Back Botheration:Stand Straight and Tall

-Sunita Gurung

Sunita Gurung gets some valuable input from Dr. Pravin Nepal about how to handle the most common problem of our generation.

“The most common cause of a back pain is when we perform our daily activities like sitting on a chair, working on laptops/computers, watching TV, lifting heavy objects, exercises, yoga, etc. in an improper way,“ says Dr. Pravin Nepal who is a senior consultant of orthopedics at Norvic International Hospital. He did his Master of Surgery (MS) in orthopedics from All India Institute of Medical Sciences, New Delhi, in 2003, and has almost 10 years of experience in the field.

Comprising of 33 vertebrae, over 30 muscles, numerous ligaments, multiple joints, and inter-vertebral discs which are interconnected into a network, the spine is indeed a complex structure. Since all of these are capable of producing pain, backache is the most common complaint faced by a maximum number of people. Fortunately, a majority of this complaints fade off within a few weeks if caused due to muscle strain, while others take longer to heal or lead to more serious complications. It has been seen that back pain can affect people of all ages but has been significantly seen to occur among adults aged between 35 and 55 years.

Types of backaches
Dr. Nepal explains, “The different types of backaches, according to cause, are: muscular strain, ligamentous strain, herniated disc, spinal stenosis, osteoarthritis, osteoporosis, fibromyalgia, infection, and tumorus conditions. At the same time, the types of back pain according to the location are also equally important: upper back, middle back, and lower back. Other causes which also result in back pain are: kidney stone, urinary tract infection, and gynecological problems.

Muscular strain and ligamentous strain: These are the most common causes of back pain. This happens when unexpected force, twist, or pull is applied to muscles or ligaments. As a result, microscopic tear of muscle or ligament occurs which causes the pain in the back.
Herniated disc: This is due to irritation or compression to the nerve root due to which the patient will have radiating pain to the upper arm or leg. This is often a result of repetitive vibratory motion (as experienced by truck drivers/machine users) or due to improper method of lifting. Commonly occurs in young adults.

Spinal stenosis: This commonly occurs in elderly people due to narrowing of the spinal canal (where the nerve roots exit), the narrowing arising because of osteoarthrtic or degenerative changes to the bone. This condition often results in back pain that worsens with every extended period of weight bearing or walking. Surgery is sometimes necessary to correct this disorder.

Osteoarthritis: This generally affects elderly people who are above 50 years and is often referred to as degenerative joint disease. With time, degeneration of cartilage takes place in the disc between our vertebra and in the joints of the spine. With a loss in the cartilaginous cushion, the bones begin to rub against each other causing inflammation, swelling, and stiffness, which cause the backaches.
Osteoporosis: Characterized by weakening of bone density, this disease occurs more in women than in men. The bone tissues start getting thin, making one more susceptible to fractures or broken bones even when simply lifting weights or even due to a slight fall.
Fibromyalgia: This long lasting (chronic) cause of backache may be a variety of rheumatic conditions. It is characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.

Infection: Tuberculosis, which is still prevalent in our part of the world, can give backaches.
Tumor: Like any other organic system, the back is also affected by tumors.

Causes
The common causes of back pain are mainly the routine activities that we do daily. So, most of the backaches that occur are a result of everyday activities that we do, like sitting on a chair, working on laptops/computers, watching TV, lifting heavy weights, improper exercises, yoga, etc. Even the simplest activity like slipping into a pair of shoes or getting into bed can trigger off pain. All the above may look or sound most simple, but when we perform without giving much thought and do it in an improper way, it definitely makes a huge impact on our spinal health.

Risk factors
The most common ones are:

  • A mentally stressful job
  • Long working hours on the computer
  • A sedentary lifestyle
  • Age: older adults are more susceptible than young adults or children
  • Anxiety
  • Depression
  • Gender: back pain is more common among females than males
  • Obesity/overweight
  • Smoking
  • Strenuous physical exercise (especially if not done properly)
  • Strenuous physical work
  • Pregnancy: pregnant women are much more likely to get back pain

Signs and symptoms
According to Dr. Nepal, “Signs and symptoms of back pain is mainly pain which lies over the upper, middle, or lower back according to its location. It just remains there or sometimes radiates to upper limb, trunk, or to buttocks, thighs, etc. The pain can develop suddenly after lifting something heavy or twisting your back awkwardly, or it can develop gradually as a result of years of poor posture. Occasionally, it may occur for no apparent reason. The pain can worsen at night, during activity, or after sitting in the same position for a long time, such as after a long car journey. Sometimes, lying down flat may help ease the pain.”

Since the back bears the brunt of our weight and is more prone to be affected, this is the reason why backaches are such a common ailment. As Dr. Nepal says, “We can prevent backache by altering our activities, practicing good posture, losing weight, quitting nicotine, and managing stress.” He further advises, “You need to see a doctor if your pain gets worse and radiates to leg and arm; if you have difficulty in walking or lifting things with hand; have numbness in the limbs; have difficulty in passing urine; etc.”

Tips for a healthier back
Before you begin any period of prolonged activity, always start off with a program of regular low impact exercises. You can ask your physician or orthopedist for a list of low-impact exercises appropriate for your age and designed to strengthen lower back and abdominal muscles. Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility. Yoga can also help stretch and strengthen muscles and improve posture.

  • Never slouch while standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when you sit straight.
  • Make sure your work surface is at a comfortable height for you at work or at home.
  • Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders straight. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. Keep a pillow or rolled-up towel behind the small of your back to provide some lumbar support. If you have to remain seated for a long period of time, rest your feet on a low stool or a stack of books.
  • Always wear comfortable, low-heeled shoes.
  • Sleep on your side to reduce any curve in your spine and always sleep on a firm mattress.
  • When transferring an ill or injured family member from a reclining to a sitting position, or when moving the patient from a chair to a bed, call out for help.
  • Don’t try to lift objects which seem heavy to you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Never twist while lifting.
  • Do exercises to strengthen the muscles that support your back, especially the abdominals, hips, back, and pelvic area.
  • Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that takes a toll on your lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
  • If you smoke, quit! Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

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