Fixing a bad back

Fans of Boman Irani were shocked when the actor took to his Instagram account and posted a picture of himself in a wheelchair, holding a walking stick at an airport on his way back from Hyderabad. After finding that all the painkillers and over-the-counter balms were useless, he apparently consulted a battery of doctors until an MRI revealed he had a herniated disc at lumbar phase 4 and 5 (L4-L5), which was additionally causing the ache radiating down the leg which was fine.

The actor is not alone — there are in fact, many who live with unnecessary pain related to spinal conditions, says Dr Sukumar Sura, senior spine and neuro surgeon, Yashoda Hospitals, as he explains what causes spinal pain, its symptoms, and how it can be treated.

Back pain is a common reason for absence from work and for seeking medical treatment. It can be uncomfortable and debilitating. “Lower back pain is caused by spinal degeneration and injury. Conditions linked to back pain are muscle or ligament strain,” says Dr Sukumar.

Time to see a doctor:

• Feel intense or constant pain
• Develop pain that extends down one or both legs
• Have weakness, numbness or tingling in one or both legs
• Experience swelling, redness or unintentional weight loss
• Can’t work, sleep or perform daily activities
• Experienced a trauma such as a car crash or fall
• Develop a fever
• Trouble passing stool or urinating

The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones, which work together to support the body.

“People with ongoing or recurrent episodes of lower back pain should consider the benefits of walking as a low-impact form of exercise. Aerobic exercise has long been shown to reduce the incidence of low back pain. However, for some back conditions, walking will aggravate or cause too much pain to be bearable,” warns Dr Sukumar.

Causes
The segments of the spine are cushioned with cartilage-like pads called disks. “Problems with any of these components can lead to back pain. In some cases, the cause remains unclear. Damage can result from strain, medical conditions and poor posture among others,” he adds.

Strain
Back pain commonly stems from strain, tension or injury. Frequent causes are:
Strained muscles or ligaments
A muscle spasm
Muscle tension
Damaged disks
Injuries, fractures or falls

Activities that can lead to strains or spasms include:
Lifting something improperly
Lifting something that is too heavy
Making an abrupt and awkward movement

Structural problems
A number of structural problems may also result in back pain.

Ruptured discs: Each vertebra in the spine is cushioned by disks. If the disk ruptures, there will be more pressure on a nerve, resulting in back pain.
Bulging disks:  In much the same way as ruptured disks, a bulging disk can result in pressure on a nerve.

Sciatica: A sharp and shooting pain travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.

Arthritis: Osteoarthritis can cause problems with the joints in the hips, lower back, and other places. In some cases, the space around the spinal cord narrows. This is known as spinal stenosis.
Abnormal curvature: If the spine curves in an unusual way, back pain can result. An example is scoliosis, in which the spine curves to the side.
Osteoporosis: Bones, including the vertebrae of the spine, become brittle and porous, making fractures more likely.
Kidney problems: Kidney stones or kidney infection can cause back pain.

Risk factors

• The following factors are linked to a higher risk of developing low back pain:
• occupational activities
• pregnancy
• a sedentary lifestyle
• Poor physical fitness
• Advanced age
• Obesity and excess weight
• Smoking
• Strenuous physical exercise or work, especially if done incorrectly
• Genetic factors
• Medical conditions, such as arthritis and cancer

Diagnosis
An X-ray, MRI or CT scan can give information about the state of the soft tissues in the back.
X-rays can show the alignment of the bones and detect signs of arthritis or broken bones, but may not reveal damage in the muscles, spinal cord, nerves or disks.
MRI or CT scans can reveal herniated disks or problems with tissues, tendons, nerves, ligaments, blood vessels, muscles, and bones.
Bone scans can detect bone tumors or compression fractures caused by osteoporosis. A radioactive substance or tracer is injected into a vein. The tracer collects in the bones and helps the doctor detect bone problems with the aid of a special camera.
Electromyography or EMG measures the electrical impulses produced by nerves in response to muscles. This can confirm nerve compression, which may occur with a herniated disk or spinal stenosis.

Surgery
“Surgery for back pain is very rare. If a patient has a herniated disk, surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness,” says Dr Sukumar.
Examples of surgical procedures include:
Endoscopic discectomy
Endoscopic decompression of stenosis
Microdiscectomy
Fusion

Medical treatment

Medication: Back pain that does not respond well to OTC painkillers may require a
prescription NSAID. Codeine or hydrocodone, which are narcotics, may be prescribed for short periods. These require close monitoring by the doctor. In some cases, muscle relaxants may be used.
Antidepressants: such as amitriptyline may be prescribed, but research is ongoing as to their effectiveness, and the evidence is conflicting.
Physical therapy: Applying heat, ice, ultrasound, and electrical stimulation - as well as some muscle-release techniques to the back muscles and soft tissues — may help alleviate pain. As the pain improves, the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques for improving posture may also help. The patient will be encouraged to practice the techniques regularly, even after the pain hasgone, to prevent back pain recurrence.
Cortisone injections: If other options are not effective, these may be injected into the epidural space around the spinal cord. Cortisone is an anti-inflammatory drug. It helps reduce inflammation around the nerve roots. Injections may also be used to numb areas thought to be causing the pain.