A pain in the back - Sports Medicine Doctor Malta - Dr Danica Bonello Spiteri

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A pain in the back

A pain in the back (First published on vida magazine on July 2013)

The advance of homo sapiens as a species has led us from getting around on all fours, to being upright on two legs. With this came the disadvantage of back pain as a common ‘defect’ in our anatomical make up. However, our ancestors, who had to hunt for food, build shelters and so on did not have the high incidence of back pain as is so prevalent in today’s’ society. So what has happened over time to result in this change?

One major cause of back pain is immobility and our sedentary lifestyles. Backs need to be kept moving to maintain their range of movement. Sitting down for prolonged periods of time is the worst thing to set off and also prolong back pain.

In the past decade or two ago, back pain used to be treated with ‘bed rest’. Yet, we now know that this is a totally wrong approach. Bed rest will mean that the muscles around the lower (lumbar) spine stop working as well as they should, and they become progressively weaker. The weaker the muscles become, the worse the back pain episodes are. Hence, the best treatment for back pain is to keep as active as possible.

The most common presenting complaint of back pain is that a sudden twist or bending down to the floor causes a sudden sharp pain or a pop in the back, as if the back has given way. Some people also attribute a minor fall to the ground or down a few steps as the cause of their prolonged misery of a lifetime of back pain. In reality, these episodes are not the actual cause, but simply the trigger of the back pain. The actual cause of back pain comes on insidiously, where there is a lack of mobility, lack of exercise and proper back movement, the back and abdominal muscles become weaker over time. This downward spiral continues with no pain whatsoever, as other muscles within the body will compensate for this lack of movement and strength. Eventually that one episode sets off the pain as the body cannot compensate any longer.

The good news to back pain is that it settles down with time (usually a few days or weeks), and the intractable pain subsides. The person incorrectly assumes that they are ‘cured’, possibly through some pain medication, yet this is totally the incorrect management. Once the back pain is gone, there needs to be aggressive input to restore the back movement and muscle strength in the spine and abdominal wall. This is referred to as ‘core strength’. If this approach is not taken, there are often repeated episodes of lower back pain, with each one often progressively worse than the previous one in terms of intensity of pain, duration for pain to resolve, and over time an increasing frequency of episodes of back pain.

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