Backache-3

Backache, no doubt is the commonest ailment that the mankind suffers from, but its causes are also the common acts of commission & omission, that we, the humans do in our activities of daily living. Here are some of the tips, if observed, can help us in prevention of backache.

How to work in the house?

House wives are the commonest victims of low backache. This is because of their working conditions. A standing kitchen is always better than the one where one has to squat on the floor to cook or clean the utensils. The washing machine for clothes should be adjusted to such a height that there is no strain on the back of the operator. Similarly ironing of clothes should be done in standing position to avoid strain on back.

Fig:

Backache-2 Know your back: It’s Structure & Functions

Human back is an amazing example of biological engineering. It provides the basic framework on which the skull, Ribs, Pelvis, & shoulder bones are attached. Can we imagine the human shape without backbone? We would have looked like a gunny bag filled with some putty like material & would have had no shape of our own. It would have been impossible to lift or carry any object from one place to another.

When we speak   of back, we usually mean spinal column which is extending from the back of skull to pelvis in a graceful yet extremely strong double S shaped curve. This natural architectural masterpiece of human skeleton consists of 33 blocks of bones called vertebra. They are given different names according to the region of spine they belong to.

In the neck they are called cervical vertebra.

In the upper back (Chest) they are called Dorsal vertebra.

In the lower back they are called Lumbar vertebra.

In the tail bone they are called Coccyx

The vertebrae are hollow structures. The hollow of all vertebrae put together make a long tunnel through which the tail of the brain (spinal cord) runs. The width of spinal canal is almost equal to the thickness of a finger.

Vertebra resembles a house in shape & functions.

As a house protects its residents, so does the vertebra protects the spinal cord.

BACKACHE-1

BACKACHE is the oldest agony that the mankind suffers from. In the prehistoric era, even the angels must have suffered from it. Though in the ancient Indian literature, no direct mention of this disease is made, it can be safely assumed that in the epic period of Mahabharata, Bhishma Pitamaha must have had some backache when he was lying on the bed of thorns.

NOT ALL PATIENTS OF BACKACHE NEED SURGERY. MOST OF THEM CAN BE TREATED WITHOUT OPERATION.

Fig: 1

Whatever be the exact etiology of backache, it is for the medical scientist & the Pundits in the field to determine. Human back is a big Pandora box. Causes for backache are many. They range from a thorn prick in the foot to prolapsed inter-vertebral disc in the spine. Even, a trauma to human pride can cause backache. It will be no exaggeration to compare the backache with an elephant that the six blind men wanted to know about. One of them called it a pillar, other called it a wall, third called it a rope, fourth it a flap of lather, & so on. Similarly many scientists have approached the problem of backache from different angles & have ascribed as many reasons as its causes & suggested remedies for the same; depending on their own concept of human back –its structure & functions.

In last few decades, much scientific work has been done; data compiled & analysed to determine the exact cause of backache. It is estimated that at one point or other in their lives, eight out of every ten people on earth suffer from this universal affliction. It can strike almost every one, the young & the old, male & female, people of all classes 7 & profession. Biggest leaders of the world have suffered from backache. President John F Kennedy spent hours in the soothing comforts of White House rocking chair, only to nurse his backache,

This was his war time injury.

The largest group of people who suffer from this are the young housewives who have small children & are fully occupied at home. They have no outside job. When they have backache, a double burden is imposed on the family. If the person affected is the chief bread earner, then the situation becomes all the more worse.

Backache is not a killing disease, but it certainly cripples the individual for the time being. No one except the victim can truly understand the complete sense of helplessness & despair that overcomes, once an energetic adult who is suddenly struck down by the devastating, usually temporary ailment. The victim’s world quickly shrinks, often limited at the onset to bed or couch. Work & house-hold rituals are totally ignored due to pain. Dressing becomes torturous, a visit to toilet is a major expedition, sitting in chair for reading or eating can be an agony. Sex becomes virtually impossible. Even after the pain subsides, the sufferer wonders, almost at every turn, whether it will strike again.

