LOW BACK PAIN & AYURVEDA












LOW BACK PAIN & AYURVEDA

Low back pain is one of the most common pain disorders today .It is a chronic condition characterized by a persistent dull or sharp pain per the lower back. It may be also associated with burning, stiffness, numbness or tingling with the pain shooting down the buttocks and the legs.

When we stand, the lower back functions to hold most of the weight of the body. When we bend, extend or rotate at the waist, the lower back is involved in the movement. Low back ache is often precipitated by moving, lifting objects or twisting of the waist. Severe pain in the low back can be quite debilitating to patients. Pain in the lower back restricts activity and reduces work capacity and quality of enjoyment of everyday living and turns daily life into a misery.

Survey indicates that 70 per cent of the people suffer from low back pain at some time in their lives. The highest rate of back pain occurs among the 45 to 64 year age group. The incidence of low back pain is greater among women. In 90 per cent of the patients, low back pain resolves within six weeks, i.e. self limited. In another 5 per cent the pain resolves by 12 weeks. Less than 5 per cent of back paid account for true nerve root pain.


What is the anatomy of the low back? The first step to understanding the various causes of low back pain is learning about the normal design (anatomy) of the tissues of this area. Important structures of the low back that can be related to symptoms there include the bony lumbar spine (vertebrae), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

The bony lumbar spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord (nervous tissue that extends down the spinal column from the brain) from injury. Each vertebrae has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue. They also have a strong bony "body" in front of the spinal cord to provide a platform suitable for weight-bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joint of the buttocks.

The discs are pads that serve as "cushions" between each vertebral body which minimize the impact on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus), which is capable of rupturing (herniating) through the surrounding outer ring (annulus fibrosus) and, thereby, irritating adjacent nervous tissue.
Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae and surround each of the discs.

The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) exit the spinal column through bony portals called "foramen."

Many muscle groups which are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.

The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine into the abdomen and pelvis. Surrounding these blood vessels are lymph glands and involuntary nervous system tissues, which are important in maintaining bladder and bowel control.
The uterus and ovaries are important pelvic structures in front of the lumbar area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.

The skin over the lumbar area is supplied by nerves that come from the roots of the lumbar spine.

What are common causes of low back pain?

Common causes of low back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. Each of these is reviewed below. (It should be remembered that it is not uncommon for doctors to be unable to make a precise diagnosis of the cause of low back pain.) 1. Lumbar Strain (Acute, Chronic): A lumbar strain is a stretching injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than 3 months, it is referred to as "chronic."Lumbar strain most often occurs in persons in their forties, but can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back. The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, x-ray testing is only helpful to exclude bone abnormalities. The treatment of lumbar strain consists of resting the back (to avoid re-injury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted as this treatment may actually slow recovery. Spinal manipulation for periods of up to 1 month has been found helpful in some patients that do not have signs of nerve irritation. Future injury is avoided by using back protection techniques during activities and support devices as needed at home or work.

2. Nerve Irritation: The nerves of the lumbar spine can be irritated by mechanical impingement or disease any where along their paths--from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.

3. Lumbar Radiculopathy: Lumbar radiculopathy refers to nerve irritation which is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain that shoots down the leg. Sciatica can be preceded by a history of localized low back aching or it can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels. Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with radiology testing, such as CAT or MRI scanning. For more information, please visit the CAT Scanning and MRI Scanning articles. Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine, and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

4. Bony Encroachment: Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal nerve compression in these conditions can lead to sciatica pain which radiates down the lower extremities. Spinal stenosis can cause lower extremity pains which worsen with walking and are relieved by resting (mimicking poor circulation). Treatment of these afflictions varies, depending on their severity, from rest to surgical decompression by removing the bone that is compressing the nervous tissue.

5. Bone & Joint Conditions: Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are from inflammation of the joints (arthritis).

Congenital Bone Conditions - Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine which can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal design of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically, but often benefit by support bracing.Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

Degenerative Bone And Joint Conditions -- As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on x-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain x-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

Injury To The Bones And Joints -- Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly persons with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor vehicle accidents. In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Fractures associated with osteoporosis can also be treated with hormone therapy to stimulate the formation of new bone. For more information, please visit the Fosamax, Actonel, Forteo, Miacalcin, and Calicmar articles in the Medications area and the Osteoporosis article.

