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Sunday, Aug 09, 2020 15:45 [IST]

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Backache and Back Care During The Times of Lockdown

Dr.THEJASWISG
Associate Professor
Dept.Orthopaedics
Central Referral Hospital

Musculoskeletal pain is amongst the most common health problems since the ape startedto walk and started calling himself a man!Nonspecific low back pain (nsLBP) is a mounting health problem in the century. After headaches, it is the second most common pain reported. According to reports, every 8 out of 10 individuals in United Kingdom has had at least one episode of backache. Uncomplicated back pain is common—the fifth most frequent reason patients visit their doctor, accounting for nearly 3% of all office visits. Uncomplicated backache refers to back pain that does not radiate below the knee in an otherwise healthy person between the ages of 20 and 55.
The present pandemic situation and the prolonged and continued lockdown as well as the lack of physical activities is bound to bring in an increase in existing backache or to make an individual susceptible for new onset backache. Among the various causes of backache, 97% are nonspecific and not dangerous. When it comes to treatment of backache, according to guidelines it consists of three aspects. First and foremost, of it is patient education about backache and its prevention and self-care, second and third being pharmacological and medical intervention. This article is intended for the first aspect of it i.e. patient education.
Backache includes upper backache and lower backache.
UPPER AND MIDDLE BACK PAIN:
The upper and middle back is the section of the back between the base of the neck and the bottom of the ribcage. This type of back pain is less common than neck or lower back pain.Like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation.
Pain in this area may be the result of a problem with the muscles or ligaments (bands of tissue around joints), an injury, or a pinched nerve in the spine. Most important and common cause of pain in this area is poor posture.
LOWER BACK PAIN:
Lower back pain is felt in the area between the bottom of the ribcage and the top of the legs. It’s the most common type of back pain. Symptoms range from tension and stiffness to pain and soreness.Most people's back pain is described as non-specific, meaning it’s caused by a minor problem with the structures in the back (such as a strain) rather than anything serious.
The back is a complex area of muscles, nerves, bones and joints, and is continuously working hard to support the weight of the upper body.
It’s often unclear why lower back pain occurs, but it can sometimes be triggered by things like bending awkwardly, lifting incorrectly, standing for long periods of time, slouching when sitting, and driving for long periods.Lower back pain usually starts to get better within a few weeks. Sometimes lower back pain will come and go over time.
What are the risk factors for backache?
Sedentary lifestyle, obesity, poor posture etiquettes, poor workplace ergonomics are among the most common risk factors for backache. Lack of or trace physical activity resulting from the sedentary lifestyle results in the reduction of muscular power and strength. Furthermore, the sedentary lifestyle leads to a reduced ability of the vertebral disc to maintain a normal concentration of water. The level of hydration of the nucleus pulposus influences development of degenerative and overload lesions. People with a sedentary lifestyle may develop flaccid hyper lordosis (increased forward curvature of spine) complex resulting in the development of nsLBP. The importance of overweight or obesity as risk factors for low back pain is also noted. Both overweight and obesity contribute to the mechanical overload of paraspinal tissues or even promotes the development of disc herniations.
Often patients feel that thee are all common and have been living like that forever so why should it pain now. But it has to be noted that it is the cumulative effect of those long-standing bad issues which are manifesting in the present. It is said that a weeklong bed rest would make the back muscles to lose its strength by 10%. Hence that is also a reason why we do not recommend prolonged bed rest.  They also feel apprehensive about some rare tumour because their neighbour’s distant aunt had same pain on and off and she died of brain tumour! Yes, it sounds exactly as silly to us (clinicians when you say that), as it sounded to you yourself when you read it out. There are some serious causes of backache such as disc prolapse, fracture, meningitis, tumour etc. But these are rare causes and will present with much grave symptoms. However, most of the cases are of nsLBP and can be managed by self-care at home itself.
Prevention of backache:
Non specific backache usually stays for few weeks and disappear and will relapse after sometime if the proper measures are not taken. Few of those preventive measures are:
Keep moving
One of the most important things you can do is to keep moving and continue with your normal activities as much as possible.It used to be thought bed rest would help you recover from a bad back, but it's now known people who remain active are likely to recover more quickly.However, in severe pain it is advisable to rest for two to three days but not longer.
This may be difficult at first, but don't be discouraged – your pain will start to improve eventually. Consider taking painkillers if the pain is stopping you from carrying on as normal.It is advisable to avoid the activities that cause pain like lifting heavy objects, driving for long duration, sitting on couch watching television for long duration. The backache treatment follows a U-shaped curve, excess of rest as well as excess of physical strain are both contraindicated. However, patients are encouraged to carry out day to day activities as early as they can do it.
