Take Care of your Back

The 6 – 12 September 2010 is the National Back and Physiotherapy awareness week. The KwaZulu-Natal Department of Health and the South African Society of Physiotherapists dedicate this week to educate and make aware health workers and members of public in the Province on the problems of back pain, common causes /risks, complications, management and prevention of common causes /risks of low back pain. Physiotherapists from both public and private sectors will be at hand to offer advice and necessary intervention

What is Back Pain?

Pain in the lower back or low back pain is a common concern, affecting up to 30 – 40 % of South Africans at some point in their lifetime. Low back pain is not a specific disease but rather, a symptom that may occur from a variety of different processes. In some cases, people with low back pain despite a thorough medical examination, no specific cause of the pain can be identified.

Low back pain is second only to the common cold as a cause of lost days at work. It is also one of the most common reasons to visit a doctor's office or a hospital's emergency department.
For 90% of people, even those with nerve root irritation, their symptoms will improve within 2 months, no matter what treatment is used-even if no treatment is given.
Doctors usually refer to back pain as acute if it has been present for less than a month and chronic if it lasts for a longer period of time.

What Causes Back Pain?

Back pain is only a symptom of an actual problem. Pain arising from other organs may be felt in the back. This is called referred pain. Many intra-abdominal disorders-such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, etc. can cause pain referred to the back. Your doctor will have this in mind when evaluating your pain.

Back pain may be caused by injury, mechanical or inflammatory conditions of the spine. The mechanical or inflammatory problem must be fixed before the pain will go away for good. Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is touched/compressed), often due to a hernia (or bulging) of the disc between the spinal bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, in one spot, and associated with numbness in the area of the leg that the affected nerve supplies.

Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.
Other skeletal causes of low back pain include osteomyelitis or sacroiliitis (infections of the bones of the spine). This pain is usually worse at night and is worse when sitting or standing for a long time.
Tumors, possibly cancerous, can be a source of skeletal pain

What are the Common Symptoms of Back Pain?

Pain in the lumbosacral area (lower part of the back) is the primary symptom of low back pain.
The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back.
The pain may become worse with activity or change of posture.

Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip.
You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.

Back Pain Treatment

Self-Care at Home

General recommendations are to resume normal, or near normal, activity as soon as possible. The best immediate care of a back injury is rest in order to allow the back to heal. However bed rest must be limited to a few days only to allow for the injury and inflammation enough time to heal. Two/three days of bed rest can be effective but can also produce severe weakness, stiffness and poor circulation to back structures. Muscles become weak and lose flexibility. Joints get stiff and become over-sensitive. Discs become starved of oxygen and nutrients. Prolonged bed rest can also produce emotional problems. These changes can prevent recovery. However, stretching or activities that place additional strain on the back are discouraged.

Sleeping with a pillow between the knees while lying on one side may increase comfort. Some physiotherapists and doctors recommend lying on your back with a pillow under your knees.
No specific back exercises were found that improved pain or increased functional ability in people with acute back pain. Exercise, however, may be useful for people with chronic back pain to help them return to normal activities and work.
Topical agents such as "deep heating rubs" have not been shown to be effective.
Some people seem to benefit from the use of ice or heat. These modalities are not considered to be harmful. However one needs to take care that he /she does not use a heating pad on "high" or place ice directly on the skin, or when using on a person with poor skin sensation
Most experts agree that prolonged bed rest is associated with a longer recovery period. Further, people on bed rest are more likely to develop depreesion, blood clot in the leg, and decreased muscle tone. Very few experts recommend more than a 48-hour period of decreased activity or bed rest. In other words, get up and get moving to the extent you can

Medication

Medication can reduce pain, inflammation and muscle spasm. They can speed recovery and help you tolerate return to activities. Like bed rest, medication reduces symptoms only. They do not restore spinal function.

Physical Modalities

Heat, ice, ultrasound and electrical stimulation can improve circulation and reduce pain. These modalities stimulate nerves that assist in decreasing pain, open blood vessels and relax muscle tension. However, they do not restore spinal function.

Massage can be very healthy for muscles and connective tissue. It can reduce spasm and improve circulation but, does not restore strength.

Mobilization is when a physiotherapist moves the joints of the spine with their hands. This is usually a gentle procedure.
A more intense, sudden force referred to as a manipulation can also be used. The purpose of manipulation is to restore mobility to the joints and to stimulate their nerves in ways that can reduce pain and spasm. Manipulation is usually accompanied by exercises that build strength and flexibility.

