Back pain

B a c k Pa i n

ASSIGNMENT BY R.RAJAN Msc.YOGA (L.E) REG NO:10056007013

TAMIL NADU PHYSICAL EDUCATION AND SPORTS UNIVERSITY DIRECTORATE OF DISTANCE EUCATION DEPARTMENT OF YOGA CHENNAI 2010 - 2011

Introduction: Back pain (also known as dorsalgia) is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. Today, a large population of the modern world faces the nemesis of back pain in its variant forms. Many of these ailments are getting neglected as minor complaints and do not even require a visit to the Medical Doctor, whereas many others will stretch the affected to the extent of crippling him. The search for an answer in this regard usually leads one to take many medications which relieve the pain, but does not provide any sort of cure for the problem as such. Otherwise he will have to opt for surgical options, which may in turn open up a plethora of complications. Adding to these are the mental strain and the financial burden afflicted on him, especially when surgical interventions are required. All these direct us to the need for a serious approach towards a treatment protocol which gives relief and that too, if possible, in a non-surgical way, which will then become the greatest boon to the ailing humanity. BACK PAIN:

Back Pain Msc.YOGA (L.E) REG.NO:10056007013

The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas. It may be a dull ache, or a sharp or piercing or burning sensation. The pain may radiate into the arm and hand), in the upper back, or in the low back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling. Back pain is one of humanity’s most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities. Classification Back pain can be divided anatomically: neck pain, upper back pain, lower back pain or tailbone pain. By its duration: acute (less than 4 weeks), sub acute (4 – 12 weeks), and chronic (greater than 12 weeks). By its cause: musculoskeletal (MSK), infectious, cancer, etc. Back pain is classified according to etiology in mechanical or nonspecific back pain and secondary back pain. Approximately 98% of back pain patients are diagnosed with nonspecific acute back pain which has no serious underlying pathology. However, secondary back pain which is caused by an underlying condition accounts for nearly 2% of the cases. Underlying pathology in these cases may include metastatic cancer, spinal osteomyelitis and epidural abscess which account for 1% of the patients. Also, herniated disc is the most common neurologic impairment which is associated with this condition, from which 95% of disc herniations occur at the lowest two lumbar intervertebral levels.

back pain Msc.YOGA (L.E) REG.NO:10056007013

Associated conditions Back pain can be a sign of a serious medical problem, although this is not most frequently the underlying cause: • Typical warning signs of a potentially life-threatening problem are bowel and/or bladder incontinence or progressive weakness in the legs. • Severe back pain (such as pain that is bad enough to interrupt sleep) that occurs with other signs of severe illness (e.g. fever, unexplained weight loss) may also indicate a serious underlying medical condition. • Back pain that occurs after a trauma, such as a car accident or fall may indicate a bone fracture or other injury. • Back pain in individuals with medical conditions that put them at high risk for a spinal fracture, such as osteoporosis or multiple myeloma, also warrants prompt medical attention. • Back pain in individuals with a history of cancer (especially cancers known to spread to the spine like breast, lung and prostate cancer) should be evaluated to rule out metastatic disease of the spine. Back pain does not usually require immediate medical intervention. The vast majority of episodes of back pain are self-limiting and non-progressive. Most back pain syndromes are due to inflammation, especially in the acute phase, which typically lasts for two weeks to three months. A few observational studies suggest that two conditions to which back pain is often attributed, lumbar disc herniation and degenerative disc disease may not be more prevalent among those in pain than among the general population, and that the mechanisms by which these conditions might cause pain are not known. Other studies suggest that for as many as 85% of cases, no physiological cause can be shown. A few studies suggest that psychosocial factors such as on-the-job stress and dysfunctional family relationships may correlate more closely with back pain than structural abnormalities revealed in x-rays and other medical imaging scans.

back pain Msc.YOGA (L.E) REG.NO:10056007013

Pain Management: The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore the individual’s ability to function in everyday activities; to help the patient cope with residual pain; to assess for side-effects of therapy; and to facilitate the patient’s passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long term pain relief. Also, for some people the goal is to use nonsurgical therapies to manage the pain and avoid major surgery, while for others surgery may be the quickest way to feel better. Not all treatments work for all conditions or for all individuals with the same condition, and many find that they need to try several treatment options to determine what works best for them. The present stage of the condition (acute or chronic) is also a determining factor in the choice of treatment. Only a minority of back pain patients (most estimates are 1% - 10%) require surgery. Pain Relief Remedies: • Heat therapy is useful for back spasms or other conditions. A meta-analysis of studies by the Cochrane Collaboration concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain. Some patients find that moist heat works best (e.g. a hot bath or whirlpool) or continuous low-level heat (e.g. a heat wrap that stays warm for 4 to 6 hours). Cold compression therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases. • Use of medications, such as muscle relaxants, opioids, non-steroidal antiinflammatory drugs (NSAIDs/NSAIAs) or paracetamol (acetaminophen). A meta-analysis of randomized controlled trials by the Cochrane Collaboration found that there is insufficient clinical trials to determine if injection therapy, usually with corticosteroids, helps in cases of low back pain A study of intramuscular corticosteroids found no benefit. • Massage therapy, especially from an experienced therapist, can provide short term relief. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage. back pain Msc.YOGA (L.E) REG.NO:10056007013

