Would it surprise you if I said that
‘vanity’ was one of the prime reasons we get back pain? The real reason you
get a bad back is because our forefathers decided we looked better walking
on our hind legs, instead of all four. Just like a horse, the bones of our
spines lock together nicely when we are on all fours, and weight can be
carried easily on our backs. However, when we stand up and try and lift, it
all goes pear-shaped from there. The spine was not designed to carry loads,
or pick up loads, in the vertical position.
But unfortunately, lift and carry is a
prime example of what we call on people to do, from mothers lifting babies
to laborers lifting bags of rice. The presenting situation is one we meet
only too often. The patient is doing something and suddenly everything locks
up and they are immobilized, frozen to the spot. I was once called out to a
factory toilet where the chap was bent over the urinal, and too afraid to
move, the pain was so acute.
Back pain is one of the commonest
orthopedic problems, and the often used terms such as lumbago, sciatica and
slipped discs are spoken about frequently.
Let’s look at the “slipped disc”
problem. First thing - discs do not “slip”. They do not shoot out of the
spaces between the vertebrae (the tower of cotton reels that makes up your
spine) and produce pain that way. The disc actually stays exactly where it
is, but the center of the disc (called the nucleus) pops out through the
edge of the disc and hits the nerve root. When this happens you have a very
painful condition, as anyone who has had a disc prolapse (our fancy name for
the “popping out” bit) will tell you. Think of the pain when the dentist
starts drilling close to the tiny nerve in your tooth. Well, this is a large
nerve! When the nucleus of the disc hits the sciatic nerve, this produces
the condition known as Sciatica - an acute searing pain which can run from
the buttocks, down the legs, even all the way through to the toes.
Unfortunately, just to make diagnosis a
little difficult you can get sciatica from other reasons as well as
prolapsing discs. It may just be soft tissue swelling from strain of the
ligaments between the discs, or it could even be a form of arthritis.
Another complicating fact is that a strain may only produce enough tissue
swelling in around 12 hours after the heavy lifting, so you go to bed OK and
wake the next morning incapacitated. And then you have to convince the
employer that you did it on his time.
To accurately work out just what is
happening requires bringing in those specialist doctors who can carry out
extremely intricate forms of Medical Imaging called CT Scans, Spiral CT’s or
MRI that will sort out whether it is a disc prolapse, arthritis or another
soft tissue problem. The equipment to do these procedures costs millions of
baht, and the expertise to use them takes years of practice and experience.
This is one reason why some of these investigations can be expensive.
After the definitive diagnosis of your
back condition has been made, then appropriate treatment can be instituted.
The forms of treatment can be just simply rest and some analgesics (pain
killers), physiotherapy, operative intervention or anti-inflammatories and
Now perhaps you can see why it is
important to find the real cause for your aching back. The treatment for
some causes can be the wrong form of therapy for some of the other causes.
“Self diagnosis” is dangerous!
So what do you do when you get a
painful back? Rest and paracetamol is a safe start. If it settles quickly,
then just be a little careful with lifting and twisting for a couple of
weeks and get on with your life as normal. If, however, you are still in
trouble after a couple of days rest, then it is time to see your doctor and
get that definitive diagnosis. It is the orthopedic chaps you need to see.