Advice and tips for back pain

The vast majority of people have experienced back pain. When back pain strikes, it is difficult to sit still and can seriously affect the quality of life.

What kind of people are prone to back pain? How does it happen? Associate Professor of Bioengineering at the University of Virginia, Dr. Xudong Li, a spine surgeon, explains in detail and introduces the treatment of low back pain.

Structure of the spine

To understand low back pain, you have to understand the structure of the spine and the tissues associated with it. The spine contains 4 parts: vertebral bones, intervertebral discs, nerves, and muscles.

The spine consists of four bones, including the cervical, thoracic, lumbar and sacral vertebrae. Among them, the cervical spine has 7 bones with an arc toward the front of the body; the thoracic spine has 12 bones with an arc toward the back of the body; and the lumbar spine has 5 bones with an arc toward the front of the body. The curvature of the spinal arrangement is important, and too much or too little curvature can lead to difficulty in standing and improper posture.

There are intervertebral discs between the vertebral bodies, which are flat, round structures that are roughly 1 to 3 mm thick each. The intervertebral discs consist of two parts: a jelly-like nucleus pulposus on the inside and a flexible fibrous ring on the outside. The function of the intervertebral disc is to cushion the vibrations that occur when a person makes a movement.

The vertebrae are joined together to form a channel through which the spinal cord passes posteriorly, protecting it. Each vertebra is connected to an arch, which is arranged to form an intervertebral foramen from which nerves extend to innervate sensation and movement in the extremities.

The periphery of the spine is encased in muscles. Strong muscles share the pressure placed on the vertebrae and support the spine so that it is in the correct position.

Problems with any part of the vertebral bones, discs, nerves, and muscles can lead to back pain.

What kind of people are prone to back pain?

1.People engaged in handling occupations: for example, freight forwarders, construction workers. These people often have to do repetitive lifting and carrying work.

2.People engaged in driving practice: such as large truck drivers, cab drivers. Their spine is often in a vertical state of vibration, which concentrates pressure on the intervertebral discs and can easily lead to disc deformation.

3.office workers: these people are prone to long-term poor posture, sedentary conditions, resulting in excessive load on the lumbar spine, the intervertebral discs are gradually compressed, resulting in back pain.

What is the cause of back pain？

1.Acute lumbar spine injury: It is more common in young people because they have more opportunities for strenuous sports, such as playing volleyball, badminton, etc.

People often do back extensions and rotations during strenuous exercise, which may lead to acute muscle strains, muscle fiber damage, microvascular rupture and other conditions, causing muscle spasm pain.

2.Herniated disc: When the outer fibrous ring of the disc loses its elasticity and strength, the nucleus pulposus inside breaks through the fibrous ring and protrudes.

The structure of the entire disc is similar to a common snack, a jelly doughnut. The nucleus pulposus is like the jelly, the annulus fibrosus is like the doughnut, and the herniated disc is like the jelly being squeezed out of the doughnut.

After the nucleus pulposus herniates, the disc becomes thinner and thus loses its cushioning function – the bones are more likely to collide with each other when a person moves around, causing back pain.

If the herniated nucleus pulposus compresses the nerve, it can also cause back pain. For example, sciatica is a herniated disc that compresses the sciatic nerve, causing numbness and pain in the lower back and lower extremities, or worse, weakening of muscle strength.

In addition, a herniated disc may cause inflammation.There is no blood supply inside the disc, so the immune system does not recognize the nucleus pulposus. When the nucleus pulposus protrudes, the immune system recognizes it as foreign tissue and sends many immune cells to attack the disc, causing inflammation. If the inflammation irritates the nerves, it can also lead to pain.

Surprisingly, herniated discs are more likely to occur in young people!

The first reason is that young people carry heavy objects more often and have a higher chance of causing injury. The second reason is that the nucleus pulposus of young people is more watery and mobile, and therefore tends to protrude, while the nucleus pulposus of older people is less watery and relatively more solidified, and therefore less likely to protrude.

3.Spinal stenosis:When the disc degenerates and does not have enough strength to maintain the stability of the spine, the surrounding tissue proliferates with the aim of protecting the nerves.

The growth of ligaments and small joints around the spine can then lead to narrowing of the spinal canal and further compression of the nerves.

The common symptom of spinal stenosis, which tends to occur in the elderly, is “intermittent claudication” – pain in the legs and lower back after a short walk, which must be relieved by sitting down for a while and then continuing to walk.

Another obvious symptom of spinal stenosis is that a person cannot stand up straight. When a person is standing, the volume of the spinal canal is reduced, so people with spinal stenosis are used to doing forward leaning movements, which can increase the volume of the spinal canal, reduce nerve compression, and also reduce pain. This is why older people often hunch over and use crutches.