Surgery

Surgery does not fix a “bad” back. It may help some people with certain severe back problems and it should be viewed as an option of last resort.
One of the most important parts of surgery is the rehabilitation post operatively.

Physiotherapy

Physiotherapy is a physical, mechanical and educational approach to correcting the causes of back problem. Specially trained medical professionals i.e. physiotherapists use a combination of treatment strategies including:

Physical modalities to control pain and inflammation
Massage to reduce pain and restore tissue mobility
Traction and joint mobilization
Exercises to build flexibility, strength and endurance
Education to make people aware of their back problem, to stay in shape and avoid re-injury.

Exercise is a key to recovery. Movement must be started as soon as pain will allow some activity. Movement, strength and flexibility are necessary to restore circulation; healing and back function for long - term recovery. Certain exercise may also help damaged discs improve their circulation and reduce disc bulging.

Taking care of your back problem

For a new/ new re-injury:
Stop, rest and apply ice. Immediately rest your injured back. A good rest position is to lie on your back on a hard surface such as the floor. Place your legs on a chair, so that your hips and knees are bent at right angles. Support your lower back with a rolled towel.

Place ice rather than heat for 10-15 min at a time. Pain should improve significantly in a day or two. You should start activity as soon as you can tolerate it e.g. walking, back exercises etc. Do not quit exercises when the pain goes away. You need to do preventative exercises for life, to avoid re-injury.

Back Exercises:

Back protection and recovery exercises:
Long- term recovery and protection come only from restoring strength, flexibility and endurance. These are restored only through exercises.
Flexibility is vital to the working spine. You must be able to comfortably maintain postures, move freely within those postures and move out of the postures. You also need adequate strength to stabilize and protect your spine during work activity.

Exercises start with gentle movement and stretches, progressing to more vigorous strengthening. One should not do any back exercises that cause pain. The very best overall exercise is walking. Walking brings rhythmic movements of the spine in its proper patterns of motion. This increases circulation, mobility, strength and endurance of all the structures of the spine working together.

Stages of exercises:

Gentle stretching
Gaining full mobility
Back strength and protection

Ergonomics

“Ergonomics” is designing your job to reduce work effort. This means avoiding bad postures and stressful movements to reduce fatigue, discomfort and damage.
Two things determine how much work your back does on the job: THE DESIGN of your job and your WORK HABITS. Following the rules of proper lifting is vital to protecting your back from fatigue and injury. The design of your job, however, is also important. Job design factors include the following:

How much weight you lift
How often you lift
How low you bend to lift the load
How high you lift the load
How far you carry the load
How far you twist with the load
How far you reach with the load
How you use the your body to move the load
How long you sit at your job
Design of seating for sitting jobs
Sustained or repeated bending, twisting or reaching
The physical environment of your job

Proper Lifting

Using your back properly is essential to a happy and healthy life. There are simple rules to safe lifting.

1. Stand with your feet apart, one foot slightly ahead with the other. A wide stance helps your balance during lifting. If you plan to move the load to the left, position the foot slightly back and turned out toward the left.

2. ARCH YOUR BACK INWARD and lock it with muscle power: tuck your chin in as in military attention and stick out your chest to arch your back. Then squat down to the load. Grasp the load securely. Curl it to your body. Keep your chin tucked and lift smoothly. Do not lift with a sudden, quick pull.

3. Keep the load close. Holding the load close to your body greatly reduces the stress to your back. Holding the load away from you at arms length can increase the load on your spine by ten times. Remember to maintain your locked back position as you put the load down.

Repeated lifting puts forward- bending loads on your lower back, stressing discs and back muscles. Do frequent standing back- bending stretches to help reverse some of these stresses. Frequent back – bending stretches may reduce disc degeneration and may help prevent disc rupture.

Push-Pull

Pushing is safer than pulling, if you have a choice. Whether you push / pull , you must follow safe back work rules:
Wide stance, tuck chin and arch back slightly, push/pull close to body, do not use sudden high – speed efforts.

Carrying

Hold the load close to your body. Keep your chin tucked and lower back slightly arched. Try to stand an inch taller than usual as you carry the load.

Think before you lift

Analyse the work task to decide how best to do it. Lift properly. Do not try to lift too heavy a load. Get help. Use equipment. DO not do something unsafe to your back.

Healthy or hurt, it’s your back for life!

For more information on back care, contact a physiotherapist at any nearest public hospital or the Disability and Rehabilitation Programme on tel. 033 846 7247 or email: Daniel.simbeye@kznhealth.gov.za

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