Q: I am a 25 years old female suffering from backache for the past 5 months which has become severe now. Six months back I had a bad fall wherein I landed on my hips and hands. I visited a doctor who asked me to get an X-ray done, the details of which are - Cervical Spine-AP/Lateral: there is loss of cervical lordosis & straightening of spine. Cervical spine shows normal mineralisation, Vertebral bodies/disc spaces are normal. Joints of Luschka are prominent at C5-6-7. Canal space is normal and no ossified cervical rib is noticed. Impression - straightening of cervical spine due to muscle spasm; early cervical spondylosis. After viewing the reports, the doctor recommended the following medicines for 10 days - Vorth 20 mg, Nimulid MR, Volini Gel and L.S. Corset. I discussed the same with quite a few people, who are advising me to go to a physiotherapist. Is my case of a slip disc? Kindly advise whether I should continue with the treatment I am undergoing? Is there some precautions I need to take while sleeping, walking, sitting, bending etc. and are there some particular exercises which I need to do?
A:No, you do not have slip disc.
A low back pain is not a specific disease but is a symptom resulting from a variety of conditions. No specific cause of pain can be identified in nearly 85% of people, despite a thorough medical examination. In more than 90% of people, even those with nerve root irritation, symptoms improve within 2 months, no matter what treatment or even if no treatment is given. Backaches are rarely caused by a serious illness and usually go away in a couple of days. Activity has been found to be beneficial and one should stay active within the limits of pain. Warmth and rest & sleep on a firm, flat surface give relief. Effort should be made to avoid stooping, bending, lifting and sitting on low chairs. While lifting place one foot in front of the other, keep back straight by bending hips and knees and keep arms and object close to the body. Lift by straightening legs. A good posture while standing prevents back strain. Working at a correct height and avoiding stooping is also helpful.
There are a large number of causes for backache but the common ones are:
Strain: resulting from unnatural posture while sitting, standing and walking, or from a one-sided occupation. Those who carry weight on one side (postmen or children with school bags over one shoulder), may have considerable backache. They may also develop a definite spinal curvature. It may also be due to poor muscular balance or obesity.
Fatigue: is caused by a constant attitude in such occupations that require stooping, bending or lifting heavy objects.
Lack of balance: may be due to fallen or broken arches of the feet or from the use of poorly fitting shoes. In these cases the pain usually extends upwards from the lower extremities to the back.
Nerve root syndromes are states that cause symptoms of nerve impingement, often due to a herniation (or bulging) of the disc between the lower back bones e.g. sciatica. The pain is sharp, at one spot, and associated with numbness in the area of the leg that the affected nerve supplies. Herniated discs are produced as the spinal discs degenerate or grow thinner. Spinal stenosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc spaces. Spinal degeneration is caused by alterations in the disc that progress to degeneration.
Musculoskeletal pain syndromes: Myofascial pain is characterised by pain and tenderness over localised areas. Fibromyalgia results in pain and tenderness of a chronic nature in muscles and ligaments.
Sacro-ileitis: Sacroilitis is simply inflammation of the sacro-iliac joints in the back and normally occurs with some rheumatological diseases such as ankylosing spondylitis, Behcet's syndrome and Reiter's disease.
General recommendations are to resume normal or near normal activity as soon as possible because prolonged bed rest has been found to be associated with a longer recovery period.
- Stretching or activities that place additional strain on the back are discouraged
- Sleeping with a pillow between the knees while lying on one side may help
- Pain killers: Ibuprofen & Acetaminophen
- Spinal manipulation: appears to benefit people during the early period
- Transcutaneous electric nerve stimulation (TENS): TENS provides pulses of electrical stimulation through surface electrodes.
- Exercises: During acute back pain there is currently no evidence that specific exercises are more effective in improving function and decreasing pain than other conservative therapy. Strengthening exercises have shown marked benefit in chronic pain.