Backache also called lumbago or sciatica, has existed since man learnt to stand erect. Descripations of the condition occur in ancient literature. Backache is a common complaint among the young and the old. How many people are there who do not suffer from backache during their lifetime? Many suffer from mild, infrequent ache for years before it becomes serious. Many complain of pain after pushing a heavy almirah or lifting something heavy even when they have no injury. Backache many start without any apparent cause. Some ladies complain of pain persisting after a pregnancy. Other complain of pain during their menstrual periods which is severe enough to keep them in bed for 2-3 days and force them to take analgesics.
Human diseases assume importance when they cause death and disability. Lumbago and sciatica do not kill a man, but they are prevalent and cause much suffering. In Sweden, members of the National Health Scheme report their illness by telephone in order to receive compensation from the Central Bureau. So statistics there are readily available. Back pain has been reported among fifty-three per cent of workers doing light jobs and sixty-four per cent of those doing heavy work. Low back pain is prevalent in the younger age group too.
The mean age of the onset of pain is thirty-five years. Among those complaining of low back pain, thirty-five per cent are likely to develop sciatica and ninety per cent will have future reccurrences. Fifty per cent of those suffering from low back pain also complain of pain in the neck, but on an average, they experienced it six years after their low back pain had started. Twenty per cent of them have pain in the thoracic spine.
A clinical and radiological survey of the British town of Leigh revealed that among males between the ages of fifty and sixty-four, eight-three per cent showed evidence of significant lumbar disc degeneration.
Low back pain can be experienced as follows:
Discomfort in the lower back.
Severe pain localised in the lower back. This may occur suddenly and is called acute lumbago. When it comes gradually and persists for a long time, it is called chronic lumbago.
Pain radiating from the lower back to the buttocks, or it may radiate to the anterior aspect of the thigh when the higher lumber area is involved. This is called sciatica.
It is quit spectacular to see a patient who is bent over as a result of pain, recover instantaneously following manipulation. These manoeuvres appear to be very simple; only the click sound is often heard during manipulation. It is generally considered that lumbago occurring in young people is the most obvious symptom for manipulation. However such cases sometimes recover after simple bedrest. But more severe cases of sciatica, persisting for years, and with no obvious sign of subsiding, improve with manipulation.
Let us examine the case of a patient with a typical history of acute lumbago. The patient probably felt pain and heard a clicking sound while lifting a heavy object from the ground. (This may also happen while pushing a heavy objects like an almirah). The pain became severe and the patient was unable to move. A few days later, the pain became less severe, but radiated to the buttocks, the back of the calf and foot. Tingling and numbness were felt in the leg. There was severe pain while sneezing or coughing.
A patient with these symptoms and acute back pain adopts a peculiar posture. Muscles in the lower part of the back look prominent as they are contracted in an effort to immobilise the painful spine. The patient tries to assume a posture of maximum comfort. He may develop a lateral curve. The curve may also get obliterated and become straight. The patient finds it difficult to bend forward or backward. Lateral bending is not so painful. He is not able to raise the painful leg high while lying on his back. A careful examination may reveal that there is wasting of the muscles. The corresponding tendonous jerks are impaired or absent.
In a few cases the pain can start without any history of injury, and the onset may be gradual. It may be confined to the back only and not travel to the legs. Sometimes a patient does not feel any pain in the lower back. He may feel it only in the legs and calf muscles. In cases where a higher lumbar disc is involved, the pain radiates to the groin or to the front of the thigh.
Patients with a prominent belly have increased anterior convexity of the lumbar spine. They have more prominent buttocks and a belly. They feel pain while standing and while bending backwards, and experience relief when they sit or bend forward, or when they lie on one side with the knee and hip bent upwards. In such cases more weight is carried by the posterior arches than by the vertebral body and disc. These arches are not meant to bear weight, hence wear and tear in the facet joints starts. This may affect the intervertebral foramen, and put consequent pressure upon the nerves.