Arthritis -- The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include Reiter's disease, ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to pain and stiffness in the low back which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation.

Back Pain Symptoms

Pain in the lumbosacral area (lower part of the back) is the primary symptom of low back pain.
The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back.
The pain may become worse with activity.
Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip.
You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.
An example of this would be an inability to plantar flex the foot. This means you would be unable to stand on your toes or bring your foot downward. This occurs when the first sacral nerve is compressed or injured.
Another example would be the inability to raise your big toe upward. This results when the fifth lumbar nerve is compromised.

Treatment

Conservative treatment is the most likely course of action for most patients. Treatment options include rest, Traction, Short wave diathermy, non-steroidal anti-inflammatory medications, weight control, steroid injections in step by step order.
If a patients does not get relief after 8 to 12 weeks of conservative therapy surgical intervention is considered.

Ayurvedic Perspective

Ayurveda holds that low back pain is a result of vitiation of one of the three principal 'doshas'. 'Kateegraham'/'Prishtasoola' or low back pain is an indication of Vata aggravation and bone and muscle weakness.

Ayurvedic Treatment

Treatment in Ayurveda is to bring the vitiated 'dosha' back to the state of equilibrium and thereby to the state of health.

ayurveda management Comprises of three approaches, Elimination (Shodhanam), of the accumulated toxic products of digestion, metabolism and the disease process, Pacification (Shamanam) and correction of the entities responsible for altered functioning and Rejuvenation (Rasayanam) of the bodily tissue to regain and maintain natural strength and vitality.

For treating low back pain, internal as well as external treatments are done. Ayurvedic medicine offers conservative treatment as oral & external medication. This herbal medicine can help you reverse the disease-process.

Ayurvedic Treatment usually involves a series of Panchakarma therapies like ABHYANGAM, SWEDAM, NASYAM, ELAKIZHI, NAVARAKIZHI, KATI VASTHI, KASHAYA VASTHI & ANUVASANA VASTHI etc. for treating low back pain.

Abhyangam & SwedamA whole body massage with specific herbal oils to nourish and revitalize the body tissues (Dhatus) and to allow the toxins to be removed from the body. Abhyanga has much deeper and far more reaching effects than an ordinary massage, that uses mineral oils and lotions. This massage is performed symmetrically by two therapists for one hour and is usually followed by medicated steam bath (Sweda). It is one of the most rejuvenating treatments of Ayurveda.

Patra Pinda Sweda (Elakkizhi)A highly rejuvenating treatment, in which fresh plants are fried with several other herbal ingredients and tied into boluses, dipped in warm medicated oil and simultaneously massaged all over the body for one hour. It is applied after Abhyanga.

Sarvangadhara (Pizhichil) KayasekaMedicated oil/milk is poured onto the body in continuous streams while being gently massaged, for one hour. It is extremely soothing and relaxing. It acts as a free radical scavenger, toning, strengthening and deeply rejuvenating the whole body. It is applied after Abhyanga.

Sashtika Sali Pinda Sweda(Navarakizhi)
Ahighly effective rejuvenation technique using a special type of rice that is cooked, tied into boluses and dipped into a herbal decoction and warm milk, then skillfully massaged simultaneously all over the body for one hour after the Abhyanga.

Kati VastiIt is done keeping a certain amount of medicated luke warm oil on the specific area of back for a prescribed period of time.

Basti (Medicated Enema)Introducing liquids like medicated oils, herbal concoctions and milk per perineum (through the anus).Cleanses the accumulated toxins from all over the body.

These are the usual therapies which are practiced for treating low back cases but if any other panchakarma therapy has to be done that is decided as per patient condition and need.

In four to six weeks, the majority of patients find their symptoms are relieved without surgery! Be optimistic about your treatment plan and remember that less than 5% of back problems require surgery!

Prevention

The prevention of back pain is, itself, somewhat controversial. It has long been thought that exercise and an all-around healthy lifestyle would prevent back pain. This is not necessarily true. In fact, several studies have found that the wrong type of exercise such as high-impact activities may increase the chance of suffering back pain. Nonetheless, exercise is important for overall health and should not be avoided. Low-impact activities such as swimming, walking, and bicycling can increase overall fitness without straining the low back.

1. Keep the muscles well conditioned by improving sitting, standing, stretching postures. Well-conditioned muscles are less susceptible to injury.
2. Never bend at the waist or stoop to pick up an object. Instead, lower the body to the level of the object by bending the knees. Grasp the item, hold it close to the body, and raise yourself with your legs while keeping your back straight.
3. Do not lift very heavy objects.
4. Whenever possible, prop yourself up.
5. Lean against a wall or pillar while waiting for a bus or standing in line at the bank.
6. Keep footstools around the house. Alternatively prop up one leg on stool while doing standing chores.
7. Sleep on a firm mattress and find a comfortable position.
8. Wear low-heeled shoes.
9. Standing straight will do wonders for your back.
10. Sit on a comfortable chair that supports the curve of lower back.
11. While sitting for long hours rest feet on a low stool so that knees are above hips.
12. Do not sit or stand in one position for a very long time. Get up periodically and walk for a while.
13. Avoid activities which hurt back.
14. Do not sit in same position for long hours. It may prove hazardous to back. Take break in between and move around.
15. Avoid becoming overweight. Overweight increases the risk of back pain.
Tips for software professionals to avoid back pain

1. Select a correct chair, with a relatively straight back and good lower back support. If the chair doesn't offer lower back support, keep a rolled up towel or cushion to support the back.
2. Correctly position the chair, keyboard, and monitor. Feet should be on the floor, with knees at hip level; forearms should form a right angle with upper arms; and the computer terminal should be at eye level.
3. Adopt a relaxed, upright working posture and allow the chair to support.
4. Avoid slouching forward or leaning back too far.
5. When you are at work stand up, walk around, stretch forward, backward, and side to side once in 30 minutes.
6. Increased stress and strain enhances the chances of back pain. Hence remember to relax! Yoga and meditation are best techniques to relax
7. Eat healthy food which is rich in fiber. Avoid sweets, oil, soft drinks and overeating to reduce the chances of weight gain.
8. Sex should be avoided during acute stage of back pain as it exaggerates the condition.

What exercises can I do to strengthen my back?

Specific exercises: Talk to your doctor about how to perform these exercises.

Some specific exercises can help your back. One is to gently stretch your back muscles. Lie on your back with your knees bent and slowly raise your left knee to your chest. Press your lower back against the floor. Hold for 5 seconds. Relax and repeat the exercise with your right knee. Do 10 of these exercises for each leg, switching legs.While some exercises are specific for your back, it's also important to stay active in general. Swimming and walking are good exercises to improve your overall fitness.

Abdominal crunches, when performed properly, strengthen abdominal muscles and may decrease tendency to suffer back pain.
Although not useful to treat back pain, stretching exercises are helpful in alleviating tight back muscles.
The pelvic tilt also helps alleviate tight back muscles.


Lumbar support belts: Workers who frequently perform heavy lifting are often required to wear these belts. There is no proof that these belts prevent back injury. One study even indicated that these belts increased the likelihood of injury.

Standing: While standing, keep your head up and stomach pulled in. If you are required to stand for long periods of time, you should have a small stool on which to rest one foot at a time. Do not wear high heels.

Sitting: Chairs of appropriate height for the task at hand with good lumbar support are preferable. To avoid putting stress on the back, chairs should swivel. Automobile seats should also have adequate low-back support. If not, a small pillow or rolled towel behind the lumbar area will provide adequate support.

Sleeping: Individual tastes vary. If the mattress is too soft, many people will experience backaches. The same is true for sleeping on a hard mattress. Trial and error may be required. A piece of plywood between the box spring and mattress will stiffen a soft bed. A thick mattress pad will help soften a mattress that is too hard.

Lifting: Don't lift objects that are too heavy for you. If you attempt to lift something, keep your back straight up and down, head up, and lift with your knees. Keep the object close to you, don't stoop over to lift. Tighten your stomach muscles to keep your back in balance.


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