CHRONIC BACK PAIN:

Only few 1.5% of acute back pain becomes chronic,if the causative factors are not taken care.

A good conditioning both at Physical level and biochemical level(balanced diet specially with more emphasis on calcium,magnesium,Vitamin D3,Vitamin B2)are vital in preventing chronic back pain .

1.Chronic back pain is pain that persists after an injury or surgery where the source is hard to determine.

2. Acute pain can develop into Chronic Pain for a number of reasons. Once these reasons have been determined through a medical evaluation, treatment can focus on reducing back pain and improving mood and function.

3. Back pain and related symptoms rank among the second most frequent medical complaints.

4. Disability from low back pain is second only to the common cold as a cause of lost work time and is the most common cause of disability in people under 45 years of age.

5.Of all the back pain 60% recover in 1 to 3 weeks;

• 90% recover in 6 to 8 weeks; and
• 95% recover in 12 weeks.
• Serious causes of low back pain (e.g. cancer) are uncommon (less than 1%).

Mechanisms

The onset of acute low back pain most often is the 

result of mechanical damage due to excessive and 

prolonged poor posture and mechanics.

Sitting in conituity 

a sedentary lifestyle and inadequate conditioning.

Seemingly trivial stress such as bending over, sneezing or 

coughing can produce a herniated disk when superimposed on 

chronic wear and tear.

People in a sedentary occupation have a high risk of herniating

 a disk.

Mounting Jar on Top.

This activity ↑ (in pic above) is considered very trivial for many but it has led to severe cervical disc related arm pain in one of my patients.He was hardly able to relate this as cause of his excruciating pain in neck and arm when he first met me.

During the flexion(bending forward at spine) that occurs with

 sitting(as shown in pic here)

Intradiscal pressure is greatest and the disc exerts pressure on 

the thinnest, least supported area of the supporting ligament 

known as the annulus fibrosus. As a result, the disc can 

herniate.

Intradiscal pressure in Lumbar Spine in different positions

Mechanical low back pain may be defined as pain secondary

 to overuse of a normal anatomic structure (muscle strain) or 

pain secondary to injury or deformity of an anatomic structure

 (herniated nucleus pulposus).

Mechanical low back pain is usually aggravated by static 

loading of the spine (prolonged sitting or standing), long 

levered activities (e.g. vacuuming) or levered postures 

(bending forward). It is eased when the spine is balanced by

 multi directional forces (e.g., walking) or when the spine is 

unloaded (e.g., reclining).

Mechanical conditions of the spine including back strain, disc herniation, disk disease, osteoarthritis and spinal stenosis account for up to 98% of cases of back pain.

Management

• The history and physical examination is the first step in the evaluation and management
• x-rays may be ordered; however, not every patient with low back pain requires x-rays.
• Cauda equina syndrome,or a secondary cause of back pain (malignancy); and other red flags are evaluated and appropriately referred.
• The majority of patients will improve with controlled physical activity( as directed by the doctor most appropriately by a well qualified and experienced Physiotherapist).

A well qualified and experienced PHYSIOTHERAPIST has extra knowledge of his own failures and his extra experience.

• Physical therapy, nonaddictive non-steroidal anti-inflammatory drugs, and, in appropriate patients, muscle relaxants.

Fortunately, chronic low back pain affects only a small percentage of patients.

The physician does not want to intervene with inappropriate 

surgery nor overlook the possibility of a serious complication 

associated with a mechanical disorder (cauda equina syndrome) or

 a secondary cause of back pain (malignancy);the latter can be 

identified in the history and physical by certain "red flags."

Prevention

Obesity and smoking correlate adversely low back pain and may adversely the progression of the disorder.

 Overall physical fitness will correlate favorably with recovery from low back pain and return to work.

Training, education and ergonomic intervention reduces the incidence of back disorders.

Sports

Most individuals who exercise regularly and maintaining a level of fitness, are less prone to lumbar spine injury and problems due to the strength and flexibility of supporting structures.

