The predecessors of Homo-sapiens were mobile on four limbs with equal distribution of the body’s weight all over. But as evolution would go on, man started moving on two lower limbs in an erect posture. But as far as the lower back was concerned there has been no further improvisation and thereby the impending weight on it has made the area more vulnerable. Added to that is the fact of rough and tumble or the contrasting sedentary lives of the modern day life which have not helped the spinal column at all. It is in view of this fact that everyone in some part of their lives has had a cold or suffered from a pain in the back. At least as far as a common cold is concerned you have an elusive virus to blame, but as far as the ubiquitous backache, probably it is only the evolution and the civilization at which one can point a finger. Amongst the common complaints is the lumbar spondylosis and prolapse of the intervertebral discs in the back which are areas of concern in many a patient.
Spondylosis is a degenerative disorder of the spine causing loss of structure and thereby function. It could affect any part of the spine i.e cervical, thoracic or lumbar and when it affects the latter it is termed lumbar spondylosis. Although it is aging which takes the blame, still the pace of degeneration differs within individuals.
The discs between the vertebrae could have the usual biochemical changes with age leading to the thinning of the disc, thereby not being able to afford the usual shock absorber like capacity. This would compromise the structure of the bones and mobility is affected and thereby structure. This is the main cause of backache.
Each vertebra has four facet joints which work like hinges and help the back with its ability for extension, flexion and rotation. Every bone and joint is covered by cartilage and with aging even this degenerates, causing formation of spurs which can irritate the nerves in the spinal canal and thereby cause backache.
The spurs or osteophytes also tend to compress the surrounding end plates and cause constriction of blood supply to the vertebrae, thereby causing thickening and sclerosis.
The ligaments around these structures help in preventing hyperextension but when these are affected, the probability of spondylosis increases.
Spondylolisthesis is another condition in which there is slipping of one vertebrae when compared to the adjacent vertebra. Apart from pain in the back there could be pain in the thighs, legs, weakness and tightness of hamstring muscles. It is a condition which could be congenital or acquired in childhood or later in life. Situations where one carries weights, sports like gymnastics, football, weightlifting or general wear and tear could lead to such slipping of the vertebra in the spinal column. This condition makes one more vulnerable to development of pain in the back and other complications. In some cases this could also lead to the narrowing of the column and thereby stenosis of the spinal cord.
The commonest of all conditions related to the back is Prolapse of the Intervertebral discs. In between each of the five lumbar vertebrae are shock-absorbing pads called discs which are held in place by the end plates. Each disc contains a tire-like outer band called the annulus fibrosus encasing a gel-like substance, the nucleus pulposus. When this gel-like substance pushes out through the outer layer a herniated disc forms. Amongst the various causes are:
Inadequate nutrition and lack of exercise which lead to gradual degeneration of the bones as well as the discs.
Due to ageing the biochemical changes lead to drying of the discs and thereby reduction in resilience and disc strength.
Poor posture due to prolonged sitting, driving and incorrect body mechanics stresses the lumbar spine and the ability to carry weight is affected.
Daily wear and tear, injuries, incorrect twisting and lifting, all lead to poor health of the disc.
Disc degeneration causes thinning and thereby incorrect postures and inability to take the weight of the body. The prolapse of the disc causes the impingement into the spinal canal as a disc or a bulge. The nucleus pulposus could swell out, called as an extrusion, but does not necessarily break out whereas in sequestration the gel breaks through the circumference and causes pressure and inflammation of the nerves through the spinal canal.
A constant pain in the lower back, uncontrollable weakness of the lower limbs, numbness of the legs and characteristically the radiating pain into the lower limbs are the usual symptoms of a prolapsed disc.
Common to all the above conditions is osteoporosis as the loss of bone structure during ageing and again it varies between individuals. In certain invalid conditions too there is Osteopenia, or the destruction of bone health and thereby any of the above conditions. Infections like tuberculosis are causative agents occasionally.
PREVENTION & HOMOEOPATHIC MANAGEMENT
Proper nutrition with calcium rich foods would prevent or delay bone degeneration.
Exercise is an ingredient which is usually neglected, which sways the body metabolism into proper balance and is of prime importance.
Obesity causes a constant weight on the lower back and contributes to this condition and should be kept under check.
Proper posture with good ergonomics at the work place and home are essential.
While lifting heavy weights care needs to be observed.
Lifestyle modification should be done in people of sedentary occupations.
Homoeopathic medicine has excellent remedies to relieve the muscular spasm, relax the tightening of the ligaments, slow down the further degeneration of the bones and cartilage, relieve the inflammation of the nerves in the spinal column occurring due to compression with the intervetebral discs and keep the symptoms and pathology at bay. All in all, homoeopathy is a safe bet and is second to none in conditions of the back while helping the patient on the way to cure.
Amongst the various remedies which would be helpful are:
ARNICA is a prime remedy when there is soreness of the muscles of the back which is worse on slightest pressure and the patient resents it. Dr. Janardhan Reddy stresses that it is always the interpretation of the symptom which is important, as the patient has difficulty lying down because of symptom of “worse on pressure”. But if the patient finds the pain is worse on slightest touch but better by pressure and is having excruciating pain on slightest motion, BRYONIA is of help. RHUS TOX follows Bryonia well and is also well suited to the condition where the tendons, ligaments and fascia are all painful with stiffness of the lower limbs. Typically the patient finds it difficult starting to move and feels better as he walks further. RUTA cannot be forgotten as the wrong ergonomics can cause a gradual injury to the muscles and ligaments of the back, and none can improve the condition as well as this remedy.
If there is a cramping pain in the hips, contraction of muscles of the lower limbs and the patient feels better by warmth and hard pressure, COLOCYNTH would help. If there are similar cramping pains of the calf muscles, radiating pain down the right lower limb and the patient is better by warmth and pressure, MAG PHOS is the remedy. Another remedy is indicated when there is contraction of the muscles of the back with typical spasm and sometimes pain radiating down through the hips. CIMCIFUGA is called for here. In neurasthenic individuals when there is weakness of the muscles and also due to over-exertion, Kali phos supplies relief. But if there is one remedy which one would study in many a case of Prolapse of the intervetebral discs and thereby the effects of those, it is Hypericum. There is compression of the spinal nerves in the lumbar spine and thereby inflammation with swelling and there is always a neuralgic pain radiating down the lower limbs with numbness and tingling. In this situation HYPERICUM never fails. Let me confess too that I do prescribe this very often with the experience of working under the eminent Physician of our State, Dr.K. Siva Shankar. Even if one follows advice blindly, one would not fail as long as the advice comes from a visionary like him.
If there is shooting pain along the course of the nerve it is always PHYTOLACCA. An acute neuralgic pain also responds to GAULTHERIA prescribed in the mother tincture. Numbness and tingling with hypersensitiveness also responds to PLATINA .
One of the commonest causes we know of the above condition is rapid degeneration of bone or ageing of bone or sclerosis of the bone cells sometimes aided by infections like Tuberculosis. When it is impaired nutrition which is the cause for the early degeneration, CALCAREA CARB is the prime remedy, even more so in obese constitutions. When it is impaired nutrition and defective assimilation Silicea cannot be forgotten. CALCAREA PHOS is known to improve assimilation of Calcium, while osteophytes causing impinging of the surrounding nerves and tissues suggests CALCAREA FLOUR.
With softening of the spinal cord, loss of bone cells due to infections like Tuberculosis, PHOSPHORUS is up to the task. The degeneration of bone is also aided by excessive fluoride in water typically found in certain areas of our state. ACID FLOUR would help them even more if they are of a syphilitic constitution. SYPHILINUM is one of the important intercurrent remedies in cases related to degeneration of the bone.
Natrum mur, Kali carb, Lycopodium, Ammonium mur are a few other deep acting remedies called on when symptomatology corresponds.
Homeopathic medicine is wholesome in the sense that the suffering of the patient is rapidly brought under control while the pathology is curtailed from further progression, while not forgetting to treat the cause.
Presented On 15 August 2006 at Apha during The Clinical Oration Dedicated To The Memory of Sri Ramaiah.