Coping with Low Back Pain

20 Apr 2013

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Low back pain is a common musculoskeletal disorder estimated to have
affected 4 out of 5 people at some point in their lives. In modern day work environment, it accounts for a number of work “absenteeism” and what is now recognized as recurrent “presenteeism”, which is a public health description of those who managed to come to their places of work but nevertheless are unable to perform their job schedules in spite of their presence at work.

Low back pain can either come as acute, subacute or chronic in duration. Most often, the symptoms of low back pain show significant improvement within a few weeks from onset with conservative measures.

What causes low back pain?
Most cases of lower back pain are due to ordinary musculoskeletal problems and are generally referred to as “non specific low back pain”. These are generally believed to be due to a sprain or strain in the muscles of the back and the soft tissues, especially if the pain arose suddenly during physical load to the back, and the pain is to the side of the spine.

The lumbar region is the area of the spine that is also the source of most movement and flexibility, and is the support structure for much of a person’s body weight. Both factors often contribute to the onset of back pain, but the causes of lower back pain are varied. Most cases are believed to be due to a sprain or strain in the muscles and soft tissues of the back. Meaning that over activity of the muscles of the back can lead to an injured or torn ligament in the back which in turn leads to pain. An injury can also occur to one of the intervertebral discs (disc tear, disc herniation).

Due to aging, discs begin to diminish and shrink in size, resulting in vertebrae and facet joints rubbing against one another. Ligament and joint functionality also diminishes as one ages, leading to the vertebrae to move much more than they should. In the vast majority of cases no noteworthy or serious cause is ever identified. Usually the pain resolves on its own after a few weeks.

How to avoid low back pain
Low back pain is common and there are several steps one can take towards prevention. Although exercise may not relieve existing back pain, it is the first step to prevent lower back pain and injury.

Exercise helps keep one’s back healthy and strong. Exercise routines such as aerobic conditioning, back stretching, back strengthening, and low impact activities (swimming, walking, bicycling) all helps prevent lower back pain and the return of it.

Maintaining good posture
It is important to note that protecting ones back while sitting and standing is another key component of maintaining a healthy back. Good posture is important because it decreases the amount of stress that is put on one’s back. A good standing posture consists of having one’s ears, shoulders, hips, and knees all in line with one another. If one must stand for long periods of time, it is recommended to have something to rest one foot at a time on to alleviate back strain.

While sitting, one should have a chair with good lumbar support. If the chair is not equipped with low back support is to put a small pillow or something of that matter behind the lumbar region.

Individual sleep positions vary from person to person, but one basic component reigns true for everyone. Mattresses that are too hard or too soft will cause back pain. One should test different mattresses to find which one is comfortable for them. While sleeping, your spine should have an “S” shape (known as the neutral position) to it. A pillow under one’s knees while sleeping on their back or a pillow in between their knees while sleeping on their side are good ways in which to keep the back in the neutral position.

One of the most overlooked things in preventing lower back pain or injury is lifting. Never lift any objects too heavy for oneself.
Ignoring this rule is a surefire way to an injury of one’s back and even a possible trip to the hospital. When lifting, one should keep the head up, the back straight and down, bend the knees and use the legs to push. Never stoop over to lift an object, and be sure to always keep the object close to oneself. Always, plan the best way to lift an object and do it slowly and carefully. Feet should be kept shoulder-width apart. Finally, set down the object carefully by bending with the knees and hips only.

Treating low back pain
For most people low back pain can be treated conservatively. Applying heat to the lower back provides temporary relief of acute low back pain. Physical therapy is beneficial in recovering from a low back injury or low back pain. Treatments include electromyography, stretching, strength conditioning and cardiovascular exercise. These days it is now realized that firm mattresses are less likely to lead to improvement when compared with a medium-firm mattress.

Short term use of over-the-counter pain and antiinflammatory medications, such as NSAIDs (Ibuprofen, Piroxicam, Aspirin etc) or Paracetamol can help with the symptoms of lower back pain. However, these medications are not without risk; hence for persistent pain a medical practitioner should be consulted for apt assessment. In the same vein Muscle relaxants for acute and chronic pain have some benefit, however, there are concerns with side effects, and their routine use is discouraged.

Staying physically active as possible is recommended. Absolute bed rest is discouraged as not being helpful. Even when the pain is severe, some activity is still preferable to prolonged sitting or lying down, as long as it does not involve movements such as heavy lifting that would further strain the back..

Generally, for most patients with acute lower back pain recover completely over a few weeks regardless of treatments. This is especially so in individuals where lower back muscle strain or sprain is the cause of the pain.


Irregular Menses: Between Contraception Pill and ‘Primolut’

I am a regular reader of your column; I read one of your past articles in the paper recently about progestogen-only pill (POP). I want to get some clarifications on the issues you raised on the working of the said drugs.

I suffer from irregular menstrual flow and I was placed on Primolut, an oral progestogen tablet, but with what you wrote about it being a contraceptive, I’m confused. Is it the right drug for my ailment and bearing in mind that I am yet to have any child of mine?

Dear Dupe,
Your mail on the need for necessary clarification on the usage of progestogen-only  pill (POP) for contraception and why your doctor is prescribing Primolut, another progestogen formulation, for you when you are supposed to be looking forward to getting pregnant sounds rather interesting.

On the above, I will like to say that there may be no problem with your present prescription of Primolut for the regulation of your menstrual flow, depending on the clinical judgment of your doctor. This is a common clinical practice.

Granted that Primolut is one of the trade names for high dose “Norethisterone”, a very potent progestogen, which is also a very effective contraceptive agent, albeit in a much smaller dosage form, this does not preclude the fact that it is equally effective for the regulation of irregular flow of the menses.

For one, the effective dose of Norethisterone for contraception is quite small (0.35mg per tablet per day) when compared with the effective dose that will be required for the control of irregular menstrual flow as it is contained in Primolut (5mg per tablets twice or trice daily). They both work for good for different conditions depending on the dosage of the medication.

A similar example here is Aspirin which is known to prevent intravascular blood clotting at very small dosage (75mg daily), in stroke and heart attack-prone patients, but becomes less effective for this purpose at higher dosage of 150mg and above.
If conception is a problem for now, which may be linked to the irregular flow, an indication that you are probably having anovulatory cycle, which is to say that you are probably not ovulating during the menstrual cycles with irregular flow.

My reckoning is with the present prescription of Primolut your doctor is trying to challenge your womb, to assess its normalcy by priming your womb with the drug toward achieving a regular menstrual flow and also for him to be sure that all is well with the womb.
This is likely to be a prelude to other management of your aforementioned infertility complaint before all other tests and investigations is done and the commencement of the definitive treatments. This is normal.
My advice to you is to worry less and discuss your fears with your doctor.

Best wishes.

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