Everybody
has backache at some time. In the majority of cases it is mechanical
pain arising from the ligaments, muscles, facet joint etc. that
surround the spine. 90% of mechanical back pain episodes are
better within a month, some in a few days. Mechanical back pain
can be due to bad posture, straining the back (as, for example,
lifting incorrectly), changing one's bed, changing one's car,
being too active, being too inactive or for no particular reason
at all. The pain is usually around the back of the waist - lower
down, to one side, suggests lumbosacral pain. Sometimes the
backache radiates down the back of the thighs. This is unlikely
to be sciatica, as found in nerve root compression, if it does
not go beyond the level of the knees. In mechanical back pain
there is no loss of muscle power, sensation or reflexes. The
back pain of nerve root compression, however, is a different
mater. It can be caused by out growths from an osteoarthritic
spine (see Arthritis/Osteoarthritis) but is more commonly due
to a problem with the intervertebral discs. These discs, found
between each of the vertebrae in the spine, are fluid filled,
fibrous pouches which act as shock absorbers. Sometimes they
can be damaged, or the fluid leaks out and impinges on the spinal
nerves as they leave the vertebral column, or on to the spinal
cord itself. Discs do not "slip". They have nowhere to "slip" to! Disc compression can be a potentially serious condition. A common symptom is sciatica, from pressure on the sciatic nerve, in which pain and/or numbness runs down the whole of the back of the thigh into the heel. Sometimes the disc can press on the spinal cord itself causing paralysis, incontinence and impotence. This is an emergency situation requiring urgent surgery. Many people who say they have "disc trouble" almost certainly have the much commoner, mechanical back pain. A far less common cause of back pain is inflammation or malignancy within the spine, itself. Some people will get a lot of pain from the crumbling nature of osteoporosis, but this is generally when it causes nerve root compression. Yet another set of causes of back pain involves all those systems, the kidney, the female genital tract, the abdominal organs, arteries, adrenals etc. all of which, although not spinal, can give back pain if inflamed or diseased
Simple backache for which there is a reasonable explanation can be treated with over the counter pain killers, proprietary rubs and some local heat. Nowadays, people with mechanical back pain are advised to keep as mobile as possible to speed recovery. NSAIDS (non-steroidal anti-inflammatory drugs) are often used by mouth or in gel form as local rubs (Caution. There are medical contraindications to their use including asthma and stomach problems) Physiotherapy- massage, heat, ultrasound, exercises, postural advice are helpful. Facet joint problems respond well to manipulation. All patients with nerve root problems must see the doctor. Rest will usually be prescribed and often referral to an orthopoedic surgeon. X rays are of little value in the diagnosis of back pain but MRI scans can be very valuable. Surgery is sometimes necessary in nerve root compression and, almost always, in spinal cord compression, sometimes as an emergency. Backache in all its forms should be treated according to the causative condition. |
