30 September 2019
Mr Praveen Inaparthy is a consultant orthopaedic and spinal surgeon, specialising in minimally invasive spinal surgery. He says he decided to specialise in this area “because of the inspiration and support I received from the spinal surgeons I trained under." He enjoys this aspect of orthopaedic surgery and says the most important step in management of spinal problems is to find out the root cause as there could be more than one reason why a patient is suffering with back pain. A thorough clinical examination is the most important step to understanding the root cause. “Patients will go on to have MRI scans and other investigations, but I believe the first clinical examination by the specialist is the most important step of all.”
Here, during Back Care Awareness Week (October 7-11) he talks about the most common causes of back pain, the treatments, and offers self-help tips:
With an aging population I am seeing more patients with degenerative back conditions. The three most common conditions I see are:
- Disc prolapse - also known as a slipped disc, this is when a soft cushion of tissue between the bones in the spine slips out. It can happen gradually or suddenly. Lifting and twisting movements are a common cause of sudden prolapsed disc – such as lifting a roast out of the oven or heavy bags out of the car.
- Lumbar spinal stenosis - which is a narrowing of the spinal canal, compressing the nerves traveling through the lower back into the legs. Often people find they need to stop or sit down when walking or lean forward in a chair to relieve the pain.
- Spondylolisthesis - this is a slipping of the vertebra (not to be confused with a prolapsed or slipped disc) that occurs, in most cases, at the base of the spine. It is a gradual process causing back and leg symptoms due to spinal instability.
All three conditions often cause pain, not so much in the back, but in the legs. Sciatica is pain going from the lower back and down the leg and is caused by the impingement of the sciatic nerve.
You may feel shooting pains down the leg and experience numbness and weakness in the leg. It can affect both legs but if you are losing control of your bladder or bowel and have numbness in the buttocks, go to A&E.
See your GP who can prescribe pain killers and may refer you to a physiotherapist. For most people, this will be all they need and their back will settle down eventually. If you are still suffering with your back for more than one to three months, ask your GP to be referred to a specialist as some of these symptoms may need further intervention.
Some patients benefit from a steroid spinal injection which reduces inflammation, provides immediate pain relief and gives the back time to heal. Only a small percentage of patients require surgery. You should remember to keep active despite suffering with back pain – lying down can make the symptoms worse.
Minimally invasive surgery
The benefits of minimally invasive back surgery are: less blood loss during the operation, smaller scars, less pain post-op and patients recover quicker. For instance, using minimally invasive surgery to carry out a lumbar decompression (relieving the pressure on the spinal nerves) an office worker can be back at work within three weeks and physically active within six to eight weeks.
Looking after your spine
It is important to look after the health of your spine. Focus on exercises to strengthen the core muscles which support the spine and do stretches every day. This is particularly important for people aged over 40 as they begin to lose muscle mass. Yoga and Pilates classes will strengthen your core muscles and increase flexibility in your back. There are plenty of apps and websites demonstrating back stretches.
Always bend your knees when lifting a heavy item. If you are working in an office, ensure your chair allows you to sit in a correct position and your computer is at the right height. Get up from the computer for a quick walk and stretch every 30 minutes to an hour. Be aware of your posture and avoid scrunching up your shoulders.
Tips for golfers: it is often wrong technique and physical imbalances which causes back pain rather than the game itself. Also, many golfers walk straight out onto the golf course and start playing without warming up. Always warm up and stretch – focus on the shoulders, lower back, hips and hamstring muscles. Continue stretching on the golf course while you wait your turn to play.
Tips for gardeners: before you go out to rake the leaves this autumn do stretching exercises for the lower back, buttocks and hamstrings. Have frequent breaks and don’t overreach when you are trying to prune or cut back trees and shrubs.
Advice from