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Acute low back pain (physician heal thyself)

By Femi Ogunyemi (Dr)

Not one for New Year resolutions, I however decided to get fitter this year.

I started a regime of sit-ups and push ups, cycling and spot jogging.

But, alas, by the third day, my back froze in a tight spasm and I was unable to walk.

My back twisted and locked into a sideways posture. I walked like the Hunchback of Notre Dame.

Any attempt to straighten my spine was punctuated by a yell and a grimace and a retreat to the bent position.

Not a pretty sight for a pain doctor scheduled to see a pain patient in 48 hours.

Typical of most doctors, I convinced myself that the “problem” will resolve itself. I took no medicines nor any action that I would probably have instructed my patients.

But, by the next day, the back pain took a nasty turn for the worst. One side of my back was hard and stiff; the other side in intermittent spasm. The pain had extended to the back of my thighs. Each footstep was like an elephant taking first steps on an ice rink.

I swung into action and began a crash course of muscle relaxing tablets, non steroidal anti-inflammatory tablets and ointment, and intensive massage. Good old acetaminophen (paracetamol) was also helpful.

By the next day, the morning of my appointment, my back pain was better and the stiff side had abated.

But the spasms were still there, and worse. I set off to the clinic with the intention to disguise any spasms or discomfort in front of my patient.

The consultation was interesting. The patient, a man in his mid fifties from Abuja, complained about low back pain of 2 months duration. His symptoms were identical to mine. As he described his spasms and pain, my own back muscles jerked and stiffened in response. Each time he seemed to catch my grimace I switched it into a smile.

At the end of the consultation, with a sense of achievement in hiding my ailment, I ushered him out with his treatment plan.

As the man stepped out, he turned back and said: “Doctor, you really must take care of that your tetanus!” Perhaps for different reasons, we both burst into laughter.

Acute Low Back Pain is not a laughing matter. It is the commonest cause of work absenteeism in the world and a great economic burden to many countries.

The lower back bears the brunt of the weight of our trunk. The tiny joints in the spine are  constantly twisting and turning and the back muscles are constantly bending and stretching. Inappropriate dynamics (movement or posture) is the commonest cause of acute low back pain, It often resolves after a few days with NSAIDS (aspirin-like drugs), simple analgesics, massage  and bed rest.

When it persists for a couple of months, it is referred to as ” sub acute “; after three to four months it becomes ” chronic” and takes on a rather different character.

Apart from the back muscles, the bones of the spine and the joints of the pelvis (women especially) are other sources of low back pain. The bones begin to show their age (wear and tear) usually after the age of 35.

If the muscle spasms trap some of the nerves that go down to the leg, a burning radiating pain develops (“sciatica”). Sometimes the worn out spine bones also release chemicals that irritate the nerve roots and also cause sciatica..

The best prevention advice is to be careful, and aware at all times, about posture and lifting and undue stress on your spine and back muscles.

That way…….you wont get tetanus!

•Dr Femi Ogunyemi MBBS(Ibadan) FRCA FWACS DAAPM is an Anesthesiologist and Pain Management Specialist with active licenses in Nigeria, UK and USA.


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