The term includes many types of pain on the lower part of the back viz,, pain at the sacrum, coccyx, on the lumbar spine, soreness on the back and sciatica; low backache is more common in women than in men.
A. Gynaecological causes. These form less important causes of low backache. The causes may be as follows: (1) Uterine prolapse withretroversion may drag on the pelvic ligaments causing backache; this gets relieved on lying. (2) tubo‑ovarian mass, parametritis and chronic cervicitis ; (3) benign and malignant pelvic tumours‑impacted uterine fibroid or ovarian cyst, pelvic endametriosis, advanced carcinoma of cervix, retroperitoneal tumour; (4) postoperative because of sacro‑iliac strain following gynaecological operation in lithotomy position under anaesthesia; (5) Premenstrual low pain especially in premenstrual syndrome.
Site of backache due to gynaecological cause is sacral but never extends above fourth lumbar vertebra; it has got bilateral distribution but not localised. Causes mentioned above do not necessarily produce backache in all cases.
I. Orthopaedic causes. These are the commonest cause. There are numerous factors that can play. Some important ones are the following-
(i) Sacro‑iliac strain or subluxation‑this often follows pregnancy and labour. Pain is felt on lifting weight or stooping movement. There may be tenderness at the sacroiliac joint; (ii) postural cause‑muscular and ligamentary strain on the back is possible due to postural defect. Obesity may also cause such strain ; (iii) Spinal arthritis ; (iv) congenital anomalies‑sacralization of last lumbar vertebra or lumbarisation of first sacral vertebra, spina bifida occulta may cause back pain; (v) lumbago‑this is due to myositis of the lumbar region; (vi) coccygodynia‑pain at the coccyx commonly following labour. Tenderness can be elicited on movement of the coccyx ; (vii) other spinal diseases‑prolapse of intervertebral disc, caries spine, spinal cord compression.
Sites of pain in orthopaedic cause vary according to the particular lesion‑ But pain tends to be localised with tenderness at a site; pain is also related to exercise or rest. Sacroiliac strain becomes worse at night while lying flat on back or turning to the side.
II. Nonorthopaedic causes.
- (1) Renal pain‑distribution of pain is characteristic i.e. unilateral arising at the Join.
- (2) Rectal pain. Constipation, rectal spasm or carcinoma may have sacral pain or discomfort.
In some cases, no demonstrable cause for backache can be found. Psychological upset is alleged to be a factor to play in this group.
Investigations. 1. Careful history taking, thorough clinical examination of the patient's general condition, pelvic condition, should be done. Examination of spine and back especially for any local tenderness is essential. Radiology of lurnbosacral region is always taken to detect any evident lesion. Urological investigations should be taken up in cases suggesting the cause.
2. Cases showing no gynaecological factor for backache should be referred to the orthopaedic surgeon.
Treatment. This is done according to the cause. The gynaecological causes are treated. For the orthopaedic causes, local application of heat, local massage of some liniment, rest, analgesics can be instituted before the orthopaedist takes up the cause for treatment.
Anatomy of Low Back
The first step to understanding the various causes of low back pain is learning about the normal design (anatomy) of the tissues of this area. Important structures of the low back that can be related to symptoms there include the bony lumbar spine (vertebrae), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
The bony lumbar spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebrae has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue. They also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joint of the buttocks.
The discs are pads that serve as "cushions" between each vertebral body. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) and a surrounding outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating) through the outer ring, causing irritation of adjacent nervous tissue and sciatica, as described below.
Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs.
The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) exit the spinal column through bony portals called "foramen."
Many muscle groups that are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.
The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph glands and involuntary nervous system tissues, which are important in maintaining bladder and bowel control.
The uterus and ovaries are important pelvic structures in front of the pelvic area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.
The skin over the lumbar area is supplied by nerves that come from nerve roots that exit from the lumbar spine.
Function of the low back
The low back, or lumbar area, serves a number of important functions for the human body. These functions include structural support, movement, and protection of certain body tissues.
When we stand, the lower back is functioning to hold most of the weight of the body. When we bend, extend or rotate at the waist, the lower back is involved in the movement. Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements.
Protecting the soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is a critical function the lumbar spine and its adjacent muscles.
Common causes of low back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below.
- Lumbar strain (acute, chronic)A lumbar strain is a stretching injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as "chronic."Lumbar strain most often occurs in people in their forties, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back.The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, x-ray testing is only helpful to exclude bone abnormalities.The treatment of lumbar strain consists of resting the back (to avoid re-injury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found helpful in some patients that do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.
- Nerve irritationThe nerves of the lumbar spine can be irritated by mechanical impingement or disease any where along their paths—from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.
- Lumbar radiculopathyLumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain that shoots down the leg. Sciatica can be preceded by a history of localized low-back aching or it can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels.Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning.Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine, and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.
