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Low back pain is very common.Almost 80% people experience low back pain at some point of their life time. As a sypmptom it is the 2nd most frequent cause of physician consultation next only to headache.It is equally important cause of disability and work absent-ism.Being so common a disease it has significant economic impact.Several key facts about Low Back pain is as followsbr /> Q1. What are the causes of Low back Pain(LBP) Ans:- The Commonest cause of Low back pain is "Idiopathic" ie exact cause is not known. Idiopathic Low back pain constitutes about 85 % of patients. In the rest 15% we can determine the cause.It can arise from any structure that constitutes the backbone or the evertebral column, starting from veretbare, muscles, ligaments, tendons, joints etc. Also it can rarely arise from organs situated outside the spine.And the cause effect relationship is not very clear.For example Changes occur in the spinal column with age and such changes can be demonstarted by X-ray, CT. MRI or other investigations commonly dubbed as "Degenertavie Changes".Most people with such degenrative changes have no symptoms and therefore attributing such changes to the symptoms are not quiet correct. 2. When Low Back Pain should be a concern? Ans:-Most cases of Low back Pain are benign and gets alright within 4-6 weeks even without treatment. So majority cases should not be alarming one.However under the following cirumstances Proper investigations and treatments become urgentbr /> If the age of the patient is less than 20 or more than 55yrs If Pain gets worse on rest in stead of getting relieved . If it increases at night and interferes with sleep. If it is accompanied by Fever and weight loss. If there is loss of control of urination and or clearing the bowel. If there is significant or progressive weakness, tingling, numbness or loss of sensation in the lower limbs. Q3.How much useful are Imagings MRI , X-rays etc. Ans:-X-Rays is not very useful for evaluation of LBP. It can depict abnormality only in 10% of cases. X-rays shows only abonormalitise of the bone and not the soft tissue structures which can well be the source of the pain. MRI or Magnetic resonance Imaging is an excellent Imaging technique and shows cleary both soft tissues and bones.However there are two disadvantages of MRI. 1.The investigation is costly and not universally available, 2:- High rate of false positive result, MRI shows abnormality in asymptomatic individuals in about 20-40% of cases.So result of MRI should always be interpreted in the light of the clinical picture. One should always remember the map is not the territory and the patient should be treated not the MRI or the X-Ray Film. Q4.How Many patients of low back pain needs operation? Ans:-Less than 5% patients of LBP need surgery.Cauda equina Syndrome(LBP accompanied by loss of control over urinary bladder and or bowel, anesthesia of the perianal region and weakness of lower limbs)is the condition where emergency operationshould be carried out.However Cauda equina syndrome represents only less than a fraction of patients. All types of conservative measures should be tried before resorting to surgery. Q5.When should be operation undertaken? Ans:-The decision for operation in a patient should be taken carefully.If not operated the condition gets al right within 4-6 weeks even where MRI shows clear cut Disc prolapse.It has been proved by MRI repeated after 6 months that the prolapsed disc retreats to its normal position. So Prolapsed disc detected by MRI does not always mean that surgery should be carried out without delay.The immediate result of surgery may be very good but the long term result may not be that encouraging. One more thing about operation is , if the pain recurrs in a previously operated patient it may be more difficult to treat and may be incurable even- the case being termed"Failed Back Syndrome" On the otherhand Unusual delay where operation is indicated may prolong suffering. So careful case selection is imporatnt and if necessary opinion of of several sepcialists can be taken. Q6. What is Disc prolapse or PLID(prolapsed Lumbar intervertebral Disc) Ans:- Our Vertebral columns consists of bones called Vertebrae stacked one upon another.In between two vertebrae a spongy Disc is interposed which acts as shock absorber. The disc under stress or sometimes withount apparent cause migrates back wards and gives pressure on the nieghbouring nerves causing intense low Back pain that may shoot down the back of the thighs and legs down to the toes .Back pain is Lumbago and pain along the Nerve that travelles down the back of the thigh and legs(Sciatic Nerve) is called Sciatica.So back pain accompanied by thigh and leg pain is called "Lumbago Sciatica Syndrome" Q7. Who are the usual sufferers of LBP? Ans:- Age- the commonest age group for LBP is 30-50.People of this age group are also the people at their most productive age group so loss from inability to work is considerable. Sex; No sex prediliction exists and both male and female suffer equally. Body Builduild with protuberant abdomen alters the mechanics of the spine and so people who have fat belly like the obese or women giving multiple child birth ar at greater risk of developping LBP. Occupation:Workers whose occupation demands sitting or standing for prolonged period of time are more vulnerable to develop LBP.Lean and fit individuals develop LBP much less often. Q8. What is acute and chronic LBP Ans:- Low back pain lasting for short period of time and usually of sudden onset is acute LBP and chronic LBP is one which is present for long period of time ie more than 3 months. The two types of Low Back pains differ in outcome. More than 90% acute LBP gets alright and on the otherhand Chronic LBP is difficult to treat and involves multiple types of treatment approaches. Q9.What is the role of physiotherapy " Ans: One should always remeber that since no clear cut cause can be established in the majority of the patients straight cut treatment prescription is difficult. Physical therapy by itself has limited value. The so called therapies" like SWD(short Wave Diathermy), MWD(Microwave Diathermy) or Ultrasound therapy are examples of deep heating only. Heating has a soothing effect on nerves and patients feel comfortable, how ever the effect is shortlasing only. . Q10. What is Multidisciplinary approach to treatment of LBP. Ans:- The best effective approach to treatment of chronic Low Back pain is "Bio-psych-social" Multidisciplinary approach.Instead of relying on any particular method of treatment all the contributing factors should be addressed. So several specialists like Neurology,neurosurgery, Physical Medicine, orthopedics, psychiatry, physical therapy should all be involved, i) Patient Education:- Patients should be given an idea about the nature of the problem and possible management approaches. ii)Good posture in works , leisure, sleep, standing, walking sitting and in day to day actvities like lifting objects from the floor driving car etc. These include :- Sleep in firm flat bed. sitting in wooden non sagging chair with arms, with back support by small pillow at the back, frequent (every 15-20 mins) change of posture .Sit straight walk straight and stand straight,never work with the spine bent , to pick up things from the floor first sit on the floor and then pick up things. Psychological Factors :- Depression can be consequence or cause of Low back pain.Worry, anxiety, loss of work, job dis-satisfaction etc all be adressed by behavioural therapy , psychiatric management or antidepressant drugs. Social contributory factors like inability to participate in social activities like attending the Prayer session or friend;s birthday or marriage ceremony ,should also be addressed. Q11.What is the role of Rest