Low back pain

Low back pain (LBP) refers to any pain or discomfort experienced in the bottom region of the spine. Which is known as lumbar spine.
* LBP is not a condition, it is the collection of several condition. It's a symptom or clinical feature.


CAUSE
√ strained ligament or muscle tissue
√ poor posture
√ muscle weakness
√ lifting heavy weight
√ twisting movement
√ infection of spine
√ traumatic injury
√ spinal deformity like scoliosis, kyphosis
√ conditions like
  > spinal stenosis (narrowing of spinal canal i:e lateral raises of intervertibral foramen by bone or soft tissue change.)
  > spondylosis (degeneration of intervertebral disc)
  > spondylolysis (defect or stress fracture in the pars interarticularis of vertebral arch.)
  >spondylolisthesis (anterior displacement of one vertebra over another.)
  > prolapse intervertebral disc PID/PIVD (herniated/rupture disc)
  >sciatica


SYMPTOMS
√ dull or acheing pain
√ local sensation upon touch
√ pain that moves dawn to one leg or to the buttock or to the upper thigh or below knee
√ stiffness or difficult to move
√ tingling or pins & needles sensation
√ numbness or weakness
√ pain may reduce by change in posture


DIAGNOSIS
√ from clinical feature
√ x-ray (AP & lateral view)
√ MRI
√ CT scan


TREATMENT
1) Medications:
The management of low back pain often includes medications for the duration that they are beneficial. The medication typically recommended are - muscle relaxant
       - NSAID (more effective for acute episodes than acetaminophen; however, they carry a greater risk of side effects including: kidney failure, stomach ulcers and possibly heart problems.)
        - acetaminophen
        - opioids like morphine (helpful but risk of addiction)
        - corticosteroid injection

2)Physiotherapy
Thorough history taking fallowed by proper evaluation to find out structure involved and treat accordingly.
* for postural syndrome
  > postural correction
  > activity modification
  > support to the part (belt/brace)
  > environment modification
* for disuse or dysfunction
  > relaxation of muscle
  > stretching of muscle
  > MET/PNF technique
* other modes of treatment
  > muscle strengthening
  > facet joint mobilisation
  > SWD, TENS,  ultrasound, traction, hot fermentation etc.
  >yoga

3) Surgery:
Surgery may be useful in those with a herniated disc that is causing significant pain radiating into the leg, significant leg weakness, bladder problems, or loss of bowel control. It may also be useful in those with spinal stenosis. In the absence of these issues, there is no clear evidence of a benefit from surgery.
-Discectomy (the partial removal of a disc that is causing leg pain) can provide pain relief
-spinal fusion (having moderate evidence of spinal fusion.)Thorou


PREVENTION
1. Correct your posture
Poor posture increase pressure on your back and can cause degeneration of discs and become more painful. Support the natural curve in your lower spine by using an ergonomic chair and while standing or walking maintain military posture.
Take breaks in between the Wark hour to relax your body and mind (at least once an hour).

2. Reduce extra body weight
Extra body weight especially in your midsection, can make back pain worse by shifting your center of gravity and putting strain on your lower back. maintain your ideal weight (BMI) may help control back pain.

3.Strengthen your core muscles
Strong core muscles are important to provide support for the lower back and avoid injury. lite exercise walking—increases blood flow to the spine, which supplies healing nutrients and hydration to the structures in your lower back.

4.Correct lifting techniques
Even if you are young and strong enough to lift heavy objects, incorrect lifting techniques can cause injury to back.
Lifting techniques -

Golfer's lift

A) Golfer's Lift
This technique is very useful to avoid back injury when lifting or picking small objects off the floor, such as a ball, keys etc.
For this technique, the knees do not bend. One leg is allowed to come off the floor behind the lifter and acts as a counter balance. The opposite hip bends and the body becomes almost parallel to the floor, except for the leg bearing the person's weight. One arm reaches to pick up the object while the other is often hanging on a stationary object for support,

Half kneeling

B) Half kneeling
This approach is useful for picking an awkward object off the floor. In this case, the lifter can kneel behind the object and first lift it on to the bended knee. Now the lifter can either straighten out the back knee to propel forward, or push with the front knee to propel backwards, depending on where the object needs to be carried. The chest may point down when the back leg is straightened, but the back will remain straight.

C) Using momentum
This method is especially helpful to avoid back injury when lifting a heavy object above the level of the waist. If done correctly, it looks like a controlled toss of the object. The lifter can keep moving towards the destination of the object and swing it up to the surface. The object is then allowed to come away from the body and the momentum will help raise it, requiring less effort by the lifter

5. Avoid frequent traveling
Traveling on jerky or uneven road can increase the pain. That's why patients having LBP adviced not to travel and drive much. Patients having LBP should not use bike or auto.
While traveling always use a towel roll to support your lower back.

6. Maintain an active lifestyle
To maintain an active lifestyle one should do yoga, exercise regularly. Play outdoor games. It will make you fit physically and mentally.

7. Stretching of hamstring
A little-known cause of low back pain is tight hamstrings. Simple hamstring stretching exercises can help decrease the pressure on your pelvis and provide relief across your low back.