I’m 30 years old and have never had any serious health complications. About three nights ago, my back started aching. I thought it was my sleeping posture causing the pain. However, the pain began to increase; it was so bad that at one point, I had to sit up. It worsened.

I couldn’t sleep at all. It felt like someone was tearing a muscle in my body. My housemate brought me a pain killer after she heard me crying in my room. It actually helped a bit but I can still feel a little pain when I bend.

What is the problem? Do I need a medical checkup? My housemate thinks it’s my mattress but this wasn’t that kind of pain.

Christine, Kacyiru

Dear Christine,

The most likely reason for sudden severe backache occurring at your age could be a herniation of the intervertebral disc, i.e. the disc present between two vertebrae of the backbone. It can occur due to lifting heavy weights, bending or any other movement which puts sudden stress on the back.

If the nerves or their branches in the backbone are compressed, it shall also cause abnormal sensations like tingling, numbness, crawling of insects, e.t.c on the back and in the hips or legs. In severe cases, undue compression of the nerves can also result in temporary paralysis of a limb or part of a limb. Rarely fracture of a vertebra can occur due to lifting a heavy weight and can cause severe backache.  

Your housemate is correct, very thick mattress can cause backache and aggravate it also because it puts undue stress on the back muscles. X-ray of the affected part of the spine if done will be normal except in cases of fracture of a vertebra.  

Precise diagnosis of the cause can be determined by a C.T.(computerised tomography) scan of the affected part of the back. Whatever may be the cause for severe backache, treatment involves total immobilisation of the spine. That means that for at least 3- 4 days, you need to rest completely on a bed in supine position. 

The bed used should be hard and plain with preferably no mattress or a thin mattress.  This ensures that the alignment of the backbone is not disturbed. Movements should be restricted to the minimum like going to the toilette.

Pain killer medicines are useful to reduce the pain and should be taken regularly in full doses, till pain goes down. But remember that they only suppress pain and have no curative value whatsoever. Medicines containing muscle relaxants are also useful.  

Hot compression of the affected part without massage can also help in reducing pain. Surgical interventions are done in cases where there is severe and persistent pain.

Once the person feels comfortable, movements can be started, but the range and frequency of movements should be increased gradually.   If possible, a lumbar belt can be used initially while standing and walking to provide support to the back. 

While sitting, one should use a straight back chair instead of the thick cushioned ones, where the back remains straight and not slumped. Bending from the back should be avoided absolutely.  

Similarly one should avoid lifting heavy weights. These precautions prevent recurrence of the problem. After the pain has subsided and the person feels comfortable, it is good to start exercises to strengthen back muscles.

These exercises should be started with a low frequency and gradually the number and range of exercises should be increased.

Dr. Rachna Pande is a specialist in Internal Medicine at Ruhengeri Hospital