These structures include strong abdominal and lumbar paraspinal muscles for support, and flexible gluteal and hamstring muscles.

Problems involving the lumbar spine are rare in athletes(10% of sports Injury).

Gymnastics, football and racquet sports have a higher incidence of associated lumbar spine problems related to repetitive twisting and bending motions.

Weekend athlete may be higher in incidence as may be related to the individual's level of fitness.

Prevention through proper conditioning and technique is important.

What can I do if I have acute low back pain?

The key to recovering from acute (abrupt, intense pain that subsides after a relatively short period) low back pain is rest from sitting and walking for first 24 hours,if required for maximum for 72 hours.

Apply ice. Ice helps reduce inflammation that may be affecting your back. Leave the ice pack on for about 20 minutes, and then remove it. You can do this every hour or so.

Use a heating pad. After any inflammation is under control (about 24 hours or so(i feel 72 hr is better)), many people find heat soothing. It also promotes healing by bringing blood to your back.

For 10 to 20 days after you experience acute low back pain, follow these guidelines:

Sitting

Sit with a back support (such as a rolled-up towel) placed at the hollow of your back.

Keep your hips and knees at a right angle (use a foot rest or stool if necessary). 

Your legs should not be crossed and your feet should be flat on the floor.

Sit in a high-back chair with arm rests. 

Sitting in a soft couch or chair will tend to make you round your back and won't support the hollow of your back.

At work, adjust your chair height and work station so you can sit up close to your work and tilt it up at you. Rest your elbows and arms on your chair or desk, keeping your shoulders relaxed.

When sitting in a chair that rolls and pivots, don't twist at the waist while sitting. Instead, turn your whole body.

When standing up from the sitting position, move to the front of the seat of your chair. Stand up by straightening your legs. Avoid bending forward at your waist. 

Driving

                      

Use a back support (lumbar roll) while sitting or driving in the car.

Move the seat close to the steering wheel to support the hollow of your back.

Standing

                  

Stand with your head up, shoulders straight, chest forward, weight balanced evenly on both feet and your hips tucked in.

Avoid standing in the same position for a long time.

Stooping, Squatting, Kneeling

For each of these positions, face the object, keep your feet apart, tighten your stomach muscles and lower yourself using your legs.

Lifting Objects

• Try to avoid lifting objects if at all possible.

• If you must lift objects, do not try to lift objects that are awkward or are heavier than 12 kg.

• To pick up an object that is lower than the level of your waist, keep your back straight and bend at your knees and hips.Do not bend forward at the waist with your knees straight.

                            

• If you are lifting an object from a table, slide it to the edge to the table so that you can hold it close to your body. Bend your knees so that you are close to the object. Use your legs to lift the object and come to a standing position.

• Hold packages close to your body with your arms bent. Keep your stomach muscles tight. Take small steps and go slowly.

• To lower the object, place your feet as you did to lift, tighten stomach muscles and bend your hips and knees.(AND BEND YOUR KNEES AS YOU DID WHILE LIFTING)

Reaching Overhead

                                 

• Use a foot stool or chair to bring yourself up to the level of what you are reaching.

• Get your body as close as possible to the object you need.

• Make sure you have a good idea of how heavy the object is you are going to lift.

• Use two hands to lift.

Sleeping and Laying Down

Select a firm mattress and box spring set that does not sag. If necessary, place a board under your mattress. You can also place the mattress on the floor temporarily if necessary.

Use a back support (lumbar support) at night to make you more comfortable. A rolled sheet or towel tied around your waist may be helpful.

Do not sleep on your side with your knees drawn up to your chest. 
                                     

                        

When standing up from the lying position, turn on your side, draw up both knees by dragging your feet (and not swinging in air, your legs) on the side of the bed. Sit up by pushing yourself up with your hands. Avoid bending forward at your waist.

Other Helpful Hints

Avoid activities that require bending forward at the waist or stooping.(use reacher instead)

When coughing or sneezing, try to stand up, bend slightly backwards to increase the curve in your spine (or simply keep straight,NO BENDING AT ALL)  when you cough or sneeze.