Beyond the personal grief, back pain exerts a staggering socio economic cost. Million & millions of work days are lost each year because of backache. It is the single largest cause of worker absenteeism in all the countries of the world.

The remedies are simple & effective in most of cases. The most important being ‘not to get tense & nervous’. An objective personal assessment of the disability with a relaxed mind & a wilful relaxation of the whole body coupled with a few pills & postures ( remedial exercises) is perhaps the secret of success in getting rid of this man’s  oldest agony. But in some cases even surgery or psychotherapy may be needed.

In the present series, I have attempted, step by step, how to modify the style of daily living so that this ‘devastating though temporary ailment’ can be prevented.

Writer’s Cramp

Writer's cramp is a focal dystonia of the fingers, hand, and/or forearm. Symptoms usually appear when a person is trying to do a task that requires fine motor movements, such as writing or playing a musical instrument. Clumsiness and painful tightness in the hand

and forearm occur during writing or playing, and abnormal tension

and strange posturing of hand develops.  

It has a strong psycological over lay. A patient hearing of the complaints of the patient  & reassuring him of recovery helps him a great deal. Tranqulizers  & anti oxydents give relief.

Local Botulinum toxin injection produces temporary relief.

Retraining and learning new techniques help some patients. But the outlook is poor  in some cases and may lead to the end of musical careers.

Transient Synovitis Or “Irritable Hip”

Transient synovitis of hip usually affects children below the age of 5 years, caused by a fall, un noticd trauma or unaccustomed physical exercise.The child limps, may have slight rise of temperature & be irritable. Affected children are not acutely ill and can

move the hip, but with some degree of stiffness. An effusion may

be seen on ultrasound images and the condition is usually self -

limiting. They respond to non  steroidal anti  inflammatory drugs well.

These children should not be allowed to bear weight on the affected limb for 2-3 wks. as they run the risk of avascular necrosis (AVN)of femoral head later in life.

Septic Arthritis Hip

Septic Arthritis of Hip is relatively uncommon condition in children, but it should be suspected in a child who is ill, toxic and unable to walk. Movement of the affected joint is not possible because of pain. Diagnosis is confirmed by raised white cell count and erythrocyte sedimentation rate(ESR) and perhaps by effusion on ultrasound images. No test is perfectly sensitive or specific, so expert clinical judgement is required.

Urgent surgical drainage should be done to save the hip joint from destruction or to reduce the risk of late osteoarthritis.

Diagnosis may be particularly difficult in neonates.

Staphylococcus aureus  is the usual infective organism.

Patient will need long term antibiotic  therapy.            

Weight bearing should be avided until complete recovery.

Rheumatoid Arthritis

Rheumatoid Arthritis is a self limiting condition. But, by the time it leaves, the patient is crippled due to deformities & contractures & is demoralised.  Medicines help in controlling the pain & inflammation. Physiotherapy maintains join mobility, prevents contractures & deformities & helps in locomotion.

Anyway it may be tried:

Acetaminophen 250 mg TDS X 5 days

Bio D3 Max  1 tab OD X 10 days

Keep your moral up.

God bless you.

Commonly used drugs in rheumatoid Arthritis are

1.    HCQS (IPCA lab)200/300/400mg tabs OD/ BD

2.    FOLITRAX tabs (IPCA lab) methotraxate  2.5,/5.0,/ 7.5,/ 10.0,/ 15.0, mg tabs. Weekly dose

3.    SAAZ tabs (IPCA lab) 500/1000mg tabs.OD

4.     LEFNO lefunomide (IPCA lab)20.0,10.0mg tabs.ODdose.

These are all effective but toxic drugs. They should be taken under close medical supervision. Their doses need to be monitored from time to time. They can cause bone marrow depression & affect other organs adversely. LFT , KFT  & other investigative procedures may have to be under taken repeatedly.

Many of the anti Rheumatoid drugs (DMRD) have teratogenic effect i.e. they affect the unborn baby adversely. You must discuss it with your treating doctor in detail.