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Backache

Dr Rajesh Shah

Pain in the back anywhere below the ribs and up to the hips is called low back pain. It is a condition that affects over 90% of the population at one time or the other. Next to common cold, it remains the most common reason why people seek medical help.

Many people who experience low back pain do not meet up with a doctor since it usually resolves on its own. They may suffer from any dull aches to sharp pains or even numbness. The pain characteristically lingers on for a day or two before it gradually subsides. In many, the pains keep recurring in varying intensities.

Studies have shown that back pain is the single most reason cited by employees for taking maximum number of 'sick leaves'. Stresses and strains of daily living and overuse and misuse of the muscles of the back are the commonest causes of backache.

Why is back pain so common?

The curvature of the normal spine is such that, the bony column is weakest at two points. The cervical spine (the nape of the neck) and the dorsal spine are the weakest points. The lower back bears at least one half of the body weight. Hence, these points bear the brunt of repeated stresses and strains.

Every joint has an optimum position of function, departures from which increase the likelihood of strains and pains. Over time muscle strains lead to an overall imbalance in the muscle structure. There is constant strain on the muscles, bones, tendons, discs etc. The most common cause of back pain is poor posture. The real pain might be triggered by sudden lifting of weights, a sudden turn or a wrench, a fall on the back, sitting in a cramped position for a long time, horse-riding, riding a tractor etc. Occasionally, it won't be one event alone which triggers your backache. You may have been doing things improperly for a long time » standing, sitting or walking, until suddenly one simple movement might trigger your pains.

These so-called last straws to the already overburdened back are some of the following:

  • Trauma: acute or chronic » unusual lifting, sudden wrenches, fall etc.
  • Psychic factors like depression ' can cause lowered (poor) muscle tone and cause backache
  • Any acute illnesses » can cause poor muscle tone
  • Fatigue
  • Pregnancy
  • Obesity » causes increased lordosis
  • General poor health
  • Localized, focal infections
  • Faulty structure of feet.

What makes backache worse is that once the pain starts, in order to avoid stressing the painful parts, we tend to perform actions ( walk, stand, lift etc.) with the use of other muscles which are not used to moving in that pattern. This further increases the stress on the muscles

Causes of backache

Apart from the above mentioned triggers, backache can be caused by a number of other conditions.

  • Osteoarthritis (OA): with increasing age, the joints of the backbones undergo degeneration. OA of the joints that link one vertebra to its neighboring ones (called the facet joints) causes back pains.
  • Vitamine D3 and Calcium deficiency: Routine blood test for Vitamin D3 and Calcium, bone density study will help evaluate the health of bones. Osteoporosis is a common condition leading to back pain.
  • Herniated Discs (disc prolapse): any heavy strain or increased pressure in the back can displace the round, resilient discs which act as shock absorbers for the back bones. They cushion every impact on the back such as when jogging, weight lifting, horse-riding etc. injuries, normal wear and tear, and diseases that affect the backbones can cause minor tears on the disc surfaces as well as make them bulge out from their places. Displaced discs can press on surrounding nerves and cause pain, tingling & numbness in the legs.
  • Injuries and fractures of the vertebrae (backbone): conditions that cause nerve, bone and tissue injury can cause back pain ' vehicular accidents, fall from a bike, fall on the back compressing the structures in the back.
  • Compression of the spinal cord itself (Spinal stenosis): the spinal cord travels through a narrow, hollow shaped bony canal called the 'spinal canal'. With aging, the lumen of this canal tends to become narrow, compressing the contents within it. Back pain is a common symptom of spinal stenosis.
  • Deformities: often the backbone curvature is damaged secondary to other diseases. The alignment which is usually straight tends to deviate either to the sides (scoliosis) or appear bent forwards (kyphosis). Long-term mal-alignment of the vertebral column can cause tremendous stress and strain on the supportive muscles that surround it. This usually gives rise to backache.
  • Occupational: many occupations can take a toll on your back. If your work requires long hours of standing, lifting of heavy weights or sitting in an uncomfortable position, your back will possibly suffer.
  • Athletes are very prone to low back aches.