Keeping your back strong
Strengthening and stretching the muscles in your back may help protect it from further problems.If you’ve had back pain in the past or experience it regularly, including some back exercises as part of your daily routine may help.Doing regular low-impact exercise may also help. Swimming, yoga and Pilates are good for improving flexibility and strength. Once you feel your back is strong enough, you might want to try something more energetic, such as jogging, cycling or dancing.Pick something you enjoy so it’s more likely to become a habit. You should aim to exercise for a minimum of 150 minutes a week.
There are manyother exercises that you could do which would be helpful. Althoughstructured exercises are extremely beneficial, there are also some exercises you cando on your own athomewithout specialist equipment that can help to strengthen your back and prevent and ease back pain. If you find that any of the exercisesexacerbates your back pain, try another one or seek advice from your GP or health professional. You should, however,expect some minor discomfort after starting an exercise programme, since your body may not be used to exercise.
Useful exercises
Lifting
Lifting can strain your back and lifting badly can lead to injury. Follow these simple tips to reduce the risk of damaging your back:
•    Adopt a stable position. Your feet should be apart with one leg slightly forward to maintain balance, alongside the load if it's on the ground.
•    Don't bend the back any further while lifting. This can happen if the legs begin to straighten too early during the lift, putting pressure on the back.
•    Avoid twisting while lifting. Change direction with your feet, not your back.
Sitting
Sitting in the wrong position may cause or aggravate back pain. Try to follow these simple tips to combat poor sitting habits:
•    Sit up with your back straight, shoulders down and back relaxed, with your elbows at your sides. Your buttocks should touch the back of your chair.
•    Avoid crossing your legs.
•    Your feet should be firmly on the floor but use a footrest if it's more comfortable.
•    Your thighs should be at right angles to your body or sloping slightly down.
•    Rest your elbows and arms on your chair's armrests or desk, keeping your shoulders relaxed.
•    Don't sit in one position for long stretches of time. Get up and move around regularly.
Driving
Driving can prove a real challenge for backs, especially if you drive for extended periods of time. Here are some tips to help support and protect your back:
•    Sit with your buttocks touching the back of the seat. Adjust the seat so your leg is slightly bent when you press a pedal to the floor.
•    For maximum back support, adjust seat depth so the distance between the edge of the seat and the back of your knees is about two or three fingers wide.
•    Your shoulders should be down and back against the backrest. They should remain in contact with the backrest when you turn the steering wheel.
•    Adjust the angle of the backrest so you can easily reach the steering wheel with your arms bent.
•    If you feel your seat isn't giving good support, try a rolled-up towel or lumbar roll in the small of your back.
•    Adjust the tilt of the seat so you can easily press the pedals down to the floor. Your thighs should rest lightly on the seat cushion without pressing on it.
•    The top of the headrest should be aligned with the top of your head. Adjust the angle to allow under an inch of space between your head and the headrest.
•    Avoid sitting still for lengthy periodsand stop regularly to walk and stretch.
Computers
Computers can be a problem when it comes to back or neck strain. Ensuring your workspace is set up correctly may help reduce the potential for harm:
•    Your keyboard should be directly in front of you. A keyboard that’s off-centre can cause bad posture.
•    You should be able to keep your arms bent in an L-shape and your elbows by your sides while using the keyboard, and your wrists should remain straight while typing.
•    Position and use the mouse as close to you as possible. A mouse mat with a wrist pad may help keep your wrist straight and avoid awkward bending.
•    Avoid cradling the phone between your ear and shoulder, as this can cause neck pain and stiffness. Consider a headset or speaker phone instead.
When to visit doctor?
Most of the backache can be treated at home by the above-mentioned methods and by over the counter painkillers such as paracetamol. The pain should come down in a week or so. Visit your doctor if:
•    pain gets worse
•    pain radiates to leg
•    you develop pins and needle sensations in legs
•    there is a new onset swelling or change of attitude of spine
•    there is fever
During these times of lockdown and pandemic it is advisable not to visit hospital for minor ailments and self-care, life style modifications are advisable so that you can prevent backache as well find remedy for existing backache.
References:
•    www.backcare.org.uk
•    https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica
•    https://www.nhs.uk/conditions/back-pain/
•    Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493-505. doi:10.7326/M16-2459
•    https://medlineplus.gov/ency/article/002119.htm

Sikkim at a Glance

  • Area: 7096 Sq Kms
  • Capital: Gangtok
  • Altitude: 5,840 ft
  • Population: 6.10 Lakhs
  • Topography: Hilly terrain elevation from 600 to over 28,509 ft above sea level
  • Climate:
  • Summer: Min- 13°C - Max 21°C
  • Winter: Min- 0.48°C - Max 13°C
  • Rainfall: 325 cms per annum
  • Language Spoken: Nepali, Bhutia, Lepcha, Tibetan, English, Hindi