- Bony encroachment(compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal-nerve compression in these conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause lower-extremity pains that worsen with Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosiswalking and are relieved by resting (mimicking poor circulation). Treatment of these afflictions varies, depending on their severity, and range from rest to surgical decompression by removing the bone that is compressing the nervous tissue.
- Bone and joint conditionsBone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are from inflammation of the joints (arthritis).
Congenital bone conditions—Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal design of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing.Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.Degenerative bone and joint conditions—As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on x-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain x-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.Injury to the bones and joints—Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly people with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor-vehicle accidents or a convulsive seizure.
In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Compression fractures of vertebrae associated with osteoporosis can also be treated with a procedure called vertebroplasty, which can help to reduce pain. In this procedure, a balloon is inflated in the compressed vertebra, often returning some of its lost height. Subsequently, a "cement" (methymethacrylate) is injected into the balloon and remains to retain the structure.Arthritis—The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping the progression.
Treatment of low back pain
So, how is low back pain treated? Well, as described above, the treatment very much depends on the precise cause of the low back pain. Moreover, each patient must be individually evaluated and managed in the context of the underlying background health status and activity level.
As was recently highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's own perception of their particular situation. Researchers from Britain found that those who believed that their symptoms had serious consequences on their lives and that they had, or treatments had, little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.
Finally, it should be noted that the conditions listed above are intended for general review. There are many other causes of back pain that have not been discussed.Low Back Pain At A Glance
- Functions of the low back, or lumbar area, include structural support, movement, and protection of certain body tissues.
- Symptoms in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
- Treatment of low back pain is directed toward a diagnosed or suspected cause.
Herbal Cure for Backache
Backache can be caused by an accident or an injury to the spine. Backache is generally a gripping pain near the inward curve of the back above the base of the spine. Back problems affect all kinds of people, men as much as women and young as well as old. Back is an important organ that bears the entire body weight. In the contemporary times. Sedentary living habits, hazardous work patterns and psychological conditions associated with emotional stress, which bring about spasm of the muscles, cause backaches. As the back bears the weight of the entire body, overweight persons feel the strain on the back when they have to carry an extra load. In most cases of backache, the pain is usually felt either in the middle of the back or lower down. It may spread to both sides of the waist and the hips. In a condition of acute pain, the patient is unable to move and is bedridden. Many people experience back pain as they age and their joint tissues deteriorate or shift. Psychological tension, stress, or anxiety about everyday problems can also lead to backache. In addition, back pain can result from diseases of the kidneys, heart, lungs, intestinal tract, or reproductive organs. Other causes include stress and strain resulting from sitting for a long time, improper lifting of weights, high heels, and emotional problems which may cause painful muscle cramping.Backache caused is degenerative disease, metabolic diseases or congenital. Acute or chronic illnesses like kidney or prostate problems, female disorders, Influenza, and arthritis, may also lead to backache. It can be the result of developmental problems or a tumour. Use this list as a basis of the possible causes of back pain. Backaches occasionally stem from a congenital (present from birth) malformation. In such cases, pain generally results from the unusual stresses that the deformity imposes on surrounding muscular structures rather than from the abnormality itself. Severe back pain may also be accompanied by pain or numbness radiating down one or both legs. Though most muscular back pains disappear within a week or two of their onset, some can last one to two months. Pain may recur unless preventive measures are taken. Usually the pain is felt in the middle of the back or in the lower back. When the pain aggravates, it tends to spread to both sides of the waist and hips. When the pain becomes very acute, the patient is recommended bed rest for sometime. Most patients suffer from a problem referred to as cervical and lumbar spondylosis, in which the spine tends to lose its flexibility.Herbal Remedies Cure for Backache1.Use of garlic. Two or three cloves should be taken every morning to get results. An oil prepared from garlic and rubbed on the back will give great relief.2.Lemon is another useful remedy for backache.3.Raw potato is an ancient home remedy for backache, characterised by incapacitating pain in the lumbar region, especially in the lower part of the back.4.Fish oil taken daily, is the least expensive and most effective manner in which to eliminate backache, joint pain, pains in the wrists.5.Mixture of powdered sonth, sweet soda and salt if consumed with hot milk or water can alleviate your backache problems.6.While sleeping, sleep on a firm mattress. Avoid sleeping face down.7.Heat may be applied with hot water bottle or infrared lamp for temporary relief in the area.8.Drink some hot milk or water with powdered sonth, meetha soda, and namak.9.Colchicine - may help with back pain caused by a herniated disc (note: colchicine may have adverse side effects).10.Willow Bark - used when experiencing pain due to inflammation.11.Cayenne Pepper - can be applied topically to areas of pain (a counter irritant).12.Devil's Claw - may reduce accute lower back pain.13.Ginger - used to decrease inflammation and associated back pain.14.Eucalyptus and Peppermint Oil - a combination of eucalyptus and peppermint oil applied topically to area of pain (a counter irritant).15.Turmeric - has anti-inflammatory effects with possible treatment of low back pain.