Depending on the particular cause of the condition, posture training courses and physical exercises might help with relieving the pain. • Exercises can be an effective approach to reducing pain, but should be done under supervision of a licensed health professional. Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. However, one study found that exercise is also effective for chronic back pain, but not for acute pain. Another study found that back-mobilizing exercises in acute settings are less effective than continuation of ordinary activities as tolerated. Physical therapy consisting of manipulation and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine). ‘Back schools’ have shown benefit in occupational settings. The Schroth method, a specialized physical exercise therapy for scoliosis, kyphosis, spondylolisthesis, and related spinal disorders, has been shown to reduce severity and frequency of back pain in adults with scoliosis. Studies of manipulation suggest that this approach has a benefit similar to other therapies and superior to placebo. • Acupuncture has some proven benefit for back pain; however, a recent randomized controlled trial suggested insignificant difference between real and sham acupuncture. • Education, and attitude adjustment to focus on psychological or emotional causes - respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain. Causes of Back Pain: Many conditions can cause back and neck pain, ranging from injury to infection to simply twisting the wrong way. An injury sustained in an automobile or other type of accident can damage muscles, joints, ligaments, and vertebrae. Overuse or underuse of the back is by far the most common cause of back pain that manifests as tightening or spasm of the muscles that connect to the spine. Inflammation and swelling often occur in the joints and ligaments, especially in the cervical and lumbar regions, as people age.

back pain Msc.YOGA (L.E) REG.NO:10056007013

A herniated disc occurs when the nuclear pulposus, the inner material of the disc, pushes through a tear in the annulus fibrosus, causing nerve root compression. The cervical and lumbar regions of the spine have the most mobility and the discs there are more likely to wear down or be injured. Ninety percent of disc herniations occur in the lower two lumbar vertebrae. Spinal stenosis, narrowing of the spine, can cause spinal cord irritation and injury. Conditions that cause spinal stenosis include infection, tumors, trauma, herniated disc, arthritis, thickening of ligaments, growth of bone spurs, and disc degeneration. Spinal stenosis most commonly occurs in older individuals as a result of vertebral degeneration. A pinched nerve, or radiculopathy, occurs when something rubs or presses against a nerve, creating irritation or inflammation. Radiculopathy can result from a herniated disc, bone spur, tumor growing into the nerves, and vertebral fracture, and many other conditions. Sciatica is a certain type of radiculopathy that involves inflammation of the sciatic nerve. Pain is experienced along the large sciatic nerve, from the lower back down through the buttocks and along the back of the leg. A spinal tumor that originates in the spine (primary tumor) or spreads to the spine from another part of the body (metastatic tumor) can compress the spine or nerve roots and cause significant pain. An infection that develops in the vertebrae (e.g., vertebral osteomyelitis), the discs, the meninges (e.g., spinal meningitis), or the cerebrospinal fluid can compress the spinal cord and result in serious neurological deterioration, if it is not diagnosed and treated immediately. Facet joints allow movement of the spine. These consist of two knobs, or facets, that meet between each vertebra to form a joint. As facet joints degenerate, they may not align correctly, and the cartilage and fluid that lubricates the joints may deteriorate. Bone then rubs against bone, which can be very painful. Bone and joint diseases (e.g, osteoporosis [link to WHC osteoporosis], ankylosing spondylitis, osteoarthritis) can cause degeneration, inflammation, and spinal nerve compression. back pain Msc.YOGA (L.E) REG.NO:10056007013

Symptoms Pain can be constant or intermittent. Intensity can vary from a dull ache to searing agony. The onset may be sudden, with or without apparent reason, or gradual. Most back pain resolves in a few days or weeks with or without treatment. However, some people have chronic pain that lasts months or years. Severe pain lasting more than a few days without improvement may require medical attention. Anyone having difficulty passing urine; numbness in the back or genital area; numbness, pins and needles, or weakness in the legs; shooting pain down the leg; or unsteadiness when standing should see a physician immediately. Localized pain is often described as aching, tight, stiff, sore, burning, throbbing, or pulling. The pain may worsen while bending, sitting, walking, or standing too long in one position. It may also be more prevalent at different times of the day, such as when a person wakes up in the morning. Pinched nerves produce numbness or tingling, warm or cold sensations, and burning or stabbing pain that begins in the back and radiates down the leg (e.g., sciatica) or arm. Activities such as coughing, sneezing, or walking may increase pressure on the pinched nerve and aggravate the pain. Compressed nerves causes numbness and weakness in the muscle associated with the nerve. The muscle may atrophy if the compression is not relieved. An infection affecting the spinal cord or nerves may produce fever and lethargy as well as symptoms of compression. Ayurvedic Treatment of Back Pain:Ayurvedic treatment brings back the balanced state of the body by internal as well as external ayurvedic therapies. Herbal products including preparations like ‘Asthavargam’ are given to the patient to be taken internally. Panchakarma treatments are also carried on which include massage, meditated enema etc. Medicines made of herbs like Yogaraja guggul, Lakshadi guggulu, Triphala Guggulu, Maanarayana tailam are also used for treatment. Posture correction is also done through “Yoga Asanas”. These treatments can be done under a well qualified ayurveda medicine practitioner. However, there are many home remedies that require common materials found in any household to cure back pain. back pain Msc.YOGA (L.E) REG.NO:10056007013

Home Remedies for Back Pain Rice: Take 1 cup uncooked rice and tie it in a thick cloth ( or fill it in a thick sock) Heat this cloth pack in the microwave for 30 to 60 seconds on mediumlow. Apply it to the back. Keep the temperature tolerable. Ice Packs: Apply ice packs immediately after back strain or injury. It reduces inflammation and helps numb pain. To prepare a cold compress, pack a few crushed cubes of ice into a plastic bag. Cover this bag with a towel, and apply it to the back for about 15-20 minutes. After 30 minutes, repeat the process. Epsom salts: These salts reduce swelling thereby relieving back pain. Two cups salts should be mixed in water in bathtub and the patient should soak in it for about 30 minutes. Ginger and Honey: It contains anti-inflammatory compounds and has mild aspirin-like effects. Take a 1- 2 inch fresh ginger root and cut into slices. Place the slices in 1 quart boiling water. Cover and simmer, 30 minutes on low heat. Cool it off for another 30 minutes. Strain the solution and mix some honey into it and drink. Yogic Treatment to Cure Back Pains: Yogic treatment: during the first week, practice the following asana: PawanMuktasana Bhujangasana Uttanpadasana Shavasana

back pain Msc.YOGA (L.E) REG.NO:10056007013

Second week and on wards: PawanMuktasana Bhujangasana Shalabhasana Uttanpadasana EkpadaUttansana Anulom-Vilom and Nadi shodhan Pranayama Shavasana Beside the above mentioned asana and pranayama practice of yoga nidra, concentration and meditation gives the best result. Asanas- Asana removes rigidity and brings flexibility to joints and help correct bad posture Pranayama -Breathing patterns can affect the spine in various ways, such as movement of the ribs and changes in pressure within the chest and abdomen. Exhaling can help relax muscles. Relaxation and Meditation- Relaxation provides a physiologic antidote to stress. Imaging techniques may also be used. For example, imagining a movement before it is actually performed makes it easier to move the muscles that are being used. Diet: It is recommended to stop taking bananas, and curd. Smokers should stop smoking. Stop taking tea or water upon rising in the morning. Reduce the number of cups of coffee tea or stop it completely. You simply don’t need any external stimulants.

back pain Msc.YOGA (L.E) REG.NO:10056007013

Include fruits (except banana), green vegetables (salad), and pulses (except arhar and kesari) in meals. You must completely stop the consumption of garlic, onion. You must consume one glass full of zero fat milk after removal of cream and in the food. One must make use of green vegetable salad along with the meal. The non-vegetarians can eat fish and liver with least amount of spices. Avoid eating fatty, spicy and fried stuffs. Drink a lot of water. Hygienic Care for Back Pain Thoroughly clean the mouth by gargling after eating anything. One can suffer back-pain even if body weight is more than essential But now a days, eating has increased too much, but working habit is com¬pletely nil. Servants mostly do all the jobs. In America, everything is done by electrical gadgets. Thus because the ligaments, and muscles of the waist and the back do not get enough exercise in the manner that is required, that part becomes rigid and brittle, hence on suffering even a small tension, the back gets stiff. Conclusion: Back pain in the elderly can be easily overlooked. Not uncommonly, it appears in an atypical manner, and the classic symptoms are often absent. Symptoms are too often explained as normal aging process or attributed to coexisting diseases. As back pain disorders are readily amenable to effective treatment by proper Diet, yoga practices and exercises that can improve quality of life.

back pain Msc.YOGA (L.E) REG.NO:10056007013