Lower back pain – Myths and Facts  

Lower back pain is one of the most common disorders encountered throughout the world. The pain is associated with reduction in quality of life sometimes leading to major depressive illnesses.Treatment of low back pain is simple. You just need to understand the cause. More than 95% of the low back pain is related to the bad postures, over-weight, level and type of the working activities and age. The spine is the pillar of our body. It helps to keep us erect and bear our body weight. At the same time it is flexible providing different range of movement to the body. Maintaining the proper shape of the spine takes care of majority of low back pain.

Normally we tend to slouch while sitting. Our daily activities involves squatting and cross-leg sitting. That way shape of the spine is deviated from normal. These positions put lots of stresses on muscles supporting the spine. As elastic deforms after prolonged traction, the elasticity of muscles also becomes loose leading to poor support to the back. The muscles thus have to put lots of effort to keep our spine straight, eventually leading to early fatigue. This fatigue is then manifested as pain. Likewise overweight, working activity that includes lifting heavy loads or prolonged standing, forward-bending leads to early muscle fatigue resulting in back pain. It does not mean that you have to refrain from your regular work but if one could apply methods that make you comfortable while working, will reassuringly help to get rid of pain.

There is a general concept that most of the back pain is associated nerve entrapment, bony erosion etc. It should be emphasized that degeneration is natural process occurring in all living beings. Bone and joint degeneration is just like growing gray hairs, passing through the stage of menopause, diminished vision and hearing etc. These processes are unavoidable. When you get your x-rays done you might see some degenerative changes depending upon the age of a person. Your MRI might show slip disc (disc is a cartilage that intervenes between two vertebrae) compressing nerve roots. These changes are all natural. Degeneration of back bone also causes nerve entrapment. But these changes should not be the reason to worry about. These changes will not cause paralysis or cancer or require surgical intervention in majority of cases.

So understanding the problem and cause of back pain is of primary importance in treatment of low back pain. It is worth reiteration that majority of the back pain is not to be worried about. Maintaining good posture, optimum body weight, optimum working environment and frequently changing postures usually takes care of your low back pain.

Physiotherapy exercises targeting spinal flexibility and maintaining muscle tone helps to alleviate the pain and improves quality of life. These types of the pain are called mechanical back pain and accounts to about 95% of all low back pain.

If you have pain radiating to one or both of the legs severe enough to incapacitate you from your regular activities, it indicates significant nerve root compression at the back (Commonly known as sciatica). Initial treatment of this condition is medications and physical therapies. If not getting better steroid injection targeting the specific nerve root or epidural space may give significant pain relief. Majority of people get better with these simple measures in due course of time and usually will never require surgery. After exhausting all these conservative measures if it is not improving then one might have to consider surgery. Or sometimes one may have significant weakness in lower limbs, numbness around the perineal area, inability to pass or control urine and very severe pain in limbs more than back (The condition known as Cauda Equina Syndrome) pose an emergency situation when you will absolutely have to undergo surgery as soon as possible.  

There are conditions when you need to worry about your back pain. There are red flag signs consisting of night pain (pain that wakes you up from your sleep), fever, weight loss, loss of appetite, weaknesses in the lower limbs and dysfunction in bowel, bladder and sexual activities, demands thorough investigations and more aggressive treatment.

There are pathological conditions which affect the spine resulting in severe back pain, neurological deficits (Weakness in the lower limbs – a kind of paralysis), deformity of the back etc. The most common conditions are Tuberculosis of the spine, Tumors (Metastatic or Primary), Fractures (Due to injury or osteoporosis) and different types of arthritis etc. These are the serious issues accounting for about 1 % of all low back pain.  

There is also a general concept that spine surgery is posed with serious complications, which is not true. We need to analyze risk / benefit ratio in surgery versus conservative treatment. There are specific indications when you must undergo surgery on time otherwise the condition may get worse. If appropriately indicated then the surgical treatment does have the best result as compared to non-surgical treatment.

We need to identify other causes of back pain originating from other regions or organs of the body. Back pain may come from Gastritis, Kidney stones, Gall stones, Pancreatitis, Aortic dissection, uterus, ovaries or other pelvic conditions. However, it accounts for only about 3 to 4 % of all the back pain.