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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 humanitys 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 individuals 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 patients 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 dont 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
completely 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