As sedentary lifestyles become the norm in urban centres, back pain and backaches are all the more common. Recently, back pain has become one of the most frequent reasons behind people visiting the doctor or failing to go to work, and the leading cause for long-term disability worldwide. Currently, more than 540 million people globally are affected by activity-limiting lower back pain.

Before moving to the causes of lower back pain, it is necessary to understand the difference between acute and chronic back pain. Acute back pain occurs due to sudden injuries, such as those caused by minor falls and heavy lifting. It can also result from various health conditions or infections of the spine. Clinicians need to look deep into the patient’s history and behaviour. In acute back pain, muscles and the ligaments supporting the back spasm or develop a strain. As a result, pain or discomfort can occur anywhere in the back or sides of the body. The most commonly affected area is your lower back and the pain lasts no more than six weeks. Most acute back pain gradually improves with domestic treatment and self-care, most often in a few weeks time. Self-care measures that can be adopted at home include the use of hot or ice packs, breathing exercises, simple mobilisation of the spine and neck muscles, and the use of over-the-counter pain relief medication.

Unlike acute pain, chronic back pain persists for 12 weeks or longer, even after the underlying causes of acute back pain have been treated, or if the pain continues to progress after it has been treated with several modalities, from home remedies to painkillers. Chronic back pain can be due to age-related musculoskeletal conditions, underlying medical health problems and untreated acute injuries.

Contrary to general assumptions, chronic back pain is not only limited to spinal nerve damage, broken spine, narrowing of the spine, herniated or bulging discs, unexplained back muscle fatigue and tenderness, and degenerative bone diseases. Chronic back pain does not resolve on its own and may severely affect daily activities. In case back pain does not resolve in a few weeks time, patients should immediately seek immediate care from physical therapists or pain specialist.

Now that the differences between acute and chronic back pain have been delineated, we can move on to the primary causes of lower back pain:

Overloaded backpacks

This is common practice in Nepal and most Asian countries. We are provoking back pain and injuries in school-going children by overloading their backpacks with school books and supplies. Carrying heavy loads every day can strain the back and cause muscle fatigue. The recommended standard weight for a school backpack is no more than 15 to 20 percent of the child’s body weight.

Poor fitness

It is necessary to walk 30-45 minutes or spend 15-20 minutes stretching the body’s muscle and spine every day. Or else, one can develop poor fitness. Back pain is very common among people who are not physically active and fit. Studies show that people with low physical activity have weak back and abdominal muscles that may not properly support the spine leading to a frozen or immobile spine.

Smoking

It might sound unrealistic and many may wonder how smoking can cause back pain in addition to lung cancer, but there is definitely a relationship between smoking and back pain. A study on smoking and lower back pain conducted at Johns Hopkins University discovered that a  history of smoking, hypertension and coronary artery diseases (all of which are risk factors for atherosclerosis or occlusion of the arteries) were associated significantly with the development of lower back pain. Furthermore, smoking reduces calcium absorption and prevents new bone growth. Coughing from heavy smoking can also cause back pain in some cases.

Obesity

Being overweight means that the back is forced to carry significant amounts of weight stress. Extra weight in the stomach pulls the pelvis forward and strains the lower back, leading to lower back pain.

Occupational factors

An active job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. Conversely, a passive job such as sitting at a desk or computer all day long may also lead to or contribute to back pain. People who have passive jobs tend to have poor postures or sit all day in chair with inadequate back support.

Treating back pain

The concept of physiotherapy is new in Nepal and has yet to be accepted by the mainstream. Physiotherapy is conducted by licenced healthcare professionals who have undergone five to eight years of rigorous training, specialising in non-invasive therapy, body movement and exercise. Treatment for lower back pain generally depends on whether the pain is acute or chronic. It is wise to consult a physical therapist rather than paying a hefty cost for surgery, which should be the last option and only undertaken if all non-invasive treatments fail and there is clear evidence through diagnostic tests of worsening nerve damage.

Physical therapists use various methods to treat back pain, among which are stretching of the lower limb and upper limb musculature; along with exercises that help strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture. Physiotherapists also emply cognitive functional therapy, which acknowledges the complex foundations of pain and integrates targeted cognitive strategies with functional rehabilitation. Occupational interventions for work and teaching proper back extension exercises are among other treatments.

Acute and chronic back pain, while common, are not impossible to avoid. Maintaining proper fitness, along with regular exercise can help prevent the worst of back pain.

- Nyaupane is physiotherapist for Nepal’s U-19 national cricket team