Low back ache is a very common problem not only seen in aged but all age groups. Low back refers to Lumbar vertebra medically derived from Latin word ‘Lumbus’ meaning lion as it has power of flexibility with lifting and bending.
Lumbar spine is so designed that Vertebrae (L1 to L5) are stacked together to provide support and protection to the spinal cord from trauma. Spinal Cord is comprised of nerves that extend from brain to upper lumbar region( between L1 and L2). Low back supports the entire weight of the upper body, helps in bending, extension, rotation at waist involving movement of lumbar vertebra. Low back also protects the nearby organs of pelvis like uterus, ovaries in women, prostrate gland in men. Kidneys on either side of back of lower abdomen is located in front of Lumbar spine.
Each Lumbar Vertebra has a spinous process behind spinal cord to protect the nerves of the cord from trauma. Vertebral body is present in front of spine which provides a platform suitable for weight bearing joints of all tissues. In between each vertebrae inter vertebral discs are present which acts as a cushion or shock absorbing pad between the bones of spine. Disc is made up of soft gelatinous material called nucleus pulposum in core and surrounding outer ring called annular fibrosis.
Causes of Low back Ache
- Trauma or Injury to Spine – Muscle spasm- Strain or Sprain to ligaments
- Overuse or Degeneration of disc
- Herniated disc
- Degenerative Spondylosis
- Lumbar Stenosis
- Cauda Equina
- Arthritis- Rheumatoid Arthritis, Osteoarthritis, Psoriatic Athritis
- Spinal Infection- Osteomyelitis
- Kidney Stones
- Diseases pertaining to Female Reproductive organs like Ovarian Cancer, Ovarian Cysts, Uterine Fibroid
Types of Low back pain & Treatment
Lumbar Strain ( Acute or Chronic)
One of the most common types of low back pain is stetch injury to the ligaments or muscles in low back leading to Lumbar Stain. This over stretching results in tears of ligaments or tissues. Usually seen in people above 40 but can happen at any age. Symptoms include difficulty or discomfort with pain in low back after a trauma. The injury or trauma range from mild to severe depending upon degree of strain resulting in spasm of muscles of low back.
Treatment of Lumbar Strain
Treatment is based on history of injury, location of pain and exclusion of nervous system injury. X- ray helps in excluding bone abnomalities.
‘Anti inflammatory medicines, Analgesic or Pain releiving medicines are given inernally as per Siddha. Light massage with local heat application, exercises and reconditioning yoga techniques is employed externally in majority of cases. Spinal manipulation with suitable oil up to 1 month is helpful for those who do not have any nerve involvement.
This is seen if nerve irritation is present which is caused by damage or degeneration of disc between the vertebra. A disc damage or wear and tear may occur due to progressing age or trauma leading to a medical condition called slip disc or herniated disc. A spinal disc herniation is caused due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allowing the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer rings. Tears are usually postero-lateral in nature owing to the presence of the posterior longitudinal ligament in the spinal canal. This tear in the disc ring may result in the severe pain, even in the absence of nerve root compression. This condition is also known as a herniated, ruptured, prolapsed, or more commonly slipped disc. Herniated discs may occur in any part of the spine. Herniated discs are mostly seen in the lower back especially at the L4-L5 and L5-S1 levels (lumbar disc herniation). This is because the lumbar spine carries most of the body’s weight. The second most common area is neck (cervical disc herniation).
Patient may have a little low back ache to severe pain radiating to regions served by affected nerve root that are irritated or compressed by herniated material. A lumbar nerve root typically exit at a corresponding disc level (ie L4- L5 intervertibral foramen). A paracentral disc herniation at L4 -L5 will compress the transversing L5 nerve root instead of L4, which will exit above the level of herniation. A central disc herniation at L3-L4 or a lateral disc herniation at L4- L5 compresses or affects the L4 nerve root causing weakness of qaudriceps muscle and patellar tendon reflex is absent or depressed.
