What is Back pain?

Back pain or lower back pain can happen for several problems with any part of the interconnected network of spinal nerves, muscles, bones, tendons or discs in the lumber spine. 

What are the symptoms of back pain?

Major signs and symptoms of back pain are:

• Dull, stabbing or shooting pain in the lower back

• Painful sensation while walking, standing, bending, lifting or pulling

• Decreased range of motion and flexibility

• Pain radiating to the leg and foot

There are certain other symptoms that are indicative of a serious underlying medical condition. People with the below-mentioned symptoms should immediately contact their physician:

• Weight loss 

• Fever

• Swelling or inflammation in the back

• Numbness in legs, buttocks, anus and around the genitals

• Loss of control bowel movements

• Urinary incontinence

• Injury or trauma to the back

What are the causes of back pain?

Back pain can result from multiple factors. Some of the most common causes include:

• Strain: A strain is a common cause of back pain. Pulling or lifting heavy objects and sudden jerking movement can strain muscles and ligaments around the spine. A recurring strain is a risk factor for muscle spasms.

• Disk problems: The spinal cord is composed of interlocking bones (known as vertebrae) that are stacked on top of each other. Between two consecutive vertebrae, there exists a disk (a tissue) that plays the role of a cushion. Back pain occurs when one or more of these disks get herniated or ruptured. Pain often results when a nerve gets compressed by a bulging disk. Such a condition is known as sciatica. 

• Scoliosis: The condition is a skeletal irregularity or deformity in which the spine curves abnormally to the side. The condition can occur in the middle age and is usually painful. 

• Arthritis: Osteoarthritis is one of the major causes of back pain. The condition occurs when the cartilage of joints in the lower back gets damaged. Osteoarthritis can also worsen into spinal stenosis, a condition that is characterized by narrowing of the space around the spinal column.

• Osteoporosis: This is a condition that is associated with poor bone density. Due to bone thinning caused by osteoporosis, vertebrae in the spinal cord can experience a greater risk of small fractures (also referred to as compression fractures). These fractures can be really painful.

Other conditions that can cause back pain are poor posture, kidney stones, sleep disorders, kidney infection, shingles, degenerative spondylolisthesis, cauda equina syndrome, a fungal or bacterial infection of the spine (Staphylococcus, E. coli, or tuberculosis) and cancer or nonmalignant tumour in the spine.

What are the risk factors for back pain?

Anyone can experience back pain. However, the following factors are believed to be associated with an increased risk of back pain:

• Excess weight: People who are overweight or obese are more likely to experience back pain as excess body weight places extra pressure on back muscles.

• Age: People often start experiencing back pain in their 30s and 40s and the risk increases with age.

• Lack of exercise: People who don't exercise usually have weak back and abdominal muscles which are more susceptible to back pain.

• Smoking: People who smoke usually have poor blood circulation. Poor supply of blood to lower back restricts the delivery of nutrients to the disks in the back. Smoking also adversely impacts healing.

• Medical conditions: People with medical conditions such as cancer or arthritis are at a greater risk of experiencing back pain.

How back pain is diagnosed ?

A physician will ask certain questions related to symptoms of the back pain. He will then carry out a physical exam to check your:

• Reflexes

• Ability to stand and walk

• Range of motion of the spine

• Strength of legs

• Sensations in legs

On the basis of the test, the physician will rate the pain by assigning a score from a scale 0 to 10. In case a serious underlying condition is suspected to be causing back pain, one or more of the following tests might be ordered: 

• X-ray: The test helps reveal the alignment of bones. A physician will also use an X-ray test report to detect signs of broken bones or arthritis.

• MRI or CT Scan: This imaging test can help show herniated disks. The test is also beneficial in detecting problems with muscles, blood vessels, tissue, ligaments, tendons, bones and tendons.

• Blood test: A blood test will help reveal if the pain is caused by an infection or any other underlying condition.

• Bone scan: These scans can help detect compression fractures, bone tumours and other abnormalities in the bone tissue. 

• Electromyography (EMG): It is carried out to check for nerve compression which may be caused by spinal stenosis or herniated disk. EMG works by measuring the electrical impulses generated by the nerves in response to muscles.

How to treat back pain?

Back Pain is a condition that usually resolves on its own. The most popular treatment for all kinds of back pains or lumber strains consists of resting the back to avoid subsequent injury. However, chronic back pain can sometimes require treatment. Some of the most common modes of treatment for back pain are:

1. Medications: 

• OTC pain relievers: Episodes of acute back pain can be treated by OTC nonsteroidal anti-inflammatory medications (NSAIDs) such as naproxen and ibuprofen. Acetomophin can also be taken although it is not an NSAID and hence doesn't fight inflammation. People with ulcers in the stomach or those with kidney problems should consult their physician before taking ibuprofen.

• Topical rubs and ointments: Topical ointments are an effective remedy for back pain. These ointments usually contain ingredients such as lidocaine and ibuprofen.

• Muscle relaxants: Muscle relaxants are used to relieve mild to moderate back pain. These are usually prescribed when OTC pain relief medications fail to provide relief from pain or when muscle spasms occur alongside back pain. Muscle relaxants provide relief by acting on the CNS (Central Nervous System). These medications are known to cause dizziness. 

