Low back pain is an omnipresent condition affecting 70-80% of people, limiting their activities and productivity at a certain period in their lifetime
Low back pain is a common muscculo-skeletal disorder which may persist for the duration of 3-6 weeks or longer
The etiology of back pain or disorders affecting the lumbar spine is often multi-factorial. It can range from genetics, wearand-tear, trauma, other medical conditions or improper posture which may lead to deterioration of water-retaining ability of the nucleus pulposus causing herniated discs, traumatic periosteal disruption from fracture may cause severe pain, as well as inflammation of the facet joints due to weight bearing imbalance.
Herniated disc occurs when the nucleus pulposus portion of the disc is forced through the weakest aspect of the disc. The presence of nuclear material (nucleus pulposus) in the spinal canal triggers an inflammatory process which then causes the radicular nature of low back pain.
Impingement of compression of a motor nerve results in weakness, while impingement or compression of a sensory nerve results in numbness.
People with herniated disc would classically present with sciatica described as a discomfort or pain running down from the back going to the legs, which may also be associated with complaints of weakness and numbness as well as changes in neural reflexes.
A thorough medical history, physical and neurologic examinations are very important in determining the causes of low back pain. Your doctor may ask you about the onset, location, intensity of the pain, duration of the symptoms and any limitations in movement. Imaging tests may not be warranted in most cases; however, they can be done to rule out specific causes of pain, possibly spinal stenosis and tumors.
D i a g n o s t i c examinations varying from plain radiographs, MRI, CT scan, and CT myelography may prove very useful to assess and confirm degenerative disc disease, loss of disc height, and facet deterioration. A herniated disc noted on imaging studies must be correlated with objective clinical examination findings.
Conservative management of low back pain includes bed rest for 1-2 days, pain medications, muscle relaxants, physical therapy and swimming exercises to enhance muscle stability and flexibility, traction and transcutaneous electrical nerve stimulation (TENS). The main objective of conservative treatment is to reduce the inflammation of the affective nerve root
There are several surgical treatment options for herniated disc although their main goal is to decompress of free up the impinged neural elements to relieve the inflammation which causes the pain.
The most common procedure for the herniated of ruptured intervertebral disc is microdiscectomy, wherein the surgeon makes a small incision and is aided by an operating microscope in performing a hemi-laminotomy to remove the extruded disc fragment that is impinging on the nerves.
A discectomy usually benefits patients who predominantly present with leg pain. Some patients would have excellent results of up to 85-90% return of full function. However, some patients would have continued back pain that may limit their return to full function, despite the absence or improvement of the raduculopathy
Guidelines for a healthy back by the National Institute of Neurological Disorders and Stroke (NINDS):
- Low-impact exercises such as speed-walking, swimming, or riding a stationary bike for 30 minutes daily increases muscle strength and flexibility.
- Yoga helps stretch and strengthens muscle as well as improves posture.
- Always stretch before exercise or doing other strenuous physical activity
- Do not slouch when standing or sitting.
- Sit in a chair with good lumbar support, proper position and height for the task.
- Wear comfortable, low-heeled shoes.
- Sleeping on one`s side with the knees drawn up in a fetal position can help open up joints in the spine and relieve pressure by reducing the curvature of the spine
- Do not try to lift objects that are too heavy.
- Maintain proper nutrition and diet to reduce and prevent excessive weight gain, especially weight around the waistline that taxes lower muscles.
- Quit smoking