Lumbago, is a pain caused by pressure of a structure on tiny nerves which innervate the muscles and ligaments in the lumbo-sacral region of the spine. Sciatica, on the other hand, is caused by a similar pressure on the sciatic nerve roots and generally extends from the origin all along the territory it serves in the buttocks, thighs, legs and feet.
Incidence: – Lumbago is more common today than during the past generation. This is due to a change in the way of life of a modern man in an industrialized country, with vehicles for his transport, sedentary life in an office or a factory, lack of exercise which help in his growing a pot-belly. Even when he works in a workshop, his work is usually of a repetitive type which forces him to adopt a posture with back held in one position over a long time. This leads to muscle fatigue, contracture, spasm and results in pain.
Lumbago is no respector of age or of sex. No profession or class of people is exempt from it. In industrialized countries, it has been estimated that about 80% of its population suffers from it. At year for any productive work. In developing countries incidence is low because of less development of industries and automation.
Etiology: – Lumbago (as also sciatica) has causes so numerous that in any particular case, it becomes difficult to pin-point the one or the other responsible for the trouble. In a large majority of cases the following causes have been detected.
- a) Pressure of a structure on a nerve in the lumbosacral region, the offending structure may be:
- HERNIATED INTERVERTEBRAL DISC: – (Popularly called the ‘slipped disc’) or the gelatinous core material of a ruptured disc. Due to some jerky movement, a load suddenly imposed on the lower back as in a fall or a severe jolt as in emergency braking of a fast running vehicle, the disc/discs become herniated or even ruptured. In such a condition, a slight movement of the spine such as is caused by coughing, sneezing or laughing elicits excruciating pain.
- VERTEBRAL PROCESSES: – Or bony knobs of the vertebrae pressing or pinching on the tiny nerves serving the area after slight dislocations of the facetal joints. This trouble is also caused by a suddenly applied load or jolt as in above.The consecutive vertebrae or their processes pressing or pinching on the nerves between them.This is brought about by thinning of the disc between them either by its rupture when the core material has escaped, by an aging process which leads to drying out of the core material or by degeneration of the disc due to rheumatoid arthritis.
- A TUMOUR: – In the spine or in an organ or structure impinging on the nerves.
- THE SPICULES:- Developed on the vertebrae due to osteoarthritis in elderly persons or after an injury, pinching on the nerves
- b) OVERTAXED MUSCLES: – These are in the lower back which suffer from fatigue, contracture or spasm.In a healthy condition, muscles relax and contract rapidly during a movement but, when they are overworked or are held in one position as in a machinist doing a repetitive type of work or when bending over an ironing table, they develop sustained contraction or spasm. The body of the muscle becomes a hard knotty mass. The blood supply to it is either reduced or even stopped, thereby depriving it of its much needed oxygen and other nutrients and making the removal of the waste products difficult. Some muscle fibres consequently die. A distress signal goes to the brain which evokes pain, warning the victim that something is wrong. The unused muscles in the neighbourhood also get atrophied.
- c) TRAUMA OR INJURY TO THE SPINE: – Even a long forgotten fall, unless effectively treated in time, may lead to a permanent straining of the spinal musculature which results in chronic lumbago.
- d) PSYCHOLOGICAL FACTORS: – They constitute a potent cause of frequent attacks of lumbago. The trouble is not due to any overt disease in any organ but is an emotional response of the patient, manifesting itself in some from in any weak part of the body, to stresses or strains or every day life, worry, disappointed love, bereavement. Masked depression resulting from difficulties on the job, difference with the boss with problems of personal relations may also bring about the attack. Boredom resulting from aimlessness or lack of direction in life is another important cause of the malady.
Quite often it leads to overeating which causes obesity which further accentuates the trouble. This category also includes another class of lumbago patients. A long married woman suffers from a fall and develops lumbago a workman gets injured while on duty in a workshop and develops low back pain. After treatment, the pain disappears in both cases but the patients still continue to complain of pain, the former to get continued love and increased attention from her busy husband which she got during her illness, the latter to get higher compensation under the Workman’s Compensation Act and premature retirement with pension such malingering is difficult to detect.
Besides the above chief causes, the following are some of the others which account for about 10% of the lumbago patients.
- Obesity: – According to a back-doctor an additional 5 kg of extra body weight on the abdomen places an additional load of about 50 kg. on the discs the pushing out of the pot belly is balanced by the buttocks pushing out the back thus resulting in permanent changes in the spinal curvature.
- Infections: – Infections in the bones, joints or in the organs in the abdomen following attacks of colds, influenza, typhoid, etc, leading to inflammations and congestions.
- Abnormalities in the spinal Column: – Some of them are congenital while others result from faulty developments.
- One leg shorter than the other leg by about one centimeter.
- Fallen arches of the feet.
- Weakened abdomen following pregnancy and long waist line in women.
PROPHYLAXIS (Preventive Treatment)
The following hints are offered for preventing an attack of back-ache:
- Since one spends most of the working hours sitting, choose a chair which provides a firm support to the back, especially its lower part. Keep feet slightly raised. Occasionally get up and walk about in the room.
- Sleep on a bed with a firm mattress, use only one thin pillow. Sleep on the right or the left side with a bend to the knee. Avoid lying on the belly.
- At stand-up (buffet) patties, do not keep standing at one place for long move about. Occasionally sit down for a while.
- While driving you car when going on a long journey, stop the car every hour, get out and stretch your legs by walking about.
- When sometime rather heavy load has to be lifted from the floor, do not bend from the waist to do so. Instead squat and pick it up keeping the back straight. A bucket full of water, instead of being lifted and moved a short distance away, should be slid along the floor.
- When carrying groceries or vegetables from the bazaar, divide the load into 2 almost equal packets, each carried in a basket, one basket to be carried in each hand. If a package cannot be divided, then shift it, while carrying, from one hand to the other.If a heavy load has to be carried over a long distance on the back, carry it in a rucsac or in a bag evenly balanced between the shoulders.
- Do not use high-heeled shoes as they throw the spine badly out of line.
- Avoid girdles and skin-tight jeans. If worn for any length of time, they tend to weaken the abdominal muscles which provide a prop for the spine.