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Back pain

From Academic Kids

Back pain is one of humanity's most frequent complaints and does not usually reflect any underlying disease. However, anyone with back pain that does not improve after a few days should first consult a Physician, as back pain can sometimes indicate significant and serious conditions which might not otherwise be diagnosed. Back pain is very rarely a sign of a serious medical problem. It is however important that the treatable medical causes are identified early on. Typical warning signs are bowel and/or bladder function disturbance, severe pain spreading along a nerve ( eg a radiculopathy - pain sprading down the back of the leg to the outside of the foot) or severe pain occurring with other signs of severe illness (eg- very high temperature, confusion).

Back manipulation, as performed by osteopaths and chiropractors is thought to be beneficial in some people. Back surgery is only considered to be necessary in very few cases of back pain - around 1-2%. Physiotherapy, and exercise are now considered to be important in reducing back pain. Incidence of back pain in western countries has increased in recent years, and this is now thought to be due to a relatively inactive lifestyle, with people taking less exercise, and doing less physical activity in their work. According to the National Center for Complimentary and Alternative Medicine, back pain is the most popular condition treated with alternative medicine. Fifty percent (50%) of all patients in the United States use alternative medicine to treat back pain.

Medical consensus is now that most back pain isn't caused by damaged disks, or any underlying physical cause other than our modern lifestyle. Postural reeducation or exercises, such as Johnston-Ruyer Back Therapy or the Alexander Technique are known to help. The pain itself is caused by strong muscle spasms severely tightening back muscles. The best immediate treatment for such spasms is now held to be the application of cold, such as by an icepack or bag of frozen vegetables wrapped in a towel, not heat. Frequently, pain will be triggered by strenuous lifting that is uncharacteristic - that is, that follows a previous period of inactivity.

Our common back problems are understandable given the recent evolutionary history of bipedalism, which leaves us not quite wholly adapted to upright movement, and not at all well adapted to modern inactivity that allows muscles to become deconditioned. Not to mention the amount of time we spend in chairs, for which our bodies aren't particularly well adapted either. Even stairs are also an evolutionary trap because small muscles at the knee are overworked by the stereotyped repetitive motion (going up or down a real hill involves much more varied muscle movements). Note that it is now never recommended that anyone walk or run down stairs for exercise, ever, only up! "Paradoxical movements" in which muscles lower weights can be very effective exercise because they work the muscles harder, but this means that going down stairs is simply too much strain on a few isolated muscles, and an invitation to athletic injury. (We'd all be healthier, and have better backs, if the escalators in subway systems took us down, and let us walk up the stairs. Fewer tumbles would result, too, as paradoxical motion is less easily controlled.)

The most frequent, and valuable, advice given to sufferers is to "lift with the legs." A more sophisticated version of this advice is given by the Johnston-Ruyer Back Therapy, a treatment plan for common back pain. In this therapy, patients learn to stand, sit down, and lean differently, keeping the centers of gravity of the three main sections of the body in a constant vertical line. Patients learn that if they do this, they can move even when experiencing severe spasms without triggering pain, and learn to strengthen the legs. Johnston-Ruyer Back Therapy also strongly advises, not back exercises, but leg exercises that help allow previously sedentary leg muscles to take over more of the work being done by back muscles.

Sufferers are sometimes advised to use an ergonomic chair or to use a standing desk on a regular basis.

Management

Part of the back pain puzzle is that – though 90% of patients with acute back pain improve within one month, the 10% who do not improve account for 85% of annual expenditures on back pain. Lower back pain is the single most common chronic pain syndrome seen in pain clinics in the Western world. The management goals when dealing with back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore function; to help the patient cope with residual pain; to assess for side effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery.

Though pain, and especially chronic pain is multifactorial in cause, local anesthetics or nerve blocks can be used to facilitate physiotherapy and help gain diagnostic information.

Several medical therapies are used, including:

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