Back Pain

Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide. Back pain can range from a muscle aching to a shooting, burning, or stabbing sensation. In addition, the pain may radiate down your leg or worsen with bending, twisting, lifting, standing or walking. Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdominal and pelvic internal organs, and the skin around the lumbar area.

Back pain can be a symptom of many different illnesses and conditions. The main cause of the pain can be a problem with the back itself or a problem in another part of the body. Back pain varies widely. Some symptoms (often called "red flag" symptoms) may suggest that the back pain has a more serious cause. These include fever, recent trauma, weight loss, a history of cancer, and neurological symptoms, such as numbness, weakness, or incontinence (involuntary loss of urine or stool). The causes of back pain include:

• A ruptured or herniated disc
• Osteoporosis
• Sciatica
• Inflammatory arthritis, including ankylosing spondylitis and related conditions
• Lumbar Spondylosis
• Baastrup Syndrome
• Strains
• Spinal stenosis
• Abnormal Spinal Curvature
• Infections of the spine

Some other Causes would Include:

• Pyelonephritis
• Cauda equina syndrome
• Cancer of the spine
• Other infections
• Sleep disorders
• Shingles

Understanding risk factors can help identify high-risk patients and improve their back pain management. Since older adults usually face both age-related physical and psychosocial issues, comprehensive assessments and treatments are needed to effectively manage back pain, especially lower back pain in seniors. Some common risk factors considering back pain management are as :

• Age. Back pain is more common as you get older, starting around age 30 or 40.
• Lack of Exercise. Weak, unused muscles in your back and abdomen might lead to back pain.
• Excess weight. Excess body weight puts extra stress on your back.
• Diseases. Some types of arthritis and cancer can contribute to back pain.
• Improper lifting. Using your back instead of your legs can lead to back pain.
• Psychological conditions. People prone to depression and anxiety appear to have a greater risk of back pain.
• Smoking. Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis.

You might avoid back pain or prevent its recurrence by improving your physical condition and learning and practicing proper body mechanics. You can help yourself avoid back pain by improving your physical condition. The best way to prevent the onset of the condition is by addressing the risk factors. So, consider the following tips to prevent the onset of back pain.

• Exercise. Regular low-impact aerobic activities — those that don't strain or jolt your back — can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices.
• Build muscle strength and flexibility. Abdominal and back muscle exercises, which strengthen your core, help condition these muscles so that they work together like a natural corset for your back.
• Maintain a healthy weight. Being overweight strains back muscles. If you're overweight, trimming down can prevent back pain.
• Quit smoking. Smoking increases your risk of low back pain. The risk increases with the number of cigarettes smoked per day, so quitting should help reduce this risk.

Avoid movements that twist or strain your back. Use your body properly:

• Stand smart. Don't slouch. Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.
• Sit smart. Choose a seat with good lower back support, armrests, and a swivel base. Placing a pillow or rolled towel on the small of your back can maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.
• Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight — no twisting — and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

Most back pain gradually improves with home treatment and self-care, usually within a few weeks. Contact your doctor if your back pain:

• Persists past a few weeks
• Is severe and doesn't improve with rest
• Spreads down one or both legs, especially if the pain extends below the knee
• Causes weakness, numbness, or tingling in one or both legs
• Is accompanied by unexplained weight loss

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

• Causes new bowel or bladder problems
• Is accompanied by a fever
• Follows a fall, blow to your back, or another injury

Your symptoms and physical examination may give your doctor enough information to diagnose the problem. If your doctor determines that your back pain is caused by muscle strain, obesity, pregnancy, or another cause that is not urgent, you may not need any additional tests. However, if he or she suspects a more serious problem involving your vertebrae or spinal nerves, especially if your back pain has lasted longer than 12 weeks, you may need one or more of the following tests:

• X-rays of your back
• Blood test
• Urine tests
• Spinal magnetic resonance imaging (MRI)
• Computed tomography (CT) scan
• Nerve conduction studies and electromyography to determine whether nerves, muscles or 
• Both may be injured
• Bone scan, especially if you have a previous history of cancer

Many individuals will not need extensive treatment for back pain. Over-the-counter pain medications are often sufficient. In more severe cases, stronger treatments may be necessary, but they’re typically provided under close supervision from your doctor. If home treatments do not relieve back pain, a doctor may recommend the following medication, physical therapy, or both.

Medication options include:

• Topical rubs and ointments
• Opioids
•  Muscle relaxants
• Antidepressants
• Steroid injections
• Surgery

After your initial assessment session, subsequent treatment sessions will be based on your physiotherapist’s recommendations and your goals. The patient may only need the treatment and education that the patient receives during the initial assessment or the patient may need months of rehabilitation. Transcutaneous electrical nerve stimulation (TENS) is a popular therapy for patients with chronic back pain. Some other physiotherapy treatment includes:

• Electrical stimulation and TENS (transcutaneous electrical neuromuscular stimulation)
• Cervical Traction
• Manual (hands-on) Therapy
• Core muscle strengthening
• Range of motion exercises
• Soft tissue treatment
• Joint manipulation
• Postural retraining
• Ergonomic advice/assessment
• Thermal modalities (heat therapy/Ice therapy)
• Acupuncture or other pain-relieving techniques
• Therapeutic taping