Lower Back Pain

Dr Putra Vatakal, Orthopaedic Surgeon, Kuala Lumpur, Selangor, Quill Orthopaedic Specialist Centre, slipped disk, back pain, spine

When I was a young boy, all I did was lie around watching TV.

“No backbone” was a word my mum frequently used describing my invertebrate activities.

The back is kind of important, though most of us hardly ever see our own backs – so important in fact, that nearly all living creatures are divided into those with backbones and those without.

This might be of vague interest only to the odd zoologist among you, but consider this – 4 out of every 5 of us will suffer from lower back pain at some point in our lives.

It is not ‘WILL’, but more like “WHEN will I get back pain?”

There are many types of back pain, but this is not a textbook of spine surgery, so we will discuss only the most common causes.

1. Compressed nerves

The spine is technically the backbone, but it is only really important because of two things – a. it has joints that allow our back to bend (like when we drop our keys while walking, and need to pick them up), and b. because it protects important nerves that connect our brain (which is the control center) to the rest of the structures in our body (hands, legs, all other organs etc).

From the neck down, nearly all our body functions need these spinal nerves to work properly, which is why someone who has broken his or her neck is often paralysed from the neck down.

You’ll know from experience that when someone pinches you, it’s painful. The same way, if one of your spinal nerves gets pinched, it’s going to be painful. Nerves carry electrical currents through the body, and so this kind of pain can sometimes feel like it’s shooting down the length of your leg – along the path of the involved nerve.

Many things can pinch a spinal nerve, but most commonly, it is a slipped disc (technically a prolapsed intervertebral disc). Think of these as a shock absorber between different parts of your backbone that can get damaged (by a sudden load or movement) and pop out of place… right onto the poor spinal nerve – compressing (or pinching) it. Lifting heavy weights with poor technique is often to blame.

The good news is that most cases of slipped disc can recover with some anti-inflammatory medicines, time, and a lot of physiotherapy and exercise. It is only when injury to the pinched nerve is bad enough to cause severe muscle weakness or problems with urination or other toilet-related activities that they require urgent surgery to relieve compression.

So a slipped disc does not always mean surgery – in fact, if you’re in your late 30s or early 40s, you probably have a slipped disc or two – even though you don’t have back pain. For this reason, learning to take care of your back should start today, and not only when you have back pain.

2. Mechanical Back Pain

We talked about the spine having joints that allow us to bend forward, backward and all around. The backbone isn’t one bone (actually it’s 33 small bones). Each individual vertebra (the Latin word for a bone in the spine) is connected to the others by joints called ‘facet joints’.

Much like a knee or hip joint can get arthritis with over-use (and age), a facet joint can get arthritis too. This can be painful, and while it can cause pain that radiates to different areas, it usually does not follow the typical nerve distribution.

As you might have guessed, this can usually be treated with physiotherapy and exercises – the point being to bulk up and strengthen the muscles surrounding the spine to take the load away from the hurting facet joints.

If you sense a pattern forming here, it’s because I’m trying to send you a not-so-subtle message that the answer to many of your back problem lies in exercising your spine. More on that later.

If pain persists, like in the knee, there are joint injections and surgery and whatnot, but we will not go into that here.

3. Muscular Strain

We’ve saved the best (or at least the most common) for last.

Most cases of back pain do not shoot down your leg or to your buttocks. Most are not caused by a slipped disc (though you may find a disc or two that has innocently ‘slipped’ years before if you have an MRI done at this point).

Muscle strain… it sounds like something you get after a hard day at the gym… but sadly, as our posture and lifestyles deteriorate with the advancement of our civilisation, our back muscles (and many other muscles) collectively get weaker and weaker, leading to abnormal loading of our spine.

This causes pain, and while it sounds trivial, the most common reason worldwide for a visit to the orthopaedic clinic is lower back pain caused by muscle strain.

Doc, is there any good news at all? Of course! Back pain caused by muscular strain usually goes away with some exercise. If your pain is really bad, a few days of rest and anti-inflammatory medicines to bring down your pain may be needed, but as soon as you can, I’ll need to see you on your yoga mat exercising like there’s no tomorrow.

NOTE: While most cases of back pain can be treated with exercise and simple medicines, there can be serious conditions that cause back pain. If you have numbness or weakness in your hands or legs, urinary or bowel problems, or you suspect something is amiss, see your friendly orthopaedic surgeon or doctor as soon as possible.