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www.rmt.org.uk :: december 2006 :: RMTnews 19 Low back pain means a pain affecting the lower part of the back (lumbar spine). The lumbar spine is an intricate structure consisting of: • Five small bones (vertebrae) • Shock absorbing discs (intervertebral discs) that sit between and cushion the bones. • Ligaments that hold the vertebrae and discs together. • Tendons that connect muscles to the vertebrae. • Fibres, which carry nerves from the brain to the lower part of the body. • Nerves • Muscles. The lumbar spine bears the entire weight of the upper body and as a result it is under constant pressure. The lumbar spine is prone to damage especially during activities, which involve bending, lifting and twisting. Damage to any of the structures of the lumbar spine can result in low back pain. Low back pain can be described as being: • Acute, lasting less than 3 months. • Recurrent, a repeat episode of the acute symptoms. Most people have at least one episode of recurrent low back pain. • Chronic, lasting more than 3 months. INCIDENCE 80 per cent of the Western population suffer with it at some stage in their lives. Five per cent of industrial workers have time off work because of it each year. In Britain it accounts for 11.5 million lost working days per year. RISK FACTORS Factors, which can increase the risk of developing low back pain: • Bad posture • Age over 30 years • Smoking • Lack of exercise • Obesity • Heredity factors • Occupational factors: • Jobs in the construction industry • Jobs involving heavy lifting, lots of bending and twisting, or whole body vibration (like truck driving or using a sandblaster). • Desk based job may result in or contribute to pain, especially if you have a bad posture, or sit all day in an uncomfortable chair. • Presence of other medical conditions: Many diseases can either cause or contribute to low back pain. These include: • Different types of arthritis such as osteoarthritis and rheumatoid arthritis. • Cancers elsewhere in the body that may spread to the spine. • Stress: Emotional stress can cause the back muscles to become tense and painful. CAUSES Mechanical Problems Mechanical problems interfere with the way the spine moves. For example: • Strain on the intervertebral disc may cause it to rupture (herniate) and press on the nearby nerves (as in sciatica). • Degeneration of the intervertebral discs with age results in loss of their shock absorbing ability. • Muscle spasm. Injury • Strain or tears to the muscles, ligaments and tendons supporting the lumbar spine. • Fractured vertebrae (may result from osteoporosis or accidents and falls). Other medical conditions • Curvatures of the spine (like scoliosis) • Spinal stenosis (narrowing of the spinal canal. The spinal canal is the tunnel through which nerves from the brain to the rest of the body pass). • Various types of arthritis Infections and tumours involving the spine Depending on the cause, the onset of the pain maybe sudden or slow. The pain maybe localised or may travel into the buttocks or down the leg. The leg pain may be associated with numbness or tingling. DIAGNOSIS By simply taking a history and carrying out a physical examination the doctor can diagnose the cause of the pain. In 95 per cent of cases there is no need for any tests. Tests such as X-rays or MRI scans etc. are only needed if the pain has been present for longer than six weeks or the examination suggests there may be an underlying cause for the pain (such as a disc problem). TREATMENT 90 per cent get better within a few weeks, irrespective of treatment received. If there is no serious underlying cause for the low back pain (like loss of bowel or bladder control, weakness involving the legs, weight loss or fever) the recommended treatment is: • Continue with normal activities as much as possible • Restrict bed rest to a minimum as prolonged rest delays recovery. • Apply ice packs to the painful area for the first 48- 72 hours, then use heat (hot water bottle) after that • Take over the counter painkillers. • Use anti-inflammatory drugs and stronger painkillers only after consulting your GP. • Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after injury may make the pain worse. PREVENTION • Stay fit • Improve your body posture. • Learn correct lifting and handling techniques. *The author is an Orthopaedic Surgeon and Managing Director of Trauma Claims Consultancy (TCC). TCC leads the market in the provision of independent medico- legal reports. TCC provides expert assistance in any medically related claim nationwide. For further information of services visit www.tccltd.co.uk For further information or advice contact Mohammed Rafiq on 01926 484 333 (Monday – Friday 9am - 5pm).