
joint functionality also diminishes as one ages, leading to the
vertebrae to move much more than they should. In the vast majority of
cases no noteworthy or serious cause is ever identified. Usually the
pain resolves on its own after a few weeks.

How to avoid low back pain
Low back pain is common and there are several steps one can take
towards prevention. Although exercise may not relieve existing back
pain, it is the first step to prevent lower back pain and injury.
Exercise helps keep one’s back healthy and strong. Exercise routines
such as aerobic conditioning, back stretching, back strengthening, and
low impact activities (swimming, walking, bicycling) all helps prevent
lower back pain and the return of it.

Maintaining good posture
It is important to note that protecting ones back while sitting and
standing is another key component of maintaining a healthy back. Good
posture is important because it decreases the amount of stress that is
put on one’s back. A good standing posture consists of having one’s
ears, shoulders, hips, and knees all in line with one another. If one
must stand for long periods of time, it is recommended to have
something to rest one foot at a time on to alleviate back strain.
While sitting, one should have a chair with good lumbar support. If
the chair is not equipped with low back support is to put a small
pillow or something of that matter behind the lumbar region.

Individual sleep positions vary from person to person, but one basic
component reigns true for everyone. Mattresses that are too hard or
too soft will cause back pain. One should test different mattresses to
find which one is comfortable for them. While sleeping, your spine
should have an “S” shape (known as the neutral position) to it. A
pillow under one’s knees while sleeping on their back or a pillow in
between their knees while sleeping on their side are good ways in
which to keep the back in the neutral position.

One of the most overlooked things in preventing lower back pain or
injury is lifting. Never lift any objects too heavy for oneself.
Ignoring this rule is a surefire way to an injury of one’s back and
even a possible trip to the hospital. When lifting, one should keep
the head up, the back straight and down, bend the knees and use the
legs to push. Never stoop over to lift an object, and be sure to
always keep the object close to oneself. Always, plan the best way to
lift an object and do it slowly and carefully. Feet should be kept
shoulder-width apart. Finally, set down the object carefully by
bending with the knees and hips only.

Treating low back pain
For most people low back pain can be treated conservatively. Applying
heat to the lower back provides temporary relief of acute low back
pain. Physical therapy is beneficial in recovering from a low back
injury or low back pain. Treatments include electromyography,
stretching, strength conditioning and cardiovascular exercise. These
days it is now realized that firm mattresses are less likely to lead
to improvement when compared with a medium-firm mattress.

Short term use of over-the-counter pain and anti-inflammatory
medications, such as NSAIDs (Ibuprofen, Piroxicam, Aspirin etc) or
Paracetamol can help with the symptoms of lower back pain. However,
these medications are not without risk; hence for persistent pain a
medical practitioner should be consulted for apt assessment. In the
same vein Muscle relaxants for acute and chronic pain have some
benefit, however, there are concerns with side effects, and their
routine use is discouraged.

Staying physically active as possible is recommended. Absolute bed
rest is discouraged as not being helpful. Even when the pain is
severe, some activity is still preferable to prolonged sitting or
lying down, as long as it does not involve movements such as heavy
lifting that would further strain the back.

Generally, for most patients with acute lower back pain recover
completely over a few weeks regardless of treatments. This is
especially so in individuals where lower back muscle strain or sprain
is the cause of the pain.