Back pain might also originate from the nerves, spine and muscles of the back. Conditions affecting structures present in the abdomen and pelvis - (kidneys, ovaries, intestines, prostate etc.) can cause a backache. In general backache is never really serious. It is self-resolving and lasts only for some days.

70% of persons approaching a GP are better in 3 weeks while 90 % are better in 6 weeks time, irrespective of the treatment received.

The less common causes of back pains include:

  • Infections:tuberculosis and osteomyelitis are conditions that cause back pains. But, fever, body ache and other symptoms generally accompany back pains in these conditions. Bacteria and viruses can enter the spine either through direct trauma, through surgical procedures, injection treatments or spread through the blood stream.
  • Ankylosing spondylitis:a condition which causes inflammation of the joints in the spine.
  • Pagets disease: a disorder which affects the bones of spine, chest, skull, pelvis and legs due to abnormal bone growth.
  • Pelvic inflammatory disease: any inflammation of the uterus, ovaries or the fallopian tubes can present with low back pains. Generally the pains are accompanied by uneasiness and fever.
  • Pancreatitis: the pancreas when inflamed can cause sudden, severe pains in the abdomen accompanied by nausea, vomiting and fever. Occasionally, the pains radiate to the lower back also.
  • Aortic aneurysm: the aorta is the largest artery carrying blood away from the heart. In some conditions, the walls of the aorta can become very thinned out due to overstretching. This can cause pain in the back especially if the thinned out wall ruptures.
  • Kidney stones or urinary tract infections: Stones in the kidneys or anywhere within the urinary tract cause obstruction to normal flow of urine as well as braise the walls of the ureters (two structures which carry urine produced within the kidneys to the bladder where they are stored before being excreted), and can also cause back pains.
  • Tumors: any abnormal growth of tissues especially in the back region.

When to see my doctor?

Your back pains definitely deserve medical attention in the following situations:

  • Your pains are accompanied by persistent fever.
  • You suddenly lose control over your bowel and bladder movements.
  • There are additional symptoms of numbness in the feet, nausea vomiting etc.
  • You have had a violent accident involving the back.
  • There is redness of the skin overlying the backbones.
  • Pain is elicited even with slight application of pressure.
  • You have developed weakness in the legs along with or after onset of the back pains.
  • The pains radiate below the hips to the legs.
  • Even the slightest movement in intolerable.
  • You have been on steroid treatment for other conditions.
  • You have a positive medical history of a tumor in the past.
  • You are HIV positive or have an addiction to drugs.
  • You have lost weight in the recent past.
  • You are above 50 years of age.
  • You are less than 20 years and feel this is the worst back ache of your life.
  • You have had back aches in the past, but this episode is clearly different.
  • Your low grade pains persist for more than two weeks.
  • In spite of resting your back, the pains do not improve significantly in one or two day's time.

How do I prevent backaches?

Some simple measures can help keep back pain at bay!

  • Learn to bend and lift objects properly.
  • Avoid standing for long periods at a stretch. If you must stand for a long time, make sure your ears, shoulders, hips and knees are in the same straight line.
  • If you have long hours of sitting, like a long car drive, try taking stops every one hour and walk around a bit.
  • When sitting for long, make sure your chair has a high back and supports your back (especially the region between the ribs and hip-bones) curvature properly. You may need the help of a pillow for the same.
  • Your chair should not be too high or too low either. Again, when sitting on a chair, make sure that both your feet touch ground completely. Your knees should extend beyond the seating provided and they should also be higher than your hips.
  • Don't slouch when sitting.
  • While sleeping, make sure your bed provides adequate support to your back. Very soft beds can strain your back muscles. If you are prone to back pains, then sleep on your back with your legs straight. Bending the legs at the hips increases stress on your back muscles.
  • Exercise daily. A good exercise will improve your posture.
  • A complete workout session should include walking/swimming aerobic activity + riding a stationary bike.
  • Never skip your warm-up exercises, even if you do regular workouts.
  • Manage your weight. Try maintaining your body weight within the range optimal for your age, sex, and daily routines.
  • Have foods rich in calcium, Vitamin D, phosphorus and proteins. They both help in building and repairing bones and muscles.
  • Wear low-heeled shoes. Avoid wearing stilettos for long periods.
  • Quit smoking. Smoking contributes to osteoporosis. It hardens the arteries supplying blood to our bones and reduces the blood supply to other vital structures that form your backbone.
  • Relax. Avoid stress from getting at you. Stress causes the supportive muscles of the back to go into an abnormally contracted state. Try yoga, tai chi and massages which are known to help.

