Low back pain

The term low back pain is used to describe pain in the lumbar spine so low back pain is a symptom and not a disease (Symeonidis 1984). 8 to 10 adults report low back pain once in their lives and according to statistics low back pain is the second most common cause of absence from work. Low activity levels, increased body weight, bad postures during the daily activities are the main risk factors for low back pain incidence (Pace 2000).

Description of symptoms:

Low back pain may have a sudden onset for example after a sudden movement or after the lifting of a weighted object, or it can have a progressive onset meaning mild pain at the beginning that worsens during the day usually when someone is standing for a long period of time or one is sitting with the same posture for a long period of time. Pain is localized in the lumbar part of the spine but it might extend to the lateral side of the thigh or even to the knee. Usually patients report numbness at the toes of the feet (Symeonidis 1984)

Diagnosis:

Low back pain is one of the most common reasons to visit a doctor. The primary aim is to identify the cause of the pain. For this reason a thorough medical history is taken. In almost every case an X-Ray of the lumbar spine is taken. In terms of diagnosis other tests might be necessary CT, MRI, blood tests, bone scintigraphy etc (Dandy 1995, Symeonidis 1984).

Prevention: The best cure

Body postures either in standing or during activities of daily living have an enormous effect in the prevention and provocation of low back pain. We briefly present some guidelines in order to prevent low back pain and avoid recurrent low back pain.

  • Sitting: we make sure while seated to support the region of the lumbar spine to avoid stress in the anatomic area. A small pillow is used to “fill” the void in the lumbar lordosis. We make sure that the height of the desk we are seated in front is suitable for our height so that we do not have to flex or extend our trunk to reach it. We make sure that the car seat is neither too close nor too far from the pedals, in general we must have in mind that seating must be interrupted every hour. For example when we travel every hour or two we must have the opportunity to stand up for a while extend our trunk 6-7 times and walk for a few minutes (McKenzie, 1981).
  • Standing: In general we must avoid standing for long periods of time. When we have to stand, we do that by having one foot forward all the time and the knee slightly bended. We do not wear high heels and we prefer anatomic soles (McKenzie, 1981)
  • Bending: We always bend by bending the knees. We never bend forward using our back with knees extended (Dandy 1995, McKenzie 1981).
  • Lifting weights: We stand in front of the object we wish to lift keeping the back straight and by bending our knees we make hold of it. In order to lift it up abdominal muscles must be tightened and knees must extend. Heavy objects must be as close to the body as possible and we must at all times use both hands (Dandy 1995, McKenzie 1981).
  • Sneezing/Coughing: Cough and sneezing may provoke an acute low back pain or relapsing. That is why when we are about to sneeze/cough we stand erect slightly extending backwards our trunk (McKenzie, 1985)

Generally we keep in mind to:

  • Keep our weight in normal levels (Pace, 2000)
  • Regularly work out. Abdominal muscles in good shape help in the better support of the back. Good shape increase flexibility and improves body posture (Symeonidis 1984, Pace 2000).
  • During activities of daily living we always take postures that will not stress the lumbar spine (Pace 2000).

WHAT CAUSES LOW BACK PAIN

Having in mind that low back pain is a symptom one must explore the causes of the pain.

The below mentioned conditions may be responsible for the appearance of low back pain:

  • Injury caused by a sudden movement, a faulty way of lifting objects or during an athletic activity (specially when warming up is omitted) (Pace 2000)
  • Conditions of the disc. During which there is a disc displacement resulting in nerve compression which in turn causes acute and intolerable pain. Pain usually radiates to the lower limb causing what we call sciatica (Symeonidis, 1984).
  •  Arthritis is a rheumatic condition affecting the joints of the body. The common symptom of arthritis of the spine is pain (Symeonidis, 1984).
  •  The decrease in bone density has a tremendous effect to the bones of the spine, making them weak and susceptible to fracture or sedimentation and resulting in low back pain (Symeonidis, 1984).
  • Infectionof vertebra (osteomyelitis) or infection of the intervertebra space. The region is affected from a virus or a bacteria (Symeonidis, 1984).
  • Conditions of the kidneys.Since the kidneys are situated low in the abdominal any condition that affects them can lead to low back pain (Symeonidis, 1984).
  • Cancer. Tumor development in the region of the spine besides of the loss of weight can cause low back pain (Symeonidis, 1984).