All you need to know about backaches

Humans are unique species in their ability to stand upright on two legs. This gift of nature to adopt upright posture extracts its price in the form of backache. The entire weight of the torso, head and upper limbs is transmitted across the column of five lumbar vertebrae and their joints. In addition, the back is subjected to constant stress and strains due to its integration with the locomotor system. So, with time, the lumbar spine, because of constant weight bearing (especially in obese persons) and its mobility, is prone to degenerative changes. These changes may occur early in life, usually after the age of 30, or may occur late.

Backache is a common symptom and can occur in anybody. With advancing age, intervertebral discs undergo age-related changes, which can be normal. However, due to daily stresses and strains, sometimes, the jelly-like disc material can undergo chemical changes and become weak. This can result in extrusion of the disc material into the canal, compressing one of the nerves.

Such nerve compression can cause pain along the back of leg and thigh; or along the entire leg especially during walking. One may complain of numbness in the foot or leg. Other changes that can occur in the lumbar spine can involve small joints at the back, and this type of pain is often constant, localised to back and worse on activity. Young, physically active individuals can have strained muscles or ligaments, which can manifest as a stiff back. Prolonged sitting too can predispose to stiffness of the back. Usually this type of stiffness is resolved with activity and stretching of spine.

Backache is common in women during pregnancy, due to stretching of the ligaments of the spine and pelvis. Other problems that can afflict the lumbar spine include slippage of vertebra, abnormal curvature of the spine and infections like tuberculosis.

Spine may also be the site of cancerous spread from other parts of the body, and such a situation needs complete evaluation and multi-specialty management. Backache should be investigated for underlying pathology, especially if pain doesn’t subside, is accompanied by stiffness, change in posture, and shooting pain over the back of thigh or leg. Management has to tailored for each individual and may require surgical intervention. Many patients benefit from physiotherapy, massage, acupuncture and spinal exercises.

Mild stresses and strains of spine can be managed by rest, massages and muscle relaxants available on prescription, and physiotherapy. Rest is essential to ensure complete recovery. Else, the problem can become chronic. Backache due to slip disc or spondylolisthesis that cause nerve root compression are cured by surgery. Disc surgery is carried out by minimally invasive keyhole techniques, and requires hospitalisation for 48 hours. Slippage of vertebra usually requires fixation with the help of titanium spinal implants.

Infections of the spine like TB is managed with antitubercular chemotherapy; however, if the vertebra is destroyed, surgery provides rapid pain relief and enables patient to walk early.