Back Pains? Get down on your hands and knees


One of the commonest ailments to result in a GP consultation is low back pain. The cause of this is locked in the history of the development of mankind. You see, when we walked on all fours, we didn’t get low back pains at all, because our spines were designed to be horizontal and weight was carried on the back, just like a horse does today. The design of the vertebrae is such that the spine in the horizontal position ‘locks’ to be able to weight bear.

Now, here’s where it all went wrong. We decided we looked much better standing upright and we could walk much quicker using our hind legs only. This meant that our spine was now vertical and we could bend it backwards and forwards. Backwards and the bones all locked together again, but forwards and the vertebrae unlock making the spine unstable.

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The next factor was we began to try and lift weights in this new upright position. We bent forwards (unstable) and lifted items like that. The era of low back pains had arrived.

Many generations development of our ancestor (called Homo erectus) kept that low back weakness and we are now Homo sapiens, older but not much wiser. Our spines are still weak. Our lumbar discs cause pain.

Many years ago I was a surgical assistant to a spinal surgeon, and the best description of the surgery was operating at the bottom of a red inkwell. Fortunately modern technology has made removal of a disc an operation that can be carried out as a minimally invasive procedure.

Let’s begin then with the “slipped disc” problem. First thing – discs do not “slip”. They do not shoot out of the spaces between the vertebrae and produce pain that way. The disc actually stays exactly where it is, but the center of the disc (called the nucleus) pops out forwards 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 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.

To accurately work out just what is happening requires bringing in specialist doctors who can carry out extremely intricate forms of X-Rays 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.

It is important to find the real cause for your aching back, as well as standing erect. The treatment for some causes can be the wrong form of therapy for some of the other causes. You can see the danger of “self diagnosis” here. Beware!

So what do you do when you get a painful back? Rest and paracetamol is a safe way to begin. 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. Might even be a good idea to miss the next couple of golf games. 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. You have been warned!

There is a Spinal Minimally Invasive surgeon in my hospital. One of my colleagues at Bangkok Hospital Pattaya has just had that procedure and was walking pain-free the next day and ran a marathon the week later.