Back pain is the most common cause of disability and work-absenteeism in the working population, worldwide. Back pain is also the most frequent cause of suffering and decreased quality of life in our seniors. Most of us have experienced back pain at some point in life. Most back pains are benign and get better within 6 weeks. One need not worry about these muscular or postural back pains which would typically disappear or start improving within a couple of weeks of their onset. A few sessions of Physiotherapy will help in cutting short the recovery period from this kind of a muscular/postural back pain. Following is a list of warning signs (RED FLAG SIGNS) that warrant a visit to a Spine Specialist:
Back pain lasting more than 6 weeks
Frequent episodes of back pain > 3 episodes in 6 months
Back pain in a child < 15 yrs or in seniors > 65 yrs
Back pain associated with fever, weight loss, loss of appetite
Back pain at night time or when one is resting
Pain in the middle of the back (thoracic region)
Back pain associated with pain/tingling/numbness in either leg (sciatic pain)
Back pain associated with difficulty with balance or walking along a straight line (The drunken driver’s test)
Back pain associated with change in urine and stool pattern including loss of control or retention
Back pain especially on getting up from bed and associated with morning stiffness
Back pain following a fall or an accident
Back pain with a past history of cancer
Back pain with a history of use of steroids or other immunosupressants
Sudden increase in back pain in a known case Ankylosing Spondylitis
If any of these Red Flags are present then your Spine Specialist will order atleast X-rays on your back and may order an MRI of the Lumbosacral (lower back) or Thoracic (upper and middle back) spine.
After ruling out more serious pathologies, the most common cause of back pain lasting more than 6 weeks is lumbarspondylosis and disc degeneration. Few sessions with a Physiotherapist, some medicines and lots of back and abdominal exercises (CLICK HERE FOR YOUTUBE VIDEO) will control most cases of back pain.
Lumbar spondylosis and disc degeneration is a process of wear and tear of the discs between our spinal bones. Due to the wear and tear, the water content in the disc decreases. As a result of this, the normal load bearing capacity of the disc is compromised resulting in back pain. Patients with back pain of disc origin typically complain of increase in pain on bending forward, stooping, coughing or sneezing. They may also have felt a catch in the back while straightening form a bent forward position.
Mostly, lumbar spondylosis and disc degeneration is caused by your own tendency or genetic make-up but a small contribution may be because of smoking, being over weight and minor or major injuries. Such a degenerated disc typically appears black on MRI as compared to other discs that look grey in color.
Most patients with disc degeneration improve with a dedicated programme for strengthening their back, abdomen and core muscles. Giving up smoking and loosing weight especially abdominal fat drastically helps in reducing back pain. Initially, the physiotherapist may use some modalities to bring the pain levels down and later on encourage the patient to work hard on strengthening the core muscles.
Sometimes, we use transforaminal or interlaminar epidural steroid injections to help our patients who are suffering from refractory back pain. Our aim in these cases is to give our patients symptomatic relief so that they are able to do the prescribed exercises to their fullest potential.
There are a plethora of intradiscal procedures that are available in India today which are commonly ‘marketed’ as the permanent cure for back pain. To name a few, these include ozone therapy, IDET, LASER, nucleoplasty, Radiofrequency ablation, ‘magic wands’, ‘percutaneous discectomy’ and so on. WE DO NOT RECOMMEND THESE PROCEDURES, as we believe they have no proven benefit.
The surgical options for the treatment of back pain include Total Lumbar Disc Replacement (TDR), Anterior Lumbar Interbody Fusion (ALIF) and Transforaminal Lumbar Interbody Fusion (TLIF). TDR and ALIF are done from the abdomen whereas, TLIF is done from the back. TLIF can be done by Minimally Invasive Spine Surgery (MISS – TLIF) using small cuts with no external stitches.