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Frequently Asked Questions from Dr. Ramani |
1. Why do I get pain the back or neck?
Pain in the neck or in the back is a symptom. It had diverse causes. Commonest being mechanical strain and sprain in the muscles and age related degenerative changes in the spine (spondylosis). Prolapse of the intervertebral disc (slipped disc) can be a common cause. Trauma, infection, tumours, metabolic disorders are among less common causes.
2. How common is this problem?
The symptom is very common. Almost eighty per cent of men and women suffer from it at one time or another in their life. In the majority the pain is self-limiting and with appropriate treatment almost 90% should feel relief.
3. Can the cause be pin pointed?
Clinical presentation and examination can give a conclusive clue to its cause. Advanced investigations like CT and MRI studies of the spine along with electrophysiological studies can virtually pin point the cause.
4. Is there any risk to life if the symptom is ignored?
Spinal ailments do not threaten life as in cardiac ailments. If ignored degeneration in the spine along with stiffness and weakness in the muscles can cause crippling. If spinal cord or nerves are compressed, associated weakness in the limbs can cause disablement.
5. Is there any risk to life if surgery is undertaken on the spine?
By and large surgery on the spine of spinal cord is safe. Mishaps do occur once in a while but in the majority of the problems the life should not be at risk when surgery is undertaken.
6. Is the patient confined to bed all the time after surgery?
This is a wrong notion arising from some misadventure during surgery. The purpose of surgery is to make him fit free of pain and disability so that he can start walking, running and doing work. However inadvertently by a misadventure if the spine has become unstable then it causes pain on sitting or standing. It does not necessarily means patient has to lie in bed all the time. The defect needs to be identified and it can be effectively corrected although it may mean one more surgery.
7. Are multiple surgeries on the spine dangerous?
Technical advance and surgeon's expertise has made the surgical procedure safe and there are examples of patients having been operated upon their spine eight and nine times, every time successfully albeit temporarily. All the same it must be remembered that following surgical intervention tissues are altered. Fibrosis set in and second operation becomes a little more difficult than the first one and subsequent operations definitely much more difficult but not impossible. What is required is expertise and experience.
8. Can disablement occur during spinal surgery?
Generally there is no disablement. But it can come under two following condition. If the spinal cord or spinal nerves are intricately intermingled with the diseased process then during dissection damage can occur resulting in disablement. This is known as accepted disablement as there is no other choice in treatment Second is of course inadvertent misadventure. There is always some improvement over a period of time with physiotherapy but some disablement remains permanently and that is why one has to be very careful in spinal surgical procedures.
9. Can one get problems in passing urine after spinal surgery?
The nerves responsible for controlling urination passes through the spinal cord and its compression or handling can cause damage to the nerves and result in urinary problems. It is unfortunate, as the problem remains permanent causing tremendous social embarrassment and inconvenience. If the problem has occurred as a result of the disease and not surgery then surgery should be undertaken as quickly as is possible (within hours) so that once the pressure on the nerves is removed there is a chance that the function may become normal again.
10. Does spine become weak after surgery?
Surgical procedures do not as a rule leave the spine weak. If at all it is stronger. The crux of the matter is the muscles, spinal and abdominal. Many times they are weak before the spinal problem came in and as a result of the pain if the patient is bedridden for a while then muscles become much more weak and then they are not in a position to support the spine resulting in weakness.
11. What can be done to prevent this weakness?
A person who has been doing exercises regularly can easily overcome the weakness in the spine. If not then one should start doing exercises as soon as is possible with the advice from the physiotherapist. At first patient is trained to feel confident that he can do exercises. The muscles are then gradually mobilized by passive exercises. The next step is stretching to do away with the stiffness and to increase resilience in the muscles. The third phase is active exercises so that general weakness in the muscles disappears and the final step is toning the specific group of muscles, for example, abdominal muscles and spinal extensors. With this principle the spine, which had become scoliotic as a result of spasm in the spinal musculature automatically becomes straight.
12. What are the best principles to keep the spine healthy?
To do regular exercises.
 Start with warm up exercises.
Do not lift weight during warm up exercises
Do not get fatigued at the end of the day
Do not try to lift something heavier than normal
Do not lift weights that one is not normally accustomed to
Do not suddenly do strenuous work like week end gardening. Learn to relax.
13. What is Back School approach?
This was first developed in Sweden some thirty years ago. Now it is used in many parts of the world. It is not meant for the acute pain when one has to relax. Its purpose is to help those with pain in the spine of some standing (chronic pain-months to years). The style differs from school to school but its main ingredients are I:
Postural advice in standing, sitting and lying. Ii:
Specific muscle strengthening exercises for the muscles of abdomen and extensors of the spine. Education: Learning the structure and functioning of the spine. Lifting and handling techniques; ergonomics in day to day work and minimize strain on the spine. Iv:
Hydrotherapy mainly to help relaxing the muscles, which have become stiff V:
Confidence building. This is very important. Proper mental state is extremely important for early relief from ailments of spine
14. Advantages of Back School Comprehensive program
Clinical examination
Functional assessment
Daily ergonomics, Appropriate therapeutic options Group classes.
Improving general fitness.
Improving posture.
15. What is the significance of posture?
This is one of the most common causes of spinal trouble. Even with good posture prolonged standing, sitting of lying in one poison can cause strain on the spine. Similarly sitting on a chair with heels lifted up on the chair even for 20 minutes, the crouched position will make the spine stiff along with knee joints. Examples like sway back syndrome, kissing spine, stoop back, lordosis, kyphosis are due to bad posture and are responsible for pain in the spine.
16. What is occupational poor posture?
Either at home or at work on a number of occasions one is forced to adopt a posture which is not correct but do the job correctly. This is known as bad ergonomics. If a worker has to stay hunched to a work or work in a factory assembly line for hours together it can lead to painful stiff spine.
17. Can one know the strength or weakness in the muscles of the spine?
Yes indeed. The procedure is called computerized isokinetic testing. Through this test one can measure the strength and weaknesses in the muscles and predict the oncoming pain in the spine. Mineworkers, fisher folk, athletes have strong spinal muscles and they can produce resistance even up to 200 times their body weight. Peons, stenos, office clerks and superintendent can manage with 70% of their body weight and executives without any recreations activities are the poorest performers.
18. What is Sports medicine principle in backpain?
Following backpain doctors may rely heavily on rest and no activity to the muscles. Muscles become weak and stiff. Recovery is prolonged and relief may not be complete. In sports medicine principle the activity in the muscles is started as soon as is possible after acute pain and preferably after 48 hours. To day athletes start rehabilitation as soon as is possible after injury.
19. Is spinal pain different for different people?
Yes indeed. The structure of the spine is complex. Different people have different thresholds for pain. Any person having chronic pain in the spine might have inadvertently become addict and dependent on the drugs.
20. Has mind to play a role in spinal ailments?
Pain in the spine is so intriguing that it is difficult at times to define it or measure. At times the doctor has to stretch his imagination to the fullest extent and yet may not grasp the cause of pain. It could be extremely frustrating. Some doctors even refuse to see patients with chronic backache. He is not in a position to relieve the pain.
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