LOW BACK PAIN

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NEUROLOGY
NEUROLOGY
ORTHOPEDICS
ORTHOPEDICS
GENERAL DISEASES
GENERAL DISEASES

LOW BACK PAIN

Low back pain (lumbago)  is one of the most agonizing conditions that affect even children and is the fifth most common reason for physician visits, which affects nearly 60-80 % of people throughout their lifeline. The lifetime prevalence of low backache is reported to be as high as 84%, and the prevalence of chronic low back pain is about 23%, with it 12% of the population being disabled by low backache. The lumbar spine carries a good amount of weight and strain of the body so usually, it is one of the most affected joints. The pain varies from dull aching to sharp or persistent. Low back pain involves the disorders of muscles, nerves, tendons, bones associated with it. A good percentage of back pain patients end up in surgery due to improper management or lack of care during the onset of disease.

In Ayurveda, few conditions which come under the back pain spectrum include Katishoolam, katigraham, Grudhrasi, and many other diseases that mention back pain as a symptom. Katishoolam is explained as vata vyadhi.

Causes

The causes can be from mild conditions to severe conditions. It is commonly seen as a common sprain due to sudden movements or during lifting weights etc.

Common risk factors include – Overweight, malnutrition, Old Age, pregnancy,

Altered positions like – improper sleeping position, sitting posture etc, keeping purse in the back pocket of trousers, high heel shoe, Travelling in jerky roads like in motorcycle, excess weight lifting, over exercises and exertion, Repeated twistings or sudden jery movements, Lying on the cold surface regularly is also another.

Food – excess – spicy, bitter or pungent tasted food, lack of proper food, improper fasting, skipping meals, lack of sleep at night, etc can also cause vata prakopam as per ayurveda and leads to low back pain.

Abhighataja – due to trauma, fall, accident etc

Vegadharana – especially due to suppressing the urges of urine and faeces

Degenerative conditions like osteoarthritis of the spinal joints is another cause, disk degeneration. Disk prolapse, Disk herniations, Facet joint arthropathy, arthritis.

Urinary calculi, urinary infections can sometimes cause back pain

Anorectal diseases like Piles/hemorrhoids can also cause back pain because it leads to improper cleansing of bowels and thus more chances for inflammations (Apana vaigunyam)

Menstrual disorders and uterine conditions like endometriosis, fibroid, etc can also cause back pain. Infections causing white discharges, ovarian cysts, pelvic inflammatory conditions, chrons disease, ulcerative colitis, appendicitis/diverticulitis, etc also can cause back pain

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Congenital -spina bifida, spondylolisthesis,

Infections like TB, shingles, or any osteomyelitis, discitis, transverse myelitis-other bacterial infections can also cause back pain

It can also due to deficiencies of Vit B12, Vit D, calcium, etc supplements

Rarely it can be due to major causes like Cancer, Secondary metastasis deposits, Paget’s disease, Aneurism, ankylosing spondylitis, etc.

A good percentage of cases are also due to psychological causes either due to stress or malingering. Fibromyalgia is another cause.

Signs and symptoms

Pain – Lower back and/or leg pain. It can be local or radiating

Numbness- tingling or weakness in the affected area

Muscle spasms or cramping

Pain worsens with sitting or leaning forward, decreased range of motion and stiffness

Coughing, sneezing, or lifting may exacerbate pain

Some times burning sensation

In chronic stages, it can lead to complete paralysis below lumbar level or sensory or motor paralysis, dual incontinence.

Sacroiliac dysfunction pain can be in the sacroiliac joint

Nerve compression leads to radiculopathy often known as sciatica

Degenerative disc disease usually leads to end-stage thinning of discs and permanent damage

Facet joint arthropathy can be often associated with bone spurs

Spinal stenosis causes spinal cord compression

Listhesis is the sliding of one vertebra over the other which can be anterior or posterior

Cauda equina syndrome is usually a surgical emergency

Piriformis syndrome is also another cause for radiating type of pain which mimics a low back issue

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Diagnosis

  • Clinical diagnosis is possible with a lot of physical examinations tests
  • Radiological examinations like X-ray and MRI is very beneficial
  • Blood evaluation is also necessary for most of the patients

Common physiotherapy techniques helpful

  • Traction
  • infrared therapy
  • transcutaneous electrical nerve stimulation
  • cupping therapy
  • dry needling
  • Chiropractic and Osteopathic techniques
  • laser therapy
  • cryotherapy
  • kinesiology taping
  • Bio magnet therapy
  • aerobic exercises
  • myofascial release

Treatment

Treatment depends upon the exact diagnosis.

Nidana parivarjanam – avoid the triggering and root causes of back pain. Proper rest will heal most of the acute cases

Pachanam, Vatanulomanam will help to reduce the inflammation.

Snehanam, Swedanam

Basti – both kati vasthi, as well as niruha and anvasana vasthis, are very helpful

Kati basti(retention of medicated oil over the back region) Virechanam(purgation ) Elakkizhi(fomentation therapy using medicated herbs) Rookshakizhi njavarakizhi(fomentation therapy using cooked njavara rice)

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