Central or paracentral disc herniation at L4, L5 affects L5 nerve root causing weakness of foot and toe dorsiflexors. A disc herniation at L5, S1 causing S1 nerve root compression which may lead to weak plantar flexion of foot, loss of achiles tendon reflex or tingling in the nerve distribution. Symptoms are variable, but L5 entrapment radiates to postrolateral aspect of thigh, posterior calf and medial aspect of foot whereas S1 sciatica has similar distribution in thigh and calf but radiates to lateral aspect of foot.
Straight leg raising test is to detect sciatic nerve root tesion performed on both legs asking the patient to lift the leg with knee straight. Pain usually increases in sciatica by increasing the angle of elevation. With L4 or higher root compression pain may be increased on lying down position. If the prolapse is very large and presses the spinal cord or cauda equina in Lumbar region, affection of both sides of the body may occur leading to permanent nerve damage resulting in paralysis, loss of bowel and bladder control and sexual dysfunction. Such patients require urgent surgical decompression however prognosis is not so good.
Treatment for disc Herniation
In Siddha proper diagnosis is made according to Nadi. Usually Vitiated vatha humour is to be normalised. Even recurrence of symptoms in post surgical cases can be well managed through Siddha Medication. Detoxification of the body, Rejuvenation and Toning the spine is done with appropriate Internal Medicines. During the External Therapy, Special Varma massage with Medicated Oil, Steam bath, Pizhichil or Oil immersion technique and other physical manipulating techniques are used to relieve spasms, inflammatory changes,nerve compressions and strengthening the spine. If the patient approaches in earlier stages, a very good prognosis is seen and surgery can be prevented. However the duration of treatment may extend from 1-5 weeks depending upon the severity of the condition, even total cure without recurrence is also possible. Internal medicines include Herbal/ herbo-mineral compounds to improve the strength of spine and the surrounding soft tissues & bones as well.
Yogasanas and Pranayama like Naadi Suddhi is extremely beneficial for such complaints. Starting with the mild stretching exercise of spine the patient can slowly switch to asanas like Bujangasanam, Salapasanam, Dhanurasanam, Pakshimosiddhasanam, Vajrasanam, Paravakonasanam, Ekapathasanam etc and twisting poses of spine like Artha Machendirasanam, Trigonasanam. Always practice yoga and Naadi Suddhi under a yoga guru. Exercises which puts excess pressure on the back like Sarvangasanam, Halasanam should be avoided.
The largest and longest single nerve in the human body is Sciatic nerve, about as big around as a man’s thumb at its largest point. The nerve originates in the lower spine as nerve roots exit the spinal cord (through gaps in the bones bones of the lower spine), and extends all the way down the back of the leg to the toes. The sciatic nerve supplies sensation and strength to the leg as well as the reflexes of the leg. It connects the spinal cord with the outside of the thigh, the hamstring muscles in the back of the thighs, and muscles in the lower leg and feet. As such, when the sciatic nerve is impaired, it can lead to muscle weakness and/or numbness or tingling in the leg, ankle, foot and/or toes. The patient suffering from Sciatic nerve compression may have a lumbar disc herniation at L4-L5 or L5-S1 level with symptoms like constant pain in one side of buttocks radiating down the leg. Pain worse while sitting and long standing. Weakness and numbness is felt in moving leg.
Yoga involving gentle back bends and twists are beneficial. Back bend Yoga postures like Dhanurasana, Bhujangasana, Salapasana etc. Yoga asanas involving compression of back must be avoided. If you your sciatic pain is caused by a herniated disk, twisting yoga poses may not be the best choice for your yoga practice. Always move into the poses slowly, and stop if you feel any pain
Mild twist yoga like Ardha Matsyendrasana can be done. Some yoga poses for sciatica should be avoided which involves forward bending, whether standing or seated. If the hips or hamstrings are too tight, forward bending can put strain on the lower back and worsen sciatic pain.
Medicines: Nervine tonics, Anti inflammatory, Analgesics can be drug of choice with exernal manipulations like massage, steam bath, certain kizhi application, Varma techniques, etc.
