Four out of five adults will experience lower back pain

Four out of five adults will experience lower back pain some time in their life. — Photos: dpa

Back pain is very common – it is, in fact, the single biggest reason for work absenteeism, discomfort and disability.

Its incidence is increasing due to prevailing sedentary lifestyles and bad postural habits.

Globally, lower back pain disability has increased by 54% in the past 30 years.

At some point in their lives, four out of every five adults will have lower back pain.

Along with age, natural changes occur in the spine, resulting in increased chances of developing lower back pain as we get older.

It occurs most frequently in middle age, and is more common in women than in men.

Lower back pain can occur suddenly or gradually, and can consist of a dull ache or a sharp intense pain.

Quite often, the pain radiates to the buttocks and legs on one or both sides.

Sometimes, there may be no obvious cause for the pain, while other times, there could be a serious underlying medical condition.

The majority of cases are due to minor trauma, strains or abuse.

Sources of pain

Bad posture, including slouching while using laptops, is one of the causes of lower back pain that can be easily corrected.

Strains and sprains are overstretching or minor tears in the soft tissues of the spine, e.g. muscles, tendons and ligaments.

Strains refer to such injuries in muscles and tendons, while sprains occur in ligaments only.

They can occur due to muscle overuse, unaccustomed work, lifting of heavy weights, improper lifting of objects, awkward twisting, bad posture and sports injuries.

These pains usually resolve within six weeks of the body healing itself.

In some individuals, lower back pain may persist for months or years, with no specific cause being found. These cases are labelled as nonspecific lower back pain.

Disc degeneration is another important cause for lower back pain.

A disc is a soft rubbery cushioning structure located between two vertebrae. It allows our spine to flex and bend, and is thus, subjected to wear and tear.

Commonly affected discs are the lower lumbar (back) and lower cervical (neck) discs.

Once the disc starts degenerating, it begins to thin and loses its cushioning effect, leading to more biomechanical stresses on the soft tissues surrounding it, resulting in strain and minor tears.

This may eventually lead to prolapse of the disc.

When a disc prolapse occurs, the surrounding nerves are compressed and patients will experience nerve-related symptoms in the legs, along with lower back pain.

These symptoms include tingling, numbness, sciatic pain, weakness, paralysis, and bladder and bowel dysfunction, depending on the extent of nerves involved.

Further degeneration of the disc can lead to instability and osteoarthritis of facet joints of the spine, which can cause both pain and stiffness.

Spondylo-arthritis is another cause for low back pain seen in patients who have psoriasis, ankylosing spondylitis, systemic lupus erythematosus (SLE), rheumatoid arthritis and inflammatory bowel disorders.

These are a group of systemic inflammatory disorders in which the spine joints are involved.

Osteoporosis also affects the spine, leading to thinning of the vertebrae.

These fragile vertebrae can collapse with any trivial injury, causing back pain.

Infections and tumours involving the spine form a small percentage of illnesses that cause back pain.

These cases usually present with other associated symptoms related to the underlying cause, apart from back pain.

Even though they occur less frequently, greater emphasis is required to diagnose and treat them early, in order to avoid serious permanent disabilities, or even threat to life.

Sometimes, lower back pain can be due to conditions elsewhere that do not relate to the back, e.g. abdominal tumours, aortic aneurysms, kidney stones or problems in the uterus or bladder.

Treating the pain

Around 85% of lower back pain is benign in nature.

It is also sometimes not possible to detect the source of the pain, even with complex imaging techniques and advanced investigations.

Research shows that about 40% of disc degeneration detected via MRI (magnetic resonance imaging) do not present with any symptoms, not even lower back pain.

Most of these lower back pain cases resolve with non-surgical treatments and by educating the patients on managing and keeping the pain under control.

According to a recent World Health Organization (WHO) bulletin, there is worldwide occurrence of unnecessary care in the form of investigations and offer of surgical treatments for those with non-specific lower back pain.

Future advances in minimally-invasive surgical procedures might allow doctors a chance to relieve lower back pain and discomfort through surgical means and improve the quality of life for millions of people worldwide.

