Low Backache

Definition. The term includes many types of pain on the lower part of the back viz,, pain at the sacrum, coccyx, on the lumbar spine, soreness on the back and sciatica; low backache is more common in women than in men.

Causes

A. Gynaecological causes. These form less important causes of low backache. The causes may be as follows:

(1) Uterine prolapse with retroversion may drag on the pelvic ligaments causing backache; this gets relieved on lying.

(2) tubo ovarian mass, parametritis and chronic cervicitis;

(3) benign and malignant pelvic tumours impacted uterine fibroid or ovarian cyst, pelvic endametriosis, advanced carcinoma of cervix, retroperitoneal tumour;

(4) postoperative because of sacro iliac strain following gynaecological operation in lithotomy position under anaesthesia;

(5) Premenstrual low - pain especially in premenstrual syndrome.

Site of backache due to gynaecological cause is sacral but never extends above fourth lumbar vertebra; it has got bilateral distribution but not localised. Causes mentioned above do not necessarily produce backache in all cases.

1. Orthopaedic causes. These are the commonest cause. There are numerous factors that can play. Some important ones are the following-

(i) Sacro iliac strain or subluxation this often follows pregnancy and labour. Pain is felt on lifting weight or stooping move¬ment. There may be tenderness at the sacroiliac joint;

(ii) postural cause muscular and ligamentary strain on the back is possible due to postural defect. Obesity may also cause such strain;

(iii) Spinal arthritis ;

(iv) congenital anomalies sacralization of last lumbar vertebra or lumbarisation of first sacral vertebra, spina bifida occulta may cause back pain;

(v) lumbago this is due to myositis of the lumbar region;

(vi) coccygodynia pain at the coccyx commonly following labour. Tenderness can be elicited on movement of the coccyx ;

(vii) other spinal diseases prolapse of intervertebral disc, caries spine, spinal cord compression.
Sites of pain in orthopaedic cause vary according to the particular lesion But pain tends to be localised with tenderness at a site; pain is also related to exercise or rest. Sacroiliac strain becomes worse at night while lying flat on back or turning to the side.

II. Nonorthopaedic causes.

(1) Renal pain distribution of pain is characteristic i.e. unilateral arising at the Join.

(2) Rectal pain. Constipation, rectal spasm or carcinoma may have sacral pain or discomfort.
In some cases, no demonstrable cause for backache can be found. psychological upset is alleged to be a factor to play in this group.

Investigations.

1. Careful history taking, thorough clinical examination of the patient's general condition, pelvic condition, should be done. Examination of spine and back especially for any local tenderness is essential. Radiology of lurnbosacral region is al¬ways taken to detect any evident lesion. Urological investigations should be taken up in cases suggesting the cause.

2. Cases showing no gynaecological factor for backache should be referred to the orthopaedic surgeon.

Treatment. This is done according to the cause. The gynaecological causes are treated. For the orthopaedic causes, local application of heat, local massage of some liniment, rest, analgesics can be instituted before the orthopaedist takes up the cause for treatment.