Dear Doctor

I am 20 years old but for the past two weeks I have been experiencing severe discomfort in my lower back. I have had a few complications with my back over the years but never this prolonged or painful. Could this be a potential health risk? Swimming does help me but only for a while.

Vanessa

Dear Vanessa,

Did the discomfort start suddenly or it started slowly and has increased progressively. Is it constantly present or occurs intermittently while walking or bending? Are there any associated abnormal sensations in the legs like feeling hot or cold or tingling/numbness?.

In a young adult, sudden, severe pain in the lower back can be due to herniation of intervertebral disc in the space below. This causes sudden severe pain, aggravated by bending, turning sidewards or lifting weights, among others. If nerves are compressed, there may be abnormal sensations in limbs, affection of nerve centers for urination/defecation in back can cause urinary and fecal disturbances like retention or incontinence. Disc herniation is diagnosed by a scans of the back. Treatment is by pain killers, complete rest till pain is relieved and gradual mobilisation. Surgical intervention is done in severe, persistent cases.

There can be severe low back pain because of a muscle pull or soft tissue injury. This is usually caused by lifting heavy weights to which one is not habituated, sudden bending, playing games without warming up. Diagnosis can be established by scans like C.T. scan, M.R.I. of the back. The treatment remains the same as for a herniated disc.

Infections of the pelvic or genital organs can also cause low back pain. But here there would be associated symptoms of the infection like painful urination, genital itching and or discharge. Among serious conditions, Tuberculosis of the back bone, tumors of back bone, metastasis of tumor to backbone from any other body part can also cause persistent backache. But here the features of the disease process would be predominant like fever and loss of appetite.

Swimming is a very good exercise which has relaxing effect on muscles. But right now you can take complete rest in a comfortable position for at least 2-3 days. If pain is severe, pain killers can be taken. When the pain is reduced, start movements and increase range gradually.

Avoid bending from back, lifting heavy weights and use a hard mattress for rest. Professional physiotherapy will also be beneficial. The improvement will be gradual but shall be complete.

Dr Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital