Ouch! That pain in the back
Dr Ravinder Chadha

Back pain appears all of a sudden and makes day to day life difficult. In few individuals back problem recurs when proper treatment/rehabilitation is not undertaken seriously. An individual with unconditional and weak back is vulnerable to back problems. The usual presentation is initiation of pain on sudden bending, lifting weight although the actual cause is weak muscles supporting the spine or incorrect bending technique. The back needs to be strong to withstand prolong sitting, standing and while playing some sport. On an average, a person has to sit for eight to 10 hours a day i.e. six to eight hours at work and two to three hours while driving, sitting in front of TV etc.

The term sciatica is used for almost all cases of leg pain and low back pain. This symptom entails varied causes hence treatment has to be specific or on an individual basis. The multi-pictorial symptoms are due to the anatomy of the sciatic nerve. It is the largest nerve in the body, around the thickness of a finger. It originates from lower part of spine behind the hip joint and buttock to the back of the leg to the foot. Therefore, the usual presentation of pain being is felt from the hip to the big toe.

The main reason for sciatica is due to disc prolapsed when the nerve is pinched. This can cause tingling, numbness or shooting pain compelling the patient to become bed ridden. Spinal stenosis (narrowing of spinal canal) and Piriformis muscle spasm can also lead to sciatica.

The usual symptoms are:

n Local pain at the back but usually it radiates to hip/one leg.

n Pain is aggravated on coughing, prolonged sitting, changing posture etc.

n Numbness and/weakness of legs.

n In some cases, pain/heaviness is felt in one/both legs while standing/ walking a short distance. The reason can be narrowing of spinal canal due to multiple disc prolapsed.

The main objective of treatment is to reduce pain and numbness and increase mobility.

n Analgesic to relieve nerve pain.

n Avoid activities that aggravate pain i.e. lifting heavy weight, bending forward, sitting on low chair etc.

n Lumbar support to give rest to low back.

n Soft mattress should be avoided. Sleeping on a firm surface with pillow under knees is ideal. While lying in side on position pillow should be placed between the knees in order to keep the back straight.

n Gradual increase in physical activity can be stressed upon e.g. Avoiding prolonged sitting and starting walking by day three or four. After a week, one should try walking for ten to fifteen minutes.

n The prevailing misconception that exercise worsens sciatica, delays treatment and makes it more cumbersome is incorrect. The fact remains that exercises are important for sciatica relief. After a brief rest for a day or two appropriate exercises should be started. Sciatica exercises are designed to stabilise the pelvis, strengthening and stretching of abdominal and back muscles.

Different exercises are recommended for the varied causes of sciatica like disc prolapsed, spinal stenosis, piriformis muscle injury as wrong exercises can aggravate the condition. It is important to note that what makes for one may not work for others even if the problem is the same.

n Extension and isometric exercises are advised for pain relief. Flexion exercises are not advised initially as they exert a greater load on the inter-vertebral disc.

n Low back is placed gently into extension by lying on the stomach. Upper body is propped up on the elbows keeping hips on the floor. This should be initiated slowly and is held from a count of 10 to 15. Similar exercise can be done while standing by arching backwards slowly.

Further exercise program has to be carefully designed to provide maximum benefit after assessing the patient's limitation.

n There are certain manipulations that help in decreasing the pain immediately.

n Lumbar traction can also be applied as it relaxes the muscles of the back and increases the inter-vertebral space.

n When conservative treatment fails epidural injection of cortisone drug can be given to decrease pain and nerve irritation so that patient can initiate physical therapy.

Surgery should only be undertaken if conservative treatment fails and pain becomes severe and disabling. To conclude, if low back pain due to prolapsed disc is diagnosed properly and treated adequately can prevent agony, disability of many individuals and also cut down the number of surgeries.

To sleep well, exercise
Dorene Internicola

Sleepless and sedentary? Instead of counting sheep in a field, try running through a meadow.

Experts agree that an aerobic exercise routine during the day can keep you from tossing and turning at night, even if they're not sure why.

"The bottom line is we really don't know why people tell us that exercise helps them sleep," said Dr. David Davila of the National Sleep Foundation.

"But if people are normally active, reaching their aerobic goals, chances are they will sleep the right amount for what they need."

Davila, who practices sleep medicine in Little Rock, Arkansas, said the low-grade sleep deprivation suffered by many time-pressed, under-rested Americans has a cumulative effect. "People have more car accidents and what they call 'presentee-ism', or poor performance, at work," he said. "There are fallouts for the average person."

But evidence is emerging that aerobic exercise can offer relief from insomnia.

A recent study at Northwestern University in Chicago, Illinois, USA, tracked 23 previously sedentary adults, primarily women 55 and older, who had difficulty falling or staying asleep.

After 16 weeks on an aerobics training program that included exercising on a treadmill or stationery bicycle, average sleep quality improved.

"Most of poor sleepers became good sleepers," said Dr. Phyllis Zee, the lead researcher in the study, which was funded by the National Institute on Aging.

She said an earlier study using Tai Chi showed less dramatic results, as did a control group doing non-physical activities such as cooking classes and museum lectures. "This is the first time that I'm aware of where we've looked at the benefits of aerobic exercise as a treatment modality in a population with insomnia," Zee said. She added that she sees a lot of patients with insomnia, which afflicts 25 percent of the population and can reach as high as 40 percent in older people.

"We tell them to get regular exercise. But we really don't emphasise how to exercise."

If your schedule dictates that you can only hit the gym at 5 a.m. Dr. Shawn D. Youngstedt, an expert on sleep and exercise at the University of South Carolina, believes that an hour of exercise can do more good than an extra hour of sleep. "There's no scientific evidence that people need eight hours, seven is fine," he said. "It's far clearer that exercise has wonderful benefits. It's better than drugs for diabetes, mental health, cancer prevention."

Dr. William Roberts, of the American College of Sports Medicine, cautions that for some people the time to exercise is not an hour before bed.

"To exercise close to sleep time is not good for everyone," he explained. "Try to get a half hour to an half hour of exercise early enough in the day and try to sleep on same schedule."

Roberts suggests doing something calming to wind down. "Do not play video games," he said. "Read away from bed and then go to bed. Avoid caffeine and other stimulants before turning in."

The improved sleepers in Zee's study also reported better moods, fewer depressive symptoms and enhanced vitality. "Vitality is everything," Zee said. "It's how somebody feels, how alert. If you think about the complaints of poor health, people will always say, 'I feel so tired'." — Reuters

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