Stretches and Strengthening Exercises

There are several exercises that will help strengthen your lower back. Try these three stretching exercises to help make your back stronger and better toned:

The plank

                               

1. Get into pushup position with your forearms on the ground.
2. Keeping your elbows in line with your shoulders, push up onto your forearms and toes, keeping your back straight and your elbows on the ground.
3. Hold for a few seconds, and then lower yourself to the floor.(initially a few 15 seconds and as you progress you should take it to one minute or more)

          

The bird dog

               

1. Get on your hands and knees, keeping your back straight.
2. Extend one leg and the opposite arm straight out.
3. Hold for five seconds, and then rest.
4. Alternate with the other leg and arm.

The arch/Bridging

                           

1. Lie on your back with your arms by your sides.
2. Gradually lift your hips using your back, buttocks, and abdominal muscles.
3. Hold for five seconds, and then relax.

TADASAN

Physiotherapy: Painful Discs and Sciatica: How To Fix Them Yourse...

Physiotherapy: Painful Discs and Sciatica: How To Fix Them Yourse...: Painful Discs and Sciatica: How To Fix Them Yourself (Following are my own findings and experience ,however for the sake of bit convenie...

Painful Discs and Sciatica: How To Fix Them Yourself

(Following are my own findings and experience ,however for the sake of bit convenience  I took the help of work done by  By Dr. Jolie Bookspan)

Despite the fact that discs usually can heal quickly and easily, people are commonly told that a disc problem is a difficult and long-term condition.

They are told to accept and “live with” pain and reduced ability.

They may stay on pain and anti-inflammatory drugs for long periods.

Recent news reports from Time Magazine and The New York Times quote spine specialists as saying that back pain is mysterious, and that commonly used modalities like acupuncture, strengthening, surgery, massage, chiropractic just aren’t working. However, the case is that back pain is usually simple to understand, and simple to fix without surgery or special beds or equipment.

Back Pain Is Not Mysterious

People do an astonishing number of things every day to strain, weaken, and pressure their backs. You know you shouldn’t lift wrong, but you do — all day, every day — picking up shoes,

 petting the dog,

                           

 for laundry, trash, making the bed, looking in the refrigerator, and all the dozens of times you bend over things. You work bent over your desk or bench. You drive bent forward.

If you go to the gym, you probably lift weights bent over, stretch by touching your toes, do yoga by bending over at the waist, then bend over to pick up your gym bag to go home. No wonder your back hurts. Most people know that bending wrong will injure your back. But they stand, bend, sit, and lift wrong many dozens of times a day, day after day.

They wonder 

 

 why they still get pain even though they take their medicine and “do their exercises.

Many wind up in back surgery, or long term or recurring pain, not understanding why their physical therapy, pills, or yoga “didn’t work.”

What Are Discs?

Discs are little fibrous cushions between each of your vertebrae (back bones).

have a look on how they are placed between two consecutive bones 

Now watch one segment out of these 

There are 23 discs in the human spine: 6 in the cervical region (neck), 12 in the thoracic region (middle back), and 5 in the lumbar region (lower back).

A.The Yellow vertical cord is spinal cord and roots are extending from the cord.

B.The light sky blue color is of disc.

Discs do many things like absorb shock, and keep your bones from grinding against each other. When you abuse them by bad habits, they can break down.

How Discs Herniate

Years of forward rounding, squashes your discs and pushes them out toward the back. The discs eventually break down (degenerate) and push outward (herniate). Think of a water balloon.

A. 

When you squeeze the front (as it happens when we bend forward), it bulges toward the back. The resulting herniation can press on nearby nerves, sending sciatic pain down your leg.

B.

 if you squash and push the discs in your neck with a forward head posture - letting your head tilt “chin-forward” instead of holding it up straight, the disc in your neck may herniate and press on nerves, sending pain down your arm. 

or may be while lifting your water jar gas cylinder.

THE INTRADISCAL PRESSURE is proportional to body weight as well.