Diagnosis of Backache

Backache is a symptom, causes for which are numerous. A sound clinical evaluation often suffices to trace the cause.

Most physical exams will involve an examination of the following:

  • Palpation: Your doctor will check for any sign of pain produced with application of pressure. He will also need to verify whether you have any outward signs of trauma » broken bones, brazed skin etc. your doctor will also assess your reflexes, joint stability and flexibility of the muscles around the joints.
  • Gait: Check the way you walk. Is pain or stiffness preventing a normal gait?
  • Stance: any abnormal posture adopted when standing
  • Range of motion: To check if the range of motion is painless or painful, restricted and stiff.
  • Straight leg test: this test is done to confirm the affection of the sciatic nerve as it passes through your leg.

Doctors may even advice a few tests and laboratory investigations.

  • A complete blood count along with erythrocyte sedimentation rates » this would help in tracing causes like infections.
  • Other tests depending on presentation of symptoms may be required e.g. the test for tumor markers where malignancies are suspected.
  • Radiographic evaluation: where the back pains are not relieved by rest or medications and where there is a history of acute trauma to the back, or other symptoms like weakness of legs or numbness, a radiographic evaluation becomes necessary.
  • Magnetic Resonance Imaging and Computed Tomographic Scanning: both non-invasive tests that provide highly accurate results. These tests can often diagnose the presence of an illness, or herniated discs even in asymptomatic patients. MRI uses no ionizing radiation and is better at imaging soft tissue (e.g., herniated discs, tumors). CT scanning provides better imaging of cortical bone (e.g., osteoarthritis). Compared with MRI, CT scanning is less sensitive to patient movement and is also less expensive.
  • Bone scanning: also called Bone Scintigraphy » useful when radiographs of the spine are normal but the clinical findings are suspicious for osteomyelitis, bony tumors or hidden fractures.
  • Needle electromyography and nerve conduction studies: useful in differentiating peripheral nerve damage from disorders of single nerve roots or muscles.

Treatment of Low Backache

Conventional treatment

Painkillers and correction of structural deformities are the mainstay of conventional approach to back pains.

  • Pain killers: Non-Steroidal Anti-inflammatory Drugs (NSAIDs) given for two weeks usually reduce the pains.
  • Physiotherapy: physical treatment through appropriate exercises for improving posture and muscle tone provide lasting relief.

Homeopathy For Low Backache

Homeopathic medicines offer excellent relief from low back pains. Homeopathic medications can relieve the spasms of the back muscles and provide effective pain relief without any side effects. Homeopathy is strongly recommended.

Homeopathic Remedies for Backache

Some common homeopathic medicines for backache:

Related conditions: Rheumatoid Arthritis, Ankylosing Spondylitis, Cervical Spondylitis, Multiple Myeloma

  • Magnesium phosphorica: This over-the-counter medicine is safe to take in 6c potency, for getting superficial relief in pain, before you consult a professionally trained homeopathic doctor.
  • Kali carbonicum: This medicine is often indicated in females having chronic backache due to physical and mental stress, prolonged anxiety. The individuals requiring this medicine are often worrying-type, slightly self-centered, fearful, and who may also have some gastrointestinal ailments such as gastritis and/or respiratory disease such a asthma or allergies.
  • Natrum sulphuricum: This medicine works especially if there is a history of back or spine injury leading to backache. The pain may aching in nature, constant, more at night and more in humid climate. The patient may be sensitive by nature, emotionally governed and might look arrogant in attitude.
  • Arnica Montana: This popular home-remedy for backache is more famous as anti-injury medicine. It helps by reducing swelling and reliving the pain in back. The potency suggested is 30c, to be repeated every 3 hours, if required.
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