Facts About Your Back:
⦁ Back pain affects people of all ages,
⦁ It is a very frequent reason for medical consultations
⦁ Back pain is the leading cause of activity limitation and work absence
⦁ For every 10 people working in offices in Nairobi, eight are likely to have back problems, a new research shows
⦁ Back pain is the leading symptom prompting visits to orthopaedic surgeons and neurosurgeons
⦁ It is the second leading symptom prompting visits to primary care physicians.
⦁ 5% to 10% of patients who initially visit a primary care physician for low back pain will ultimately develop chronic back pain.
Functions of Low back, or lumbar area:
# Structural support the weight of the upper body
#Movement when we bend, extend, or rotate at the waist (Photo)
# Protection of related body tissues – soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is a critical function the lumbar spine and adjacent muscles of the low back (Photo).
Common causes of low back pain:
⦁ Lumbar strain or injury (acute, chronic) – a stretch injury to the ligaments, tendons, and/or muscles of the low back.
⦁ Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical pressure (impingement) by bone or other tissues, or from disease, anywhere along their paths — from their roots at the spinal cord to the skin surface
⦁ Lumbar radiculopathy: Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae
⦁ Bony encroachment: Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves.
⦁ Bone and joint conditions: Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are due to inflammation of the joints (⦁ arthritis).
⦁ Congenital bone conditions: Congenital causes (existing from birth) of low back pain include ⦁ scoliosis and spina bifida.
⦁ Degenerative bone and joint conditions: As we age, the water and protein content of the body’s cartilage changes.
⦁ Injury to the bones and joints: ⦁ Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with ⦁ osteoporosis, especially those who have taken long-term cortisone medication
⦁ Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include ⦁ reactive arthritis (Reiter’s disease), ⦁ ankylosing spondylitis, ⦁ psoriatic arthritis, and the arthritis of ⦁ inflammatory bowel disease
Other causes include:
⦁ Kidney problems: Kidney infections, stones, and traumatic bleeding of the kidney (⦁ hematoma) are frequently associated with low back pain. Diagnosis can involve urine analysis, sound-wave tests (ultrasound), or other imaging studies of the abdomen.
⦁ Pregnancy: Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors’ advice. Natural labor can also cause low back pain.
⦁ Ovary problems: Ovarian cysts, uterine fibroids, and endometriosis may also cause low back pain. Precise diagnosis can require gynecologic examination and testing.
⦁ Tumors: Low back pain can be caused by tumors, either benign or ⦁ malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even ⦁ incontinence of urine and ⦁ stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.
⦁ Paget’s disease of the bone: a condition of unknown cause in which the bone formation is out of synchrony with normal bone remodelling. This condition results in abnormally weakened bone and deformity and can cause localized bone pain, though it often causes no symptoms. Paget’s disease is more common in people over the age of 50. Heredity (genetic background) and certain unusual virus infections have been suggested as causes. Thickening of involved bony areas of the lumbar spine can cause the radiating lower extremity pain of sciatica.
Physiotherapy Management:
1) Active physical therapy:
They include the following:
⦁ Stretching for back pain exercise, which includes simple hamstring stretches
⦁ Strengthening for back pain exercise, involving 15-20 minutes of dynamic lumbar stabilization or other prescribed exercises
⦁ Low impact aerobic conditioning
2) Passive physical therapy:
These are prescribed in cases where exercise is either too painful or otherwise not possible. They include:
⦁ Heat/ice packs
⦁ STM
⦁ TENS units
⦁ Ultrasound
Specific Exercises
There are a series of stretching, weight-training and miscellaneous exercises that help alleviate lower back pain. The main ones amongst these include:
⦁ Ankle Pumps
⦁ Heel Slides
⦁ Wall Squats
⦁ Straight Leg Raises
⦁ Single Knee to Chest Stretch
⦁ Hip Flexor Stretch
⦁ Piriformis Stretch
⦁ Lumbar stabilization exercises