However, at present, surgical treatments are offered only in the following situations:

• Lower back pain that does not improve even after three months of non-surgical treatment.
• Increasing severity of pain and recurrent pain disturbing normal activities of daily living.
• Pain associated with symptoms of nerve compression, like sciatica, and numbness or weakness in the limbs.
• Pain associated with bladder and bowel dysfunction.
• Lower back pain associated with specific pathology like infection and tumours.

Apart from surgery, invasive procedures like facet joint injections or radiofrequency ablations are widely used to control pain. However, there is lack of supporting evidence for their use.

The best recommended approaches for non-surgical management of low back pain are:

Physical activity and regular routine

Those who have mild chronic symptoms need to be physically active and continue their normal activities.

Patients need to be aware that the pain, to a certain degree, is a part of life and learn to manage their stresses with the appropriate coping techniques.

They should understand the cause of the pain is not something serious and learn to self-manage accordingly.

Cognitive behavioural therapy

This will provide the patient with relaxation techniques and positive ways of thinking to help deal with their pain.

Regular exercise

Regular physical exercise will help build strength and maintain the tone of the back and abdominal muscles to help decrease the pain.

Limit pain medications

Painkillers can be prescribed for relief of initial acute pain and from any further episodes of acute pain.

However, chronic pain care should be without medications.

Opioid drugs are to be avoided in general.

Physical therapy

Certain physical therapy modalities like electrotherapy and hydrotherapy, can help relieve the pain.

Complementary therapies

Such therapies that are evidence-based, can be useful to relieve pain.

It is important to seek out a well-qualified, registered therapist when considering complementary treatments.

Quit smoking

This, along with a healthy lifestyle, will help reduce the pain.

A healthy diet

Adopting a healthy diet to help maintain or achieve good body weight and support a healthy lifestyle is essential.

Proper posture

Ensuring you have a proper posture while sitting, lying, working and carrying heavy objects or weights, will help prevent lower back pain to a large extent.

Prevention tips

A prolapsed disc (in blue third from the top on the left) can not only cause lower back pain, but also nerve-related symptoms like tingling, numbness or sciatica, among others. — Filepic

The following prevention tips are generalised.

If you are worried about developing lower back pain, it is highly recommended to consult a physiotherapist or occupational therapist to get individualised advice, based on your body mechanics, body shape and work habits.

While sleeping, the natural curves of the spine need to be supported and maintained.

The mattress should be moderately firm and not be too soft.

Individuals can choose their own most comfortable position to sleep.

For acute lower back pain caused by a prolapsed disc, sleeping on the back with a pillow under the knees, sleeping on the side with a pillow in between the knees, or a curled-up foetal position, is recommended.

Maintaining a proper posture while standing, sitting and driving is important to prevent back pain. Slouching should be avoided.

An ergonomically-optimised work space, as well as regular breaks from sitting, are essential.

If possible, the lifting of heavy weights should be avoided.

But if necessary, your back should be kept straight and your knees bent while lifting heavy objects.

Doing regular exercises to stretch and strengthen your back and abdominal muscles will help in preventing back pain.

Do note that any new type of exercise should be done with caution and with the help of a trainer.

There are various exercise regimes available to help prevent or decrease lower back pain, but a physiotherapist or occupational therapist will be able to advise on a personalised exercise programme to improve your posture, strength and movement.

In summary, the majority of lower back pains are due to natural ageing changes in the spine, associated with poor postural and work habits.

By maintaining proper body weight, staying active with regular exercises and paying attention to preventive measures, most chronic back pains and discomfort can be controlled and managed without the need for any major surgical procedures.

However, a certain percentage of back pains do need active treatment, including surgeries, to address the causative factors.

It is always advisable to seek medical consultation to get a proper diagnosis early for this ailment.

Dr Neelakanta Reddy is a clinical associate professor of orthopaedics at the Perdana University Graduate School of Medicine. This article is courtesy of Perdana University. For more information, email [e-mail]. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.