Almost 80% of the population suffers from low backache at some time or the other after 40 years of age. The cause is most commonly due to muscle sprain or degenerative changes in the vertebral spine. Pain lasting for more than 4 to 6 weeks requires thorough evaluation.
What are the common causes of low back pain ?
- Muscle sprain due to improper posture, lifting of heavy weight, compression of a nerve in the vertebral common are common causes. Osteoporosis, obesity, lack of physical activity, pregnancy, endometriosis, pelvic infections are common predisposing factors.
What about arthritis ?
- Certain types of arthritis like ankylosing spondylitis, osteoporosis of the spine, reactive arthritis can cause low backache. Inflammation of the sacral joints as in psoriasis can also cause low backache.
How to suspect a degenerative form of arthritis as against inflammation ?
- Pain that increases on activity or exercise is generally due to degenerative changes in the vertebral column. If you get up in the morning with pain that continues for an hour or so, implies inflammation. This is generally due to ankylosing spondylitis or its variant.
What are the symptoms that should cause concern ?
- Low backache associated with blood in urine, or blood in stools needs urgent evaluation. Backache associated with fever or weight loss may be due to tuberculosis of the spine.In the elderly backache could be the first symptom of cancer of an intra abdominal organ that has spread to the spine. Thyroid, breast, prostate cancers can spread to the spine and can be the first manifestation of the disease. Multiple myeloma can present with backache as the first symptom.
How to prevent low backaches ?
- Proper posture in children is necessary to prevent backaches when children become adults. Maintaining an ideal weight is necessary. Regular exercises is a must. Weight training and specific exercises for the back are important. Children should not carry heavy school bags on their back. Adequate supplements of Calcium and Vitamin D is necessary particularly in adults and post menopausal women.
What are the investigations your doctor is likely to advise in case you have low back pain ?
- Besides the routine tests that may include blood tests for anemia, infections, urine and stools examination for occult blood particularly if you are in the older age group, Xray’s of the spine are important. MRI of the spine or even PET scan in a very few selected cases may be necessary to arrive at the diagnosis. A routine ultrasound examination of the abdomen is necessary in patients with low backache if the cause for back ache is not clearly evident.
What are the common causes of backache in women ?
- Besides pregnancy related issues, low backache in elderly women can be associated with uterine infections or malignancy. Osteoporosis with compression fractures of the vertebrae is a common cause in elderly women. Endometriosis, pelvic infections, ovarian malignancy and uterine displacement or rotation can be a cause for backache.
What about low backache and pain in the legs ?
- Backache that radiates to the legs, or associated with numbness or weakness needs prompt attention. Inability to climb stairs is also a serious symptom if associated with backache.
- What are the common exercises recommended for backache ? Swimming, yoga and other spinal extension exercises are recommended. Proper foot wear and avoiding high heel footwear may be suggested. Lift objects from the ground with your knees bent. Computer operators need to be extra careful with their posture and spine exercises.Low backache is a very common symptom. Most of the time it is due to a simple innocuous pathology. However if it lasts for more than a month or associated with weight loss or prolonged fever or weakness or numbness in the legs, it would require urgent attention.
Author: Dr Jay Deshmukh
Dr Jay Deshmukh is Chief Physician and Director, Sunflower Hospital, Nagpur Honorary Physician to Honorable Governor of Maharashtra and PondicherryCentral. Dr Jay Deshmukh is an M.B.B.S., M.C.P.S., F.C.P.S., M.N.A.M.S., MD From Internal Medicine – Bombay and New Delhi.