Article of the Month is on Low back pain which is commoner than general expectation. It is second only to the standard flue in prevalence. Everyone during some phase of life suffers back pain.

The common causes of low back pain are lack of physical activity, obesity, working while bending forward, lifting heavy weight and prolonged sitting. Therefore it is widespread in homemakers, computer operators, weight lifters, persons having a sitting job and young boys doing weight lifting in gyms unsupervised. It is also prevalent among BPO and call centre workers.

Many generalised diseases, which alter the bony architecture, also sometimes manifest themselves as back pain. The most important of them are osteoporosis, hypothyroidism, fluorosis, osteopetrosis, gout, etc. Even undiagnosed diabetes, many of the times present with back pain. Back muscles and bones are also involved in many arthritis, e.g. ankylosing spondylitis, rheumatoid arthritis, etc.

Disc prolapse, more commonly known as slip disc, initially caused by severe back pain. A patient may become bed ridden for many days. The pain gradually subsides, and he joins his routine until he gets the next attack of back pain. Slowly the interval between two episodes of back pain starts decreasing restricting the person’s activities.

If the prolapsed disc compresses any nerve root, the person gets severe pain in the legs of the same side associated with weakness of leg muscles and numbness in the foot, commonly known as “sciatica”. If the nerve compression is severe, he may even develop foot drop. And if unfortunately, the spinal cord compressed, he may lose control of bladder and bowel. The most basic level of disc prolapse in the lower back is at the L4-5 level, then at L5- S1 & L3-4 levels, although it can happen at any level.

In treatment, initially, the patient is investigated with blood tests, x- rays and MRI. MRI is the most sensitive test to diagnose disc prolapse, as the nerves and nerve roots are visible only on MRI. In initial stages, analgesics, muscle relaxants, hot packs, etc. are given. For radicular (referred) leg pain-specific medicines, like pregabalin, gabapentin, Tegretol, etc. are provided. Physiotherapy has a role in the early stages, but prolonged physiotherapy weakens the back muscles and is harmful. As the patient starts improving, spinal exercises have started, and he is encouraged to go for a walk. Prolonged use of lumbosacral belts is also detrimental if there is no improvement, caudal epidural steroid injections are given.

There is a group of patients who do not improve with these measures. In them, surgery has got a definitive role. Surgery is advised if the patient does not improve even after three months of conservative treatment; any neurological deficit appears during treatment or neurological deficit deteriorates. Recent studies show that patients do better after spinal surgery than after analgesics and exercises.

Spinal Surgery has become very safe and routine now. There is a general misconception that patients become bed ridden after surgery. Most of the extruded discs are removed either with the help of endoscope or microscope. Patients are allowed to walk either on the same day or next day of surgery. After 3- 4 weeks, they join their routine.

But they are forbidden to do any work while bending forward or lifting heavy weight and are encouraged to do spinal exercises routinely. But as has been rightly said, “prevention is better than the cure”, take proper care. Keep your weight under control, do regular exercises and take appropriate precautions. And above all, keep moving, because, “life is movement, movement is life”.