Author: Dr. Simranjeet Singh

The human spine is a beautiful piece of engineering, with multiple vertebrae as the building blocks, separated by the cartilaginous discs which act like elastic cushions – providing mobility between these vertebrae while also holding them together and also acting like mini shock absorbers when needed. And the muscles and ligaments are like guy ropes, providing stability to the spine while allowing for mobility.

The human spine has adapted for the erect posture but the sitting posture seems to put the maximum strain on it. Add to it the additional stress of bearing the weight of a large belly coupled with weakened muscles of the core and it soon becomes a recipe for disaster; with loss of elasticity of the cartilaginous discs as we reach middle age adding fuel to the fire. In the end all this culminates into what almost all young adults / office goers seem to be suffering from today, that is chronic low back ache.

But sometimes the symptoms of chronic low back may be more specific, or there may be exacerbation or super imposition of acute, specific symtoms over the background chronic pain which may prompt seeking urgent medical attention. We call these red flag signs. For example if the pain becomes so severe that it does not allow more than a few minutes of sitting, or if it compels you to take multiple pain killer medications every day, or there is pain which is not relieved even after prolonged rest, or there is pain shooting down the legs or the pain is associated with additional symptoms like weakness or dimunition of sensation in the legs or with loss of bladder/bowel control.

Chronic back ache usually tends to have a more indolent course with a chronic character, with maybe periods of waxing and waning of the pain, with a chronic and more subtle impairment in the quality of life. Home remedies are definitely something all of us are inclined to try out at first; from hot fomentation to light massage to turmeric milk to some more elaborate ones. Though these may be tried; the warning signs should not be missed, and an effort should be made to identify the culprit cause and to specifically rectify them for lasting relief. As a rule of thumb if pain is not improving after trial of home remedies for say 72 hours, then medical attention should be sought.

The usual culprits for low back pain are usually so ubiquitious that they are easily missed. Prolonged sitting involved in desk jobs is definitely culprit number one in todays age. Prolonged sitting may be unnoticed, as in people who drive long hours to work, then have to sit for the day at the office desk, then get back home to relax by sitting in front of the TV, leading to 10 – 12 hours of sitting time, which is probably way more load for the spine than it can take. Prolonged standing too might sometimes be the cause, eg for the house wife standing long hours in the kitchen. Sometimes the culprit may be even more difficult to identify, like a heavy bag that the person carries. Bad posture while sitting, bad car seat adjustment, bad roads we travel on,  or good roads with multiple speed breakers, all can all be culprits contributing to chronic back pain. Add to that intrinsic factors like poor core muscle strength, a burgeoning waist line, age related decreasing elasticity in the inter vertebral discs, progressive decrease in bone density, then it further exacerbates the problem.

So, as we can see the treatment for chronic low back begins from first identifying the causative factors/ culprits, rectifying these, learning to maintain a good posture, avoiding prolonged sitting, adding regular stretching exercises to our routines, progressively improving core muscle strength; simple steps, which can all add up to relieve chronic low back pain.

Investigations may sometimes be necessary when an underlying pathological cause is suspected or sometimes to rule out a serious underlying pathology which has significant risk of progression on  conservative management.

Bed rest for chronic low back pain, especially the duration of bed rest is another subject for debate. Short duration of bed rest, maximum three to five days is considered beneficial, but anything longer than that is considered to cause more harm than benefit. That means, after say maximum three days of bed rest, gradual mobilization is advisable to avoid getting stuck with chronic back pain.

Proper lifting technique, where you bend your knees and hips to squat to lift rather than bend down to lift objects again can avoid inadvertent injuries to the back. Investing in a good chair which offers proper support to the back is definitely recommended.

So as we can see now, the best way to avoid chronic low back pain would be to adopt healthy lifestyle habits, avoid prolonged sitting, to maintain an ideal body weight, to exercise regularly, to eat healthy and to avoid smoking, high caffeine intake etc.

So eat healthy, exercise regularly, maintain a good posture at all times, and avoid chronic low back pain!