Conditions We Treat

Back Pain

Pain felt in the back that arises due to strain on muscles, joints, nerves or bones is known as back pain. Most of us experience back pain at some point in our lives. Clinicians most commonly classify back pain by the duration of the pain. Accordingly, it may be classified as either:

Acute back pain (short term) is an episode of pain that is short term and does not last more than four weeks. Most acute back pains are caused by a sudden injury to muscles or ligaments supporting the back. Many episodes subside automatically given adequate rest and precautions.

Chronic back pain (long term), is pain that extends beyond the expected period of healing. Clinically it is defined as back pain that lasts for 3 months or more. It often progresses gradually and the cause is difficult to determine in the vast majority of cases. Chronic back pain has the potential to cause serious disability in leading a normal productive life and an accurate diagnosis is critical to ensuring effective treatment that gets the patient back to a functional, pain-free state.

The American College of Physician recommends that Clinicians involved in the diagnosis and treatment of back pain, should attempt to classify chronic back pain into three categories:

Non-specific low back pain: Back pain for which the clinician cannot identify the exact underlying cause is termed as non-specific back pain. At least 85% back pain cases are clinically classified as ‘non- specific in nature. MRl’s and other imaging tests fail to help the clinician arrive at a precise diagnosis, and therefore majority of back pain patients continue to suffer without an effective treatment.

Low back pain associated with radiculopathy or spinal stenosis:
Radiculopathy and spinal stenosis are specific causes of back pain that may be identified through a complete physical evaluation of the spine and imaging tests like MRI. However, these two specific causes arc estimated to cause not more than 8% to 15% of all back pain cases. Standard treatment for such cases can range from guided medical movements to medication.

Other forms of specific low back pain:
These comprise causes like tumour, cancer, and disorders of certain organs not associated with the spine. These cases are estimated to comprise not more than 2% of all back pain cases.
Thus, not more than 2 out of 10 people suffering from chronic back pain are able to know the specific cause.

There are several causes of back pain such as:

  • Lack of exercise/sedentary lifestyle/muscle weakness
  • Prolonged or frequent bending or twisting
  • Poor posture/slouched sitting
  • Use of gadgets that cause stress to the back or neck
  • Repetitive stress like sitting or standing for long hours
  • Non-ergonomic office chair/sofas
  • Wrong/poor footwear
  • Poor lumbar support while sleeping
  • Lifting heavy weights/backpacks/shoulder bags
  • Strained ligaments
  • Stress/depression
  • Smoking
  • Structural problems like osteoporosis, sciatica, abnormal curvature of the spine
  • Cancer or infection of the spine/Bladder/Kidney
  • Pelvic inflammatory disease
  • Sleep disorders
  • Shingles

The main symptom is persistent back ache that may or may not reach till the legs. If the back pain is accompanied by any of the below, you should see your doctor:

  • Weight loss, fever, swelling of the back
  • Persistent back pain – lying down or resting does not help
  • Poor posture/slouched sitting
  • Pain radiating to the legs / below the knee
  • A recent injury, blow or trauma to your back
  • Urinary incontinence or difficulty in urinating
  • Fecal incontinence
  • Numbness around the genitals, anus or the buttocks

The National Health Service (NHS), UK, recommends the following set of people to seek medical advice if they experience back pain:

  • People aged less than 20 and more than 55 years
  • Patients who have been taking steroids for a few months
  • Drug abusers
  • Patients with cancer or who had cancer in the past
  • Patients with low immune systems.

Back pain often prevents us from getting enough exercise, and lack of exercise can worsen the pain by leading to stiffness, weakness, and deconditioning. This can cause further pain and thus causing a vicious cycle of pain and inactivity. Movement is necessary to keep the discs, muscles, ligaments, and joints healthy.

Back pain treatment involves identifying the root cause of the back pain and then targeting the treatment towards it. Injections, medications, and other passive therapies can help temporarily in providing pain relief, but they cannot stimulate the healing process. Medical movements in a controlled, gradual, and progressive manner is the only way to stimulate the healing process.

Controlled movements allow diffusion of nutrients into the injured disc space and help it to stay healthy. Additionally, an active lifestyle maintains the exchange of fluids in spinal structures and reduces swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material, which is highly inflammatory.

Be active. It gives you the muscle tone needed to support your back and keep it pain-free. Strengthening your back helps to reduce the stress on the spine and reduces chances of injury.

Correct posture is the key. Your ears should be over your shoulders, your shoulders over your hip joints, and your hips over your ankles. Our society has a head-forward posture, but leaning your head forward or slumping your shoulders can pull on your back and cause pain. Make a conscious effort to maintain good posture during the day to ease or help prevent back pain.

Keep moving. Back pain can result any time you stay in one position for an extended period of time, whether it’s sitting in an office chair, a driver’s seat, or standing in one place for your job. The more pressure you have on the discs in your spine, the more the discs will wear away. The human body was meant to move, so to relieve or avoid pain, get up from the computer at least every hour to take a short walk, and choose an aisle seat at the movie theatre to stretch your legs. Make sure while sitting, you move all the way behind on the chair and support your back completely.

Proper arch support. We all know that stilettos are not the best shoes for your back. But even a sensible pair of shoes can change your gait and lead to back pain if the soles are worn, so be sure to replace old shoes.

Proper lumbar support. A mattress should give you uniform support, so there shouldn’t be air between your body and the mattress when you lie down. We recommend going with a mattress that has medium firmness to avoid back pain symptoms. But probably the most important factor is the age of your mattress. If you’re sinking in when you lie down, it’s probably time to get a new one to help keep the back pain away.

Distribute weight of object while lifting/carrying. Any time you have to balance the weight of a purse, shoulder bag, or even a heavy wallet in a back pocket, you change the curve of your spine and that can lead to back pain. Avoid carrying heavy shopping/ grocery bags. They put additional load on the spine and could lead to low back pain. Carry bags which distribute the weight evenly across your shoulders.

Be stress-free. Any type of stress can make back pain worse. Depression has also been known to aggravate back pain symptoms. It’s probably a combination of lifestyle (becoming sedentary when you’re overwhelmed with stress or depression) and the fact that emotions can make pain feel worse. If exercise doesn’t bring you stress relief, talk to your doctor about other approaches

Quit smoking. Cigarettes hurt more than just your heart and lungs. In fact, smoking deprives cells all over your body of oxygen, including those that control the motion of your back. Studies show that smokers are more than twice as likely to develop lower back pain as those who have never smoked.

In the following cases a second opinion can help resolve doubts about your condition and help choose the right treatment:

  • Repeated bending and lifting at work or home
  • Prolonged or frequent bending or twisting
  • Whole body vibration like in driving

Recent medical research suggests that surgery should be advised only if bowel or bladder movements are affected. These are less than 5% of severe back pain cases. For back pain caused by mechanical factors, conservative treatment is the most effective treatment available.