• Opioids (narcotics): These include medications such as oxycodone, hydrocodone or a combination of acetaminophen and hydrocodone. Opioids are usually prescribed for a short duration to relieve severe acute back pain. Long term use of opioids can lead to addiction. Therefore, these medications should only be taken under the supervision of a physician. 

• Antidepressants: Loses doses of amitriptyline, a tricyclic antidepressant, can be prescribed by a physician to provide relief from against certain types of severe and/or chronic back pain. 

• Steroid injections: Injections are considered when all other options fail to provide relief from back pain. A physician injects cortisone, an anti-inflammatory drug, in the epidural space (space surrounding the spinal cord). The injection works by limiting the inflammation around nerve roots. A major drawback of cortisone injection is that it provides pain relief for only a few months. 

2. Therapy: 

• Cognitive Behavioural Therapy: The therapy revolves around relaxation techniques and ways to promote a positive attitude to manage chronic back pain.

• Acupuncture: The ancient Chinese physical therapy is believed to relieve back pain by stimulating muscle tissues and nerves. It also triggers the release of endorphins, the natural pain relievers of the body.

• Shiatsu: Also referred to as finger pressure therapy, Shiatsu involves the application of pressure with the fingers, thumbs and elbow along energy lines in the body.

3. Surgery: When all other modes of treatment fail to work, whether medications or injections, then surgery becomes the only remaining option. It is usually recommended only for people who are experiencing: 

• persistent and severe back pain 

• muscle weakness due to nerve compression

• pain caused by structural deformities (such as spinal stenosis) 

Some of the surgical procedures that are used to treat the underlying condition causing back pain are:

• Fusion: The surgery is performed by inserting a bone graft between two painful vertebrae to fuse them into a single solid bone. Screws, metal plates, screws or cages are used to secure the vertebrae together. The surgery reduces the likelihood of painful motion of the spine.

• Artificial disk: The procedure is used to replace the damaged cushion between two vertebrae by inserting an artificial disk.

• Diskectomy: The procedure is performed to remove a part of a disk that may be pressing against a nerve.

• Partially removing a vertebra: This involves removal of a small of a vertebral column that is pressing a nerve or spinal cord.

What happens when you don't get treated on time :

In rare cases back pain can also be a sign of CES (Cauda Equina Syndrome), which is a condition that requires immediate surgical treatment. 

In patients suffering from CES, something compresses their spinal nerve roots, which cause severe pain. As the cauda equine are a bundle of nerve roots which is located in the lumbosacral spine and sends messages to the brain from the feet, legs and pelvic organs, inability to provide a fast treatment, often leads to lasting damage which can lead to incontinency and also permanent paralysis of the legs. 

MRI (Magnetic Resonance Imaging) scan is also prescribed at time along with a Myelogram (X-ray of the spinal cord after injecting contrast material into the spine), which aids in pinpointing the pressure point on the spinal nerves or on the spinal cord. 

How to prevent back pain?

Back pain caused by medical condition may not be prevented. However, back pain caused by poor physical health and lifestyle can be prevented. Some of the tips that may reduce the risk of back pain are:

• Exercise regularly

• Build muscle strength

• Maintain a healthy weight

• Quit smoking

• Consume a diet rich in calcium and vitamin D

• Wear flat shoes

• Stretch often

• Don't slouch while standing

• Use back support while sitting

• Avoid heavy lifting

Back pain home remedies:

There are a few things that an individual can do at home to get relief from back pain. Some of those things are:

• Exercises to reduce back pain: 

A physiotherapist can teach you certain exercises that can help improve your posture and strengthen the muscles of the abdomen and back. The exercises often involve:

• Correcting the posture

• Stretching to improve muscle flexibility

• Using proper technique while lifting

• Strengthening the core muscles

• Essential oils to reduce back pain: 

Emerging scientific evidence suggests that essential oils such as lavender oil or capsaicin-infused ointments are effective against back pain.

Capsaicin is an active ingredient that is found in peppers. The active ingredient is responsible for the chilly and hot taste of the peppers. Capsaicin is believed to desensitize the nerves in the affected region and reduce the intensity of the pain.

• Salt baths to reduce back pain: 

Soaking the sore muscles in warm water infused with epsom salt can provide therapeutic relief from back pain. Epsom salt contains minerals that are absorbed by the body. These minerals are known to relax the sore muscles.

• Heat/ice therapy:

Warm compresses and ice packs can help provide relief from back pain by reducing the inflammation.

Yoga for back pain:

For people with a problem of severe back pain, yoga provides relief from the pain through a more natural way. There are various asanas that not only improve the overall health of the person but they also help in strengthening muscles that are causing pain.

Given below are the asanas of yoga that help a person to alleviate pain from the back.

Yoga asanas for back pain:

1. Downward Dog

2. Child’s Pose

3. Plow Pose

4. Cat/Cow

5. Bow Pose

6. Seated Forward Fold

The stretching and poses of yoga help in concentrating on the specific muscles of the back that are causing pain.