Lower Back Pain Symptoms, Causes and Treatment
Posted by Spinesurgeon on February 29th, 2016
What are the causes of low back pain?
Low back pain can be caused by various causes that may be located within the spinal column or outside the spinal column.
Causes outside the spinal column include pancreatitis, pelvic inflammatory disease, intraabdominal or pelvic tumours, and peripheral neuropathy.
Causes related to the spinal column include postural causes, osteoporosis, degenerative spinal instability, spinal tuberculosis, inflammatory spondylitis such as ankylosing spondylitis, vertebral tumours, intradural tumours, tethered cord syndrome, fatigue pains in spinal deformities.
An accurate history is the most important diagnostic tool. The way the pain started and progressed; specific aggravating and relieving factors of pain; distribution of pain over your body, associated complaints such as weakness or numbness over the lower limbs will be a guide to short listing the possible causes of your low back pain.
A detailed clinical examination by top spine surgeons in Bangalore involves assessment of spinal motion, assessment of your neurology and certain special tests that will allow to further narrow down the causes to 2-3 most probable ones.
Though this process of history-taking and clinical examination may appear boring and long-drawn, it is the most crucial part towards prescribing the correct treatment to you. So, it is essential to cooperate with your doctor throughout this entire procedure, which gives more information to the doctor regarding your ailment than any other investigation on earth.
On the first visit to the spine consultant, if your problem is short-lived and there are no major signs or symptoms, you may not need any further investigation. However, if your problem has been present for some time, or if there is some history of trauma, fever, any other major illness, or any unusual findings on clinical examination; you are likely to require some further investigations.
Commonly, plain x-rays of the spine may be ordered with or without some basic blood investigations such as hemoglobin, erythrocyte sedimentation rate [ESR], CRP, RA test, serum calcium, phosphorus and alkaline phosphatase by the spine specialist.
Based on these tests, or sometimes, in the presence of some very significant signs or symptoms, you may be asked to undergo MRI scanning. Plain x-rays demonstrate bony features; while MRI demonstrates the spinal cord, its nerve roots, the intervertebral disc between the two bones of the spine. Both these tests are complementary in nature; doing one does not necessarily mean that the other one is not needed.
In some cases such as peripheral neuropathy, additional investigation in the form of EMG-NCV test, to assess the function of each of the various nerves in your limbs may be required.
Rarely, a nuclear bone scan may be asked for.
The treatment would naturally depend on the exact cause of your low back pain. As far as postural and chronic mechanical low back pain is concerned, it can generally be treated without surgery. Various nonoperative means of treatment include bed rest, painkillers, muscle relaxants, various modalities such as heat and electrical stimulation, activity restrictions, etc.
How should you sleep? You should sleep on your side, either right or left, whichever is comfortable, with a pillow in between your legs. A cotton mattress is ideal! No need to sleep on hard beds, nor do you need to fall for any kind of so-called “spine-friendly” expensive mattresses sold out in the market! During this period, you should eat, drink and sleep in the bed. Only sponge bath is allowed. Ideally, you should not get up even to visit the washroom; you should use a bedpan or urine-pot.
How long should you take bed rest? If the pain has to respond to bed rest, it will do so within 2-3 days; continuing beyond this much time only further weakens your spinal muscles without really decreasing your pain; in other words. Painkillers will be prescribed to allow a smoother and easier return to normal function.
If the above-mentioned nonoperative treatment fails to give good relief after a period of at least about a month, you are likely to require surgical intervention for permanent relief of your low back pain. The surgery would aim to correct or control the underlying disease. Surgical intervention aims at either replacing the damaged disk with an artificial disk and thereby correcting the abnormal motion or by abolishing the abnormal motion altogether by fixing it with rods and screws.
Are there any risks associated with this form of surgery?
It is important to realize this as nothing in life comes without an element of risk; even the simple act of walking out on the street is fraught with risk, which we know may sometimes be life threatening too! So, do not confine your life to months and months of futile bed rest for misplaced fears of spine surgery.
your exercises would aim at strengthening these muscles. It is not just the strength of individual muscle that is important; it is important to have good coordination among these as well. If one side is pulling, the other side has to relax. Based on your pain pattern, the exact muscles that need to be strengthened and coordinated would be identified and you would be started on appropriate exercises. Among all the positions; sleeping, sitting, standing and walking, the load on the spine is highest in the sitting position, as the weight of the body is directly transmitted to the spine. So, it is not advisable to sit for prolonged time. Always sit in a comfortable upright position. Having a big protuberant stomach shifts the weight-bearing axis to the front of the lower spine, leading to back pain. So, watch your paunch and your body weight!
What is the ideal exercise for weight reduction for spine patients?
Brisk long walk for an hour everyday! This walk has to be brisk, not a casual stroll!
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