4.Compression fracture: This is a more serious condition and must be given special attention.

Compression fractures are common in the elderly, especially in postmenopausal women. This population usually has osteoporosis and weaker bones, which cause fractures in the front of the vertebrae of the spine when carrying heavy objects or accidentally falling with the body in a forward leaning position.

How can I tell if I have a compression fracture? When an elderly person falls and there is a “pop” sound of breaking, it may be a fracture.

In addition, if there is only pain in the low back after a fall, but no neuropathic, radiating pain in the leg, it is also important to be aware of the possibility of a compression fracture.

What are the treatment methods for back pain？

●Acute lumbar spine injury: can be improved by rest, medication (medication to relax the muscles), and cold compresses (to reduce the inflammatory response).Most people can get relief with rest, medication, and cold compresses and do not need to see a doctor. However, about 5% of patients will have persistent, chronic pain (more than 4 weeks), at which point they will need to see a doctor for further x-rays and magnetic resonance imaging (MRI) to confirm the presence of an organic lesion.

● Herniated discs: there are five major categories of treatment.

If there is no loss of muscle strength or persistent numbness in the hands and feet, it means that the disc is not compressing the nerve and a more conservative treatment can be used.

1.Medication: Take a non-steroidal anti-inflammatory drug, such as Ibuprofen.

2.Physiotherapy: Properly exercise the muscles of the low back to increase strength or lightly pull the nerve to free it from compression.

3.Atypical treatments: acupuncture, massage, cupping.

If the pain is not relieved despite trying the first 3 treatments, or if symptoms of nerve compression appear, it is important to see a doctor for further treatment.

4.Occlusion therapy: Steroids are injected into the herniated disc with a syringe to reduce the inflammatory response.

5.Surgery: This is the treatment of last resort and is not required in more than 95% of patients.

Some back pain must be operated as soon as possible

In general, surgery should be considered only if there is severe loss of muscle strength, persistent numbness in the hands and feet, or if there is still unrelieved pain after completing 6 weeks of non-surgical treatment.

In a very small probability, some complications of surgery can occur, such as dural injury. Although the chance of occurrence is small, try to avoid surgery if possible. In addition, local scar tissue tends to form after surgery, making the next surgery more difficult.

On the other hand, if a patient has severe neurological symptoms, surgery must be performed as soon as possible under safety considerations, otherwise irreparable nerve damage may result.

Currently, doctors mostly use minimally invasive surgery with an incision of only 2 to 3 mm. The surgery improves the pain dramatically and the patient’s muscle strength and skin numbness gradually improves.

Some professional medical literature states that most patients who have surgery within 4 months of the onset of muscle strength loss will recover completely. If more than 4 months have passed, even if surgery is performed, it is possible that the patient will not recover completely.

How to maintain the lumbar spine and prevent back pain?

1.Posture is important: be sure to sit up straight and avoid leaning forward.

Why is it that sitting and leaning forward puts more pressure on the discs than standing?
As the saying goes, “standing does not hurt,” and there is truth to this. The upper body is supported by three forces: the abdominal muscles in front, the spine in the middle, and the lumbar muscles in the back. When we stand, the abdominal and back muscles are working, so they can take some of the pressure for the spine.When we sit and lean forward, the muscles of the abdomen and back are relaxed, leaving only the spine and intervertebral discs under pressure, which can easily cause disc herniation.

2.There are skills to carry heavy objects: keep your spine straight.

Many people’s herniated discs are caused by lifting heavy objects in an incorrect position.
When lifting something, be sure to bend your knees, keep your spine straight, and use the strength of your thighs and calves rather than your low back muscles to lift heavy objects.

3.Sleeping on a hard bed: It supports the spine.

When we sleep on a soft bed, the back and hips are less supportive, so that the lumbar spine can not be in the normal physiological curvature. At this time, the lumbar back muscles are in a state of tension, resulting in muscle soreness.

4.Lumbar cushion: help relax the muscles of the lower back.

Whether sitting or lying down, you can put a small pillow in the waist to support the physiological curve of lumbar lordosis and relax the muscles of the lower back.

5.No smoking: Smoking accelerates disc degeneration.

The nicotine in tobacco products prevents the body’s nutrient fluids from entering the discs. This causes the discs to degenerate faster, become thinner and weaker, and the nucleus pulposus in the disc is more likely to protrude.

X-rays can also show if a patient has a smoking habit. For example, if a person is young but has a lot of bone spurs or a thinning disc, the likelihood of that person smoking is high.