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Low back pain condition and management

By Alero Binitie
10 July 2016   |   3:30 am
Omaseyin, a 41-year-old male, suffers from low back pain. He was playing basketball one day, when he felt a sharp pain.

Lower-Back-Pain

Omaseyin, a 41-year-old male, suffers from low back pain. He was playing basketball one day, when he felt a sharp pain. Initially, it seemed like torn flesh, and every movement he made was painful. Later, it became difficult to sit down. “I was self-medicating, but when it got very serious, I went to a massage parlour for physiotherapy. However, the man kept applying heat balm to the inflamed area, as well as red light to the affected area, which only worsened my case,” he said.

According to the Nigerian Journal of Orthopaedics and Trauma, low back pain (LBP) is one of the most frequently reported chronic health problems affecting the adult population and is the most prevalent musculoskeletal condition in Orthopaedics practice.

Dr. Alimi Mustapha, a consultant spine surgeon at the Orthopaedic Hospital, Igbobi, Lagos, explained that low back pain is a common problem. He told The Guardian that infections, tumours, cancer, fungi, accidents, as well as tuberculosis could cause low back pain. In females, medical conditions that affect their reproductive systems, including endometriosis, ovarian cyst and uterine fibroids can also lead to low back pain

“Most of the patients we see having low back pain is from degenerative spine, which means they have grown older, their back is no longer so flexible and the discs have become dry, ligaments are no longer supple, muscles are not as strong as they used to be and the bones are not so strong,” Mustapha said.

He continued, “There are additional factors though. For instance, somebody who is obese is more likely to have low back pain than some one who is not. Somebody with trauma or accident is more predisposed to low back pain than one who doesn’t have. Somebody who has an infection is more likely to have low back pain than some one who doesn’t have.”

Mustapha further explained that people who sit in the office from 9am to 5pm are more likely to have low back pain than a labourer, who does a lot of unskilled manual work, because the labourer subconsciously trains his muscles to become tough, while the ligaments become more supple and tougher and the bones are stronger so that even when he grows older, he is still stronger than an office worker, who does very little running around, with no pulling, dragging or pushing. Those who exercise are also less likely to have low back pain.

Lumbar (low back) degenerative disc disease can affect patients as young as 20 years old. When the lumbar discs between the vertebrae begin to break down, the damaged disc can cause both inflammation and slight instability in the lower back, bringing about pain, muscle spasms, and sometimes sciatica.

He explained that most people have at least one backache during their lifetime. “Here, at the orthopedic hospital, I treat at least 120 to 130 patients a week and we perform surgeries weekly for different causes of low back pain,” he said.

“Although low back pain may not always present signs, but as doctors our advice is that any pain that occurs at your low back region and goes away after 24 to 72 hours shows you are fine, but once the pain is persistent for more than 72 hours, go see a doctor.”

He pointed out that in a lifetime, about 80 to 97 people would experience low back pain. Globally, chronic low back pain is a common health problem, although it is not an epidemic. Nigerians need to be aware of low back pain because it could be a red flag, a warning sign of cancer or an autoimmune disease. The commonest is urinary infection, which can move from anywhere and settle at the back, as it grows.

As many Lagosians are sedentary and do not exercise, come back home late due to traffic and end up eating late, all these can also lead to low back pain, the expert said.

Dr. Mustapha advised that women approaching 50 should realise that this is when osteoporosis starts setting in. So, they need to take calcium and vitamin D supplement to strengthen their bones.
“People should eat healthy diet, stop smoking, exercise regularly and reduce alcohol intake,” he said.

Dr. Adetoyinbo Adedoyin, a senior physiotherapist at the National Orthopedic Hospital Igbobi, Lagos, said: “I have patients who consume Jedi jedi (local herbs) to cure low back pain and this is actually doing more damage than good to the body. When patients tell me they have pain in their low backs and they believe it is excess sugar, I usually ask them ‘how long do you stay in traffic? What are the conditions of your chairs at home and at work?’ Because this can lead to back pain. Also, if your economic factors are poor, that can expose you to back pain.”

According to Adetoyinbo, low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. Due to muscle spasms or a strain or tear in the muscles, ligaments and pain in itself is a sign that something is wrong, which must be fixed before it gets worse and so, sugar is not the reason humans have back pain.”

Adetoyinbo said some patients confuse low back pain for pile (hemorrhoids) and instead of visiting a medical doctor, they patronise local herbs such as Jedi jedi, which they believe is something that can be treated easily. He explained that pile is different from low back pain and once a patient is in pain, he/she needs to go see the doctor.

“Low back pain is very common,” he said. “It can be acute, lasting less than one month, but chronic low back pain lasts beyond three months. On the average, we have a high caseload because 50 to 60 per cent of every case we see daily is related to low back pain. Statistics show that one in three persons will have low back pain. In the United Kingdom, it is one of the most expensive cases, which costs them 1.53m pounds per annum.

“Unfortunately, in Nigeria we do not have such data, but it is actually a big case, when it comes to cost, management and effects even psychologically and socially, because it could lead to permanent disability even in the elderly.”

The physiotherapist listed the mental impact of low back pain as anxiety, depression and sleeplessness, whilst poor physical performance and deterioration in health status, are the physical impacts.

“People begin to experience back pains from age 20 to 60. However, 40 is the peak age, when most people have chronic low back pain. If you take an x-ray, you will start seeing signs of the bones degenerating, and though they may not feel pains, but the signs are there depending on the factors such as economic and social lifestyles. Some common symptoms of low back pain include; weakness, numbness in the legs and pain like a wildfire all over the spine,” he said.

According to Adetoyinbo, the treatment of low back pain consists of using medications to relieve pain prescribed by the medical doctor, depending on the type of low back pain.

“Drugs do not solve chronic pain and some patients still need to undergo physiotherapy, while for some, it is surgery. Whichever method of treatment, a patient still needs therapy,” he explained.

Usually, the physiotherapist will try to improve the range of motion in the spine because when back pain occurs, the mobility in the joint reduces and that is when patients complain of not being able to bend or stand upright or even move. So they try to improve that range movement.

“We conduct therapy to improve the strength of the muscles called motor control exercise, which is specifically targeted at the muscles so they can do their primary assignment by stabilising the spine and reducing the pressure because the whole weight of the body is actually attached to the spine. In addition, there are therapeutic exercises to help improve the muscles and range of motion in the spine. People with chronic low back pain experience huge social, mental, physical and occupational disruptions.

“Avoid intense massage, if you have persistent pains in your low back. Do not go to a spa to get a massage, rather go see a doctor. Low back pain is a huge condition that really needs public health attention,” Adetoyinbo advised.

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