Understanding Your Low Back - Part II

Saturday, August 12, 2006 | 0

By Jomar Almeda, M.D.

The lower back is an incredible structure. It supports most of the body's weight, and is involved in a number of our day to day activities, including sitting, standing, walking and lifting. Unrecognized, it had started to bear the stresses placed on it the very moment we learned to walk. Except for an acute injury, most causes of pain are therefore due to an accumulation of microtrauma acquired through the years, and not necessarily from a single incident alone.

Most adults will suffer low back pain at some point in their lives. It may come on suddenly from one simple false movement of bending from the waist, or incorrect lifting technique, or gradually, resulting from poor posture, or from improper approach of doing things in a long time. Most individuals will have more than one episode, with each occurring at variable intervals. An acute episode is one that lasts for a few days to a few weeks. The condition becomes chronic if it lasts for more than 3 months.

Causes:

1. Muscle spasm
2. Sprains or strains of the ligaments and muscles of the low back.
3. Abnormal alignment of the spine (exaggerated lumbar lordosis, scoliosis).
4. Spondylosis (arthritis), and degeneration of the intervertebral discs.
5. Disc herniation with impingement of the nerve root(s).
6. Spinal stenosis (narrowing of the spinal canal).
7. Osteoporosis (loss of normal bone density).
8. Fractures.

Who Are At Risk?

1. Most of the time, low back pain is attributed to poor muscle tone. Thus generally, people who lack exercise, those with poor physical conditioning, and who are overweight will be more at risk.
2. Also at risk are those engaged in heavy work with long periods of sitting or standing, and/or repetitive bending and/or twisting, and heavy-lifting. Such individuals often present with back pain due to excessive muscle tension or spasm, back sprains/strains, and lumbar disc problems.
3. Those who are emotionally stressed and on long periods of inactivity.
4. Pregnant women, and those with bad posture.
5. Heavy smokers.
6. Individuals over the age of 30, and those with arthritis.

Initial Treatment:

1. Stop any strenuous physical activity within the first few days. Avoid heavy lifting or twisting of the back.
2. Apply heat or ice to the injured area. Ice may be used within the first 48-72 hours, followed by heat.
3. Pain medications if not contraindicated may help ease the pain.

A usual misconception is that when one has back pain he would need protracted bed rest, and avoid activity for a lengthy period. On the contrary, absent any serious underlying cause, prolonged bed rest and inactivity is not actually recommended. Most individuals recover from back pain within a few days to a few weeks, and symptoms usually improve on their own, with little or no medical treatment.

Patients may obtain benefit from physiotherapy and exercises that are instituted early. Although imaging tests are not always warranted in the absence of a history of acute trauma, presence of certain symptoms may prompt the primary care physician to order x-rays or MRIs of the spine, and make referrals to an orthopaedist or neurologist. These include muscle weakness with atrophy, pain or numbness that radiates to the extremities, unexplained fever, redness, swelling, and tenderness in any region of the spine, advanced age (over 65), weight loss, diagnosed case or if with family history of malignancy, and pain of more than 4 weeks duration.

Prevention:

1. Exercise. This conditions and strengthens the back and abdominal muscles, and improves flexibility.
2. Maintain a good posture.
3. Maintain an ideal weight.
4. When lifting an unusually heavy object, get help. Keep the object as close to the body as possible.
5. When lifting or picking up something off the floor, bend at the knees, not at the waist.
6. If you must stand for a long time, rest the foot alternately on a low stool.
7. If you must sit for a long time, rest your feet on the floor or on a low stool every once in a while.
8. Make sure your work surface is adjusted to your height and reach.
9. Use a chair with good back support with adjustable arm rests.
10. If you must drive long distances, stop intermittently to walk around and stretch.
11. For women, alternate use of high-heeled shoes with low-heeled and comfortable shoes.
12. Quit smoking.
13. Try various relaxation techniques.
Low back pain is a common problem with a wide range of causes. It could result from a minor strain to nerve impingement syndromes, to complex traumatic injuries, or disorders of intraabdominal or pelvic organs. But while symptoms can sometimes be very alarming, patients often recover on their own, and it is seldom life-threatening. What is important is that the symptoms are not ignored, the individual knows when to seek medical care, treatment is instituted promptly, and the health provider's instructions are thoroughly complied with.

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Postscript: Birthday greetings to August celebrants, Rebeca Laitano, and Sigris Esmeralda Gonzalez, of Integrative Industrial and Family Practice Medical Clinics.

Reminder to CSC Batch '78: Get together on August 27, 2006, at Rodel Hidalgo's residence. Classmates, former Carmona Cavite Mayor Roy Loyola and his wife, who now holds post, Mayor Dahlia Ambayec-Loyola, M.D., will be joining us.

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Prior to his involvement with Workers' Compensation, Jomar Almeda, M.D., a graduate of the U.E.R.M. College of Medicine, has over 12 years of active orthopaedic practice in Manila, Philippines. He was Arthroscopy Journal's Traveling Fellow in 2000, and later became an International Member of the Arthroscopy Association of North America in the same year. Jomar also received extensive training at the Nobuhara Orthopaedic Hospital and Institute of Biomechanics in Japan, at the National University Hospital in Singapore, and at Warwick Valley Orthopaedic Surgery, PC in New York.

Jomar is also certified in Occupational and Industrial Medicine and had served as a medical consultant for various multi-national companies in his native country. He is currently with the Workers' Compensation Department of Integrative Industrial and Family Practice Medical Clinics.

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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.