Back pain is one of the most common reasons for a visit to the doctor. I am sure
you have had back pain yourself at some time or other. Would it surprise you if
I said that ‘vanity’ was one of the prime reasons we get back pain? The reason
you get a bad back is because our Neanderthal forefathers decided we looked
better walking on our hind legs, instead of all four. Just like a horse, the
bones of our spines lock together nicely when we are on all fours, and weight
can be carried easily on our backs. However, when we stand up and try and lift,
it all goes pear-shaped from there. The spine was not designed to carry loads,
or pick up loads, in the vertical position.
But unfortunately, lift and carry is a prime example of what
we call on people to do, from mothers lifting babies to laborers lifting bags of
rice. The presenting situation is one we meet only too often. The patient is
doing something and suddenly everything locks up and they are immobilized,
frozen to the spot.
Back pain is one of the commonest orthopedic problems, and
the often used terms such as lumbago, sciatica and slipped discs are spoken
about frequently.
Let’s look at the “slipped disc” problem. First thing - discs
do not “slip”. They do not shoot out of the spaces between the vertebrae (the
tower of cotton reels that makes up your spine) and produce pain that way. The
disc actually stays exactly where it is, but the center of the disc (called the
nucleus) pops out through the edge of the disc and hits the nerve root. When
this happens you have a very painful condition, as anyone who has had a disc
prolapse (our fancy name for the “popping out” bit) will tell you. Think of the
pain when the dentist starts drilling close to the tiny nerve in your tooth.
Well, the sciatic nerve is a large nerve! When the nucleus of the disc hits the
sciatic nerve, this produces the condition known as Sciatica - an acute searing
pain which can run from the buttocks, down the legs, even all the way through to
the toes.
Unfortunately, just to make diagnosis a little difficult you
can get sciatica from other reasons as well as prolapsing discs. It may just be
soft tissue swelling from strain of the ligaments between the discs, or it could
even be a form of arthritis. Another complicating fact is that a strain may only
produce enough tissue swelling in around 12 hours after the heavy lifting, so
you go to bed OK and wake the next morning incapacitated. And then you have to
convince the employer that you did it on his time.
To accurately work out just what is happening requires
bringing in those specialist doctors who can carry out extremely intricate forms
of Medical Imaging called CT Scans, Spiral CT’s or MRI that will sort out
whether it is a disc prolapse, arthritis or another soft tissue problem. The
equipment to do these procedures costs millions of baht, and the expertise to
use them takes years of practice and experience. This is one reason why some of
these investigations can be expensive.
After the definitive diagnosis of your back condition has
been made, then appropriate treatment can be instituted. The forms of treatment
can be just simply rest and some analgesics (pain killers), physiotherapy,
operative intervention or anti-inflammatories and traction.
Now perhaps you can see why it is important to find the real
cause for your aching back. The treatment for some causes can be the wrong form
of therapy for some of the other causes.
So what do you do when you get a painful back? Rest and
paracetamol is a safe start. If it settles quickly, then just be a little
careful with lifting and twisting for a couple of weeks and get on with your
life as normal. If, however, you are still in trouble after a couple of days
rest, then it is time to see your doctor and get that definitive diagnosis. It
is the orthopedic Spine Clinic chaps you need to see.
