Back problems have become extremely common and are no longer restricted to the older age group. Teenagers and young people in their 20s are also often affected. Most people will experience back pain at some time or other during their life. With good posture and by maintaining strong and healthy back muscles, it is possible to avoid back trouble but very few of us actually put our back muscles to their proper use – that of supporting the spine.
With present day job situations where people spend long periods of time sitting at desks, the risk is increased. Even people who are physically active get at risk if they do not learn correct and safe lifting techniques. When heavy and awkward objects are lifted and carried with a bent back and straight legs, there is great strain on the vertebrae and the cartilage discs between them.
Back pain can arise in any of the structures in or around the spine. Also, the pain arising from inflammation in one area can be transmitted along a nerve to a totally different area; this can be misleading about the actual location from where the pain arises.
85% of all back pain is due to injury, inflammation or arthritis in the various structures that make up the spine. A further 10% are due to true ‘slipped disc’ or prolapsed intervertebral disc which is due to damage to the cartilaginous disc between the vertebrae. The centre of the disc is pushed backwards against the spinal cord itself or against the nerves emerging from it, thus causing pain. This is usually caused by a bad lifting technique or a sudden awkward movement. A small proportion of back pain is caused by serious disease elsewhere in the body. Rheumatoid arthritis and cancer spreading from other sites can erode vertebral bone and cause severe, boring pain in the back area. Occasionally, back pain may be due to gynaecological or kidney problems.
Visualising the normal curvature of the spine can be an important diagnostic tool. When you stand sideways in front of a mirror, you should be able to see the four basic curves of the spine. In the neck region, the spine should curve inwards, towards the throat – a similar curve should be seen in the small of the back. Between the shoulder blades and the back of the pelvis, the spine should curve outwards, away from the body. In certain conditions, this curvature gets altered. For eg., in a prolapsed disc with accompanying muscle spasm in the small of the back, there is loss of the forward curvature in this area and the spine looks flat and rigid. In osteoporosis or ankylosing spondylitis, there is marked forward curvature of the spine between the shoulder blades with hunching of the back and a stoop. Shortening and forward bending of the spine is also seen in osteoporosis.
X-Rays are rarely useful, as soft-tissue injuries are not shown up on X-Rays. MRIs are more useful than X-Rays for diagnosing back-related problems.
Sudden acute back pain brought on by lifting a heavy object or by twisting awkwardly is generally due to trauma to the structures in or around the spine itself. Muscles may be torn or strained, a disc may have prolapsed and may be pressing on nerves, or the nerve may be stretched over a bony outgrowth which is the result of wear-and-tear arthritis. Weakness of the bones due to osteoporosis or metastatic cancer can also cause problems due to sudden movement.
Sharp stabbing pain brought on by movement is probably due to one of the nerves being entrapped – this pain serves as a reminder to the patient that he should be resting. (Very often, instead of taking the time off for healing, patients indiscriminately take pain killers and continue to do their daily tasks, thereby worsening the damage). The pain should settle down within 3 days or so, since most trivial muscle strains and spasms settle on their own by this time. If prolonged, consulting a doctor is necessary. Pain on coughing or sneezing also suggests movement of a freshly prolapsed disc pressing on a nerve – it again needs rest. A slipped disc may create weakness or numbness in the legs, this can have potentially serious consequences for mobility and muscle strength in the legs in future. A severe slipped disc in the lowest part of the spine can bring on difficulty in controlling the bladder or bowels.
Most back pain is long-standing. Muscles heal fairly rapidly but ligaments and inflamed joints take several weeks or months to settle down since they have relatively poor blood supply. Inflammation and arthritis of the joints tends to be chronic and emphasis should also be laid on preventing further deterioration.
Previous back injury like bruised or fractured vertebrae can later on lead to the development of arthritis with resulting stiffness and pain.
Fever, weight loss and fatigue can represent problems affecting other areas of the body as well as the spine. Rheumatoid arthritis could produce all these symptoms, as well as pain, stiffness and swelling in other joints.
If the backache is much worse during a woman’s menstrual period, it could be due to a retroverted uterus. An internal examination by the gynaecologist could confirm that. Prolapse of the uterus can also cause backache. This happens when the muscles of the pelvic floor that support the uterus become weak. It may occur in overweight women or in women who have not toned up their muscles after delivery of children. Associated symptoms are a constant discharge, alteration of bladder and bowel function with possible constipation and even stress incontinence (leakage of urine on coughing, sneezing or straining). There will be a feeling of bearing down esp. when standing or exercising with a dragging feeling in the abdomen. Backache and general tiredness with fatigue is a usual accompaniment. Certain other gynaecological disorders can also produce back pain.
Kidney infections and kidney stones are capable of producing pain in the back because of the location being so close to the spine.
Generalised weight loss with a chronic boring pain in the back could indicate a serious disorder within the body – chronic infections, tuberculosis, blood disorders like leukemia and multiple myeloma and cancer spreading from elsewhere. A full investigation is essential.
In rare cases, a rupturing aortic aneurysm can cause intense back pain. This pain will be felt in the back as well as the abdomen. This is a medical emergency and urgent referral to a hospital is necessary.
TREATMENT:
Injuries are best treated with initial application of ice, followed by heat later; bed rest is necessary depending on the extent of injury. Homoeopathic remedies are very useful in helping the hurt tissue heal faster. The patient’s symptoms of pain will guide the physician to the correct remedy.
Exercise is very important for patients with osteoporosis. Weight-bearing exercise and walking are particularly beneficial. Homoeopathic treatment will include detailed constitutional treatment along with homoeopathic mineral supplements which have the advantage of better absorption within the body.
Rest and homoeopathy do wonders for people with slipped discs. Later on, homoeopathy and exercise are essential to strengthen the back muscles to prevent recurrence.
Even long-standing back pain can find considerable relief through good holistic therapy, physiotherapy, exercise and correct posture.
The other medical conditions that do cause back pain can also be well treated with homoeopathic remedies. The focus is on curing the underlying condition and not jut giving pain relief by suppression of the pain. Constitutional homoeopathic treatment is necessary – this involves detailed case taking followed by good case management.