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Pain in the...Back, and its Reasons By- Ragini Chaturvedi Ragini Chaturvedi has been living in New Jersey , USA for the last 3 years. Before that she was in New Delhi and Bombay. Ragini has a 12 years of experience in Print Media in the capacity of transcriber, translator, copy-editor and editor with various reputed publishing houses.

Back pain is one of the most common health complaints. More time is lost to back problems than any other work-related injury. After the back has been injured once, the likelihood of recurring back problems increases significantly.

Reasons for back injuries are related to incorrect body mechanics, faulty posture over-use of certain muscles and joints stress and fatigue and trauma. Some patients report a sudden onset of back pain, related to a specific accident at a certain time and place. Others report a gradual onset before severe pain occurs.

Warning Signs for Serious Problems.

Certain warning signs should alert a patient to see a physician immediately for low back pain. Any very severe back pain warrants attention, particularly if any of the following conditions are present: being over 50; recent injury; fever; pain awakens the person at night, is increased by lying down, or is unrelated to movement. A patient should seek medical help for back pain if there is history or the presence of cancer, chronic use of corticosteroids, intravenous drug use, or urinary tract infection. Parents should call a physician immediately if children experience any severe neck or back pain.

Symptoms of Cauda Equina Syndrome Cauda equina syndrome can cause permanent incontinence if not promptly treated with surgery. Symptoms of the syndrome include dull back pain, weakness or numbness in buttocks, genital area, or thigh and an inability to control urination or defecation. Pain accompanied by fever can indicate an infection. Pain that lasts for a month, unexplained fever or weight loss, and a history of cancer may indicate a tumor.

Over time, greater loads on the spine lead to more serious back injuries, such as disc degeneration, which require surgery.

Recurring back injuries debilitate workers, and create massive health care costs.

In the first study of its kind, Ohio State University researchers believe they have found an important factor in recurring back injury: our natural tendency to avoid using .

The findings of this study were published in the December 1 issue of the journal Spine. It points to new forms of physical therapy and new safety standards for physical labor in the workplace.

In the first study of its kind, William Marras (right), director of the Biodynamics Laboratory at Ohio State, and his colleagues developed a mathematical technique to gauge the muscle exertions of people with back injuries. Here, a volunteer (left) in the Biodynamics Laboratory wears the Lumbar Motion Monitor, a device Marras invented in the early 1990s to electronically monitor back movements. Photo by Jo McCulty, courtesy of Ohio State University.

William Marras, professor of industrial, welding, and systems engineering, and his colleagues discovered that people tend to compensate for back injuries by using many inappropriate muscles in place of the muscles that hurt. Mr. Marras directs Ohio State's Biodynamics Laboratory, where he and his colleagues conducted this study to compare how people with and without back injuries use their muscles. His colleagues included Sue Ferguson, a research scientist, Benjamin Lucas, a graduate student, and Kermit Davis, a former graduate student who is now an assistant professor of environmental health at the University of Cincinnati.

Studies show injured people tend to use muscles in their abdomen or sides, or other, uninjured back muscles, even though these muscles are not necessary for lifting. Marras pointed out, "People with back pain guard the injured area by using more muscles than they need to. The more muscles they use, the greater the load there is on the spine."

The Ohio State study compared the lifting activity of 22 uninjured adults to that of 22 people who were suffering from lower pack pain (LBP). The LBP participants were recruited from the practice of Dr. Purnendu Gupta, an orthopaedic surgeon formerly at Ohio State, and now at the University of Chicago

The study revealed that people with back injuries unknowingly inflict twice as much twisting force on their spine, and 1.5 times as much compressive force as uninjured people, when lifting the same object.

Injured people also tend to lift objects slowly. It only intensifies the harm. "Moving slowly just increases the length of time the spine has to endure those extra forces," Marras said.

This research was funded by The Ohio Bureau of Workers Compensation to combat back injury -- the number one reason Americans miss work, after the common cold. Across the country in 1999, more than 420,000 people missed work because of back injury. Each lost an average of 6 days on the job, according to the U.S. Bureau of Labor Statistics.