Any condition resulting in movement or growth of vertebra of lumbar spine causing encroachment or limiting space for adjacent spinal cord and nerves. Causes of encroachment usually seen are
Narrowing foraminal through which nerves passes in and out of spinal cord
Spondolisthesis that is slippage of one vertebrae relative to another.
Spinal stenosis meaning compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal. Spinal-nerve compression in such conditions can lead to sciatica pain that radiates down the lower extremities. Spinal stenosis can cause pain in lower-extremity that worsen with walking and is relieved by resting.
Bone and Joint Diseases
Aging can bring changes in the water and protein content of the body’s cartilage making the cartilage weaker, thinner, and more fragile. As both the discs and the joints that arrange the vertebrae (facet joints) are partly composed of cartilage, these areas are subjected to degenerative changes. Degeneration of the disc is called spondylosis. Spondylosis can be seen well on X-rays of the spine as a narrowing of the normal “disc space” between the vertebrae and is a predisposing factorthe disc to herniation asd localized lumbar pain or lumbago. Degenerative arthritis (osteoarthritis) of the facet joints may be a cause of localized lumbar pain that can be detected with plain X-ray testing.
Such diseases can be treated well through Siddha Medicines and has a very good prognosis in early stages. Massage with correct oil, Kizhi or formentation, External Manipulation tehniques with varma, Steam bath, Bandaging with oil, Pooch or application of medicated pastes etc can be done.
Other diseases pertaining to bone and joint include Oteoporosis, fracture, Arthritis, Spondyloarthropathies etc which can be treated according to the symptoms, history and severity of the disease.
Other Causes of Low Back Pain
Low Back Pain is usually associated with Kidney stones, infections and traumatic bleeding of the kidney (hematoma). Diagnosis can involve urine analysis, sound-wave tests (ultrasound), or other imaging studies of the abdomen.
Low back pain in pregnancy is due change in the normal lumbar curvature by the positioning of the baby inside of the abdomen. Also minor side effects of the female hormone estrogen and the ligament-loosening hormone relaxin contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are good for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors’ advice. Natural labor can also cause low back pain.
Ovarian cysts, uterine fibroids, and endometriosis not infrequently cause low back pain. Precise diagnosis can require gynecologic examination and testing.
Tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors) low back pain. . Symptoms may be localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.
Diagnosis of back pain be made and reviewed including injury history, aggravating and alleviating conditions, associated symptoms (fever, numbness, tingling, incontinence, etc.), as well as the duration and progression of symptoms. Aside from routine abdomen and extremity evaluations, rectal and pelvic examinations may eventually be required as well. Further tests for diagnosis of low back pain can be required including blood and urine tests, plain film X-ray tests, CAT scanning, MRI scanning, bone scanning, and tests of the nerves such as electromyograms (EMGs) and nerve conduction velocities (NCVs)
Siddha Medicine, Treatment & Prognosis :
Spine strengthening medicines, medicines to prevent degeneration, pain relieving medicines, Anti-inflammatory medicines , Rejuvenatory medicines etc are available in Siddha. These medicines are safe, natural without side effects unlike those pain killers and steroidal drugs used in Allopathy. External manipulation together with internal medication and good co-operation of the patient proves to be very effective. Patients should always approach a physician who administer the external treatment themselves and not by any trainee or therapist. A new trend of business is present today like massage parlors and resorts advertising great unexpected results of such diseases in their place. As a matter of fact most probably no qualified doctors may be available and such treatment would worsen the disease and aggravate the symptoms. Such people may hesitate to approach even the right place from the fear of getting cheated again. A Siddha Physician who has the true knowledge of Varma and Thokkanam will surely carry all the external procedures himself for best results.
What ever may be the cause of back pain, an earlier diagnosis always makes a promising result. People often gets misguided by the interpretation and remarks of the physician and approach for a surgery even for minor disc or spine complaints. A second opinion, a deep thought and analysis should be made before each treatment. Surgery can only make some temporary changes but ultimately the movement and locomotory aspect does not get corrected.
This article may be a help for all those who keep surfing the net about their low back problems. Make your own decision wisely because you and your spine both are precious.