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 Dr. Harshvardhan Hegde


Almost all of us suffer from lower back problem at least some time in her/his life. It is one of the commonest reasons for missing work and for many people chronic pain can lead to depression.

The lumbar spine – which allows a range of movements from bending forward and backward, twisting and turning is nature’s marvel of fine engineering. With 5 stacked vertebrae with intervening shock absorbers called discs, the central cavity has the spinal canal which houses the nerves which carry messages from the brain and are responsible for almost every bodily function. And then there are muscles which support the lumbar function. Pain from the lower back can come from discs, nerves, facets and ligament muscle complex.
In the young, lower back pain is usually due to excessive strain of the muscle/ligament which can be managed by rest, physiotherapy and analgesics. The other common problem is a disc lesion where the disc may bulge or rupture and put pressure on the nerve. This is commonly seen at the L4 and L5 levels. Treatment is rest and analgesics followed by exercises. In less than 15% surgery is recommended if there is a threat of paralysis especially bladder / bowel involvement and/or if there is unrelenting back and leg pain.

In the elderly, back pain is due to degeneration which results in loss of disc height, overgrowth of bone, arthritis of the facet joint and weakness of the muscles. Here the pain is more chronic and may be associated with heaviness and numbness in the legs accentuated by standing or walking. The treatment is exercises, postural training and management of co-existing medical problems. Less than 15% might require nerve root and facet blocks to reduce the pain and in less than 5% surgery may be indicated. Surgery is directed towards decompression of the nerves and in some cases, stabilization of the affected levels of the spine using screws and cages.

Prevention of lower back pain is focused towards strengthening of muscles, avoidance of smoking and leading a healthy lifestyle. Exercises and maintaining a good posture are key to a healthy, pain-free lower back.

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