In the first study of its kind, William Marras, director of the Biodynamics Laboratory at Ohio State, and his colleagues developed a mathematical technique to gauge the muscle exertions of people with back injuries. Here, a volunteer in the Biodynamics Laboratory lifts a box while wearing the Lumbar Motion Monitor, a device Marras invented in the early 1990s to electronically monitor back movements. Photo by Jo McCulty, courtesy of Ohio State University.

To study the problem, the researchers created a mathematical technique to obtain needed information from the partial exertions an injured person can comfortably provide.

The technique takes data from an injured person's electromyogram (EMG), a measure of a muscle's electrical activity, and calibrates it to provide a basis for comparison with an uninjured person's EMG. The researchers were then able to calculate what the forces on the spine would be if an injured person were able to exert the full power of their muscles.

For the same exertion, LBP participants used many more muscles in the back, creating much larger forces on the spine.

These forces were likened to a seesaw, where people apply all those extra muscles. Like they would push down on the short end of a seesaw, and try to lift something on the far end. It was inferred they exert more force, and to little effect.

On an average, the LBP participants weighed more than their uninjured counterparts, and weight also increases force on the spine. That's why losing weight can help people recover from back injury, Marras said.

Physical therapy is one of the route to recovery. Typical therapy for back injury involves helping the patient regain strength and learn to use back muscles appropriately. "After a back injury, people need to re-learn how to use their muscles naturally. The timing of the muscles working together needs to return to normalcy," Marras said.

Marras points out that the guidelines for injured workers need to be very strict. The study suggests that the new rehabilitation strategy, combined with weight loss and a redesign of the workplace, could reduce the possibility of repeat back injuries.

"There are some motions, such as bending to lift far away from the body, or lifting something off the floor, that a normal person can do once in a while without serious harm. Those are the kinds of motions an injured person should never do at all," Marras said. Bottom line, is people can be sent back to work after a back injury, but have to be very careful about what they do.

In Ohio 16 percent of people with back injuries account for 80 percent of the total health care costs for this injury. That's because the recurring injuries suffered by this 16 percent cost so much more to treat than first time injuries.

For a first time back injury, the cost of drugs, doctor's visits, and physical therapy can add up to as much as $10,000. But for more severe cases -- the kind that result when a person is hurt over and over again -- the costs can climb as high as $300,000.

Lower back pain

Lower back pain is a too-familiar problem for nearly 80 percent of Americans. If it's not part of your daily vocabulary, consider yourself fortunate. If it is, you might be interested to know that this type of pain is usually the result of excess stretching of the ligaments of the spine, and that it affects far more women than men. Lower back pain is usually due to muscle imbalance, in which either the curvature of the lower back is increased, or a lack of flexibility in your lower back and the muscles surrounding it, which can predispose you to tight, rigid muscles, making you more susceptible to lower back injury.

Why are women the more frequent sufferers? Because high heels or pregnancy can shift your weight forward and increase the curve in your back, which leads to back pain. Men who carry excess pounds in their bellies also have their weight shifted forward and, as a result, are more likely to experience lower back pain than other men.

If you have trouble with your back-either from the causes mentioned above or from a birth defect, stress, illness or can either be your best friend or your worst enemy. Exercise is typically the main treatment for lower back pain. If you do the right exercises, you can improve mobility and minimize pain; if not, you could be in big trouble. The rule is if you suddenly develop pain in your back, you should rest it. If after a few days the pain continues, see a physician.

Recovery

Even the simplest household tasks may be extremely painful during the recovery period. More seriously, they may result in further injury. The people with back injuries should be taught how to perform essential household tasks safely to reduce the risk of injury. Some easy-to-follow instructions are mentioned below. Through application of these methods, people with back injuries can speed their recovery and nurture work habits that will help prevent future back problems.

• Seek professional care for any injury.
• Feet should be shoulder width apart.
• Tighten your stomach muscles.
• Make sure objects are close to you body.
• Think ahead.
• Ask for help if you need it.
• Keep your back straight.
• Don't stay in one position too long.
• Move your feet when you turn. Don't twist at the waist.
• Use your legs to lift, not your back.

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