LOW BACK ACHE (LBA)

LOW BACK ACHE

INTRODUCTION:

                              Almost everyone will experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, low back pain can make many everyday activities difficult to do.

                                           

ANATOMY:

                                   

DESCRIPTION:

                           Back pain is different from one person to the next. The pain can have a slow onset or come on suddenly. The pain may be intermittent or constant. In most cases, back pain resolves on its own within a few weeks.

CAUSES:

Ø  Over-Activity: One of the more common causes of low back pain is muscle soreness from over-activity. Muscles and ligament fibers can be overstretched or injured. This is often brought about by too much yard work in one day. We are all familiar with this "stiffness" and soreness in the low back and other areas of the body that usually goes away within a few days.

Ø  Disk Injury: Some people develop low back pain that does not go away within days. This may mean there is an injury to a disk.

·         Disk tear: Small tears to the outer part of the disk (annulus) sometimes occur with aging. Some people with disk tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.

·         Disk herniation: Another common type of disk injury is a "slipped" or herniated disc. A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive spinal nerves, causing pain. Because a herniated disk in the low back often puts pressure on the nerve root leading to the leg and foot, pain often occurs in the buttock and down the leg. This is sciatica. A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

  

Ø  Disk degeneration: With age, intervertebral disks begin to wear away and shrink. In some cases, they may collapse completely and cause the facet joints in the vertebrae to rub against one another. Pain and stiffness result. This "wear and tear" on the facet joints is referred to as osteoarthritis. It can lead to further back problems, including spinal stenosis.

Ø  Degenerative Spondylolisthesis: Changes from aging and general wear and tear make it hard for your joints and ligaments to keep your spine in the proper position. The vertebrae move more than they should, and one vertebra can slide forward on top of another. If too much slippage occurs, the bones may begin to press on the spinal nerves.

Ø  Spinal Stenosis: Spinal stenosis occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves. When intervertebral disks collapse and osteoarthritis develops, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth (called Bone spurs) can lead to a narrowing of the spinal canal. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.

Ø  Scoliosis: This is an abnormal curve of the spine that may develop in children, most often during their teenage years. It also may develop in older patients who have arthritis. This spinal deformity may cause back pain and possibly leg symptoms, if pressure on the nerves is involved.

SYMPTOMS:

                         Back pain varies. It may be sharp or stabbing. It can be dull, achy, or feel like a 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:

Ø  Back pain may be worse with bending and lifting.

Ø  Sitting for long time may worsen pain.

Ø  Standing and walking few steps may worsen pain

Ø  Back pain comes and goes, and often follows an up and down course.

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

Ø  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.

Regardless of your age or symptoms, if your back pain does not get better within a few weeks, or is associated with fever, chills, or unexpected weight loss, you should consult your doctor.

TESTS AND EXAMINATION:

Ø  Physical Examination: The physical examination is not as important as the history in identifying secondary causes of acute low back pain. Nevertheless, certain aspects of the physical examination are considered important.

·        Gait and Posture.

·        Range of motion.

·        Palpation or Percussion of the spine.

·        Heel-Toe walk and Squat and rise.

·        Straight leg raising Test.

·        Limited Neurologic Testing.

DIAGNOSTIC METHODS:

Ø  X-rays: Although they only visualize bones, simple X-rays can help determine if you have the most obvious causes of back pain. It will show broken bones, aging changes, curves, or deformities. X-rays do not show disks, muscles, or nerves.

Ø  Magnetic resonance imaging (MRI): This study can create better images of soft tissues, such as muscles, nerves, and spinal disks. Conditions such as a herniated disk or an infection (TB spine) are more visible in an MRI scan.

Ø  Computerized axial tomography (CAT) scans: If doctor suspects a bone problem, he or she may suggest a CAT scan. This study is like a three-dimensional X-ray and focuses on the bones.

Ø  Bone density test: If osteoporosis is a concern, doctor may order a bone density test. Osteoporosis weakens bone and makes it more likely to break. Osteoporosis by itself should not cause back pain, but spinal fractures due to osteoporosis can.

TREATMENT:

Ø  Nonsurgical Treatment:

·         Medications: Several medications may be used to help relieve your pain.

v  Non-steroidal anti-inflammatory medicines like ibuprofen and naproxen reduce pain and swelling.

v  Narcotic pain medications may help.

v  Steroids, taken either orally or injected into your spine, deliver a high dose of anti-inflammatory medicine.

·         Physical medicine: Low back pain can be disabling. Medications and therapeutic treatments combined often relieve pain enough for you to do all the things you want to do.

v  Physical therapy can include passive modalities such as heat, ice, ultrasound, and electrical stimulation. Exercising to restore motion and strength to your lower back when you suffer from severe pain is NOT advisable.

v  Braces are often used. The most common brace is a corset-type that can be wrapped around the back and stomach. Braces are not always helpful, but some people report feeling more comfortable and stable while wearing them.

v  Traction is often used.

  

Ø  Surgical Treatment:

                            Surgery for low back pain should only be considered when nonsurgical treatment options have been tried and have failed. It is best to try nonsurgical options for few months to a year before considering surgery. In addition, surgery should only be considered if doctor can pinpoint the source of your pain. Surgery is not a last resort treatment option. Some patients are not candidates for surgery, even though they have significant pain and other treatments have not worked. Some types of chronic low back pain simply cannot be treated with surgery. The following mentioned are surgical techniques.
     

·         Spinal Fusion/ Spinal stabilization.

·         Discectomy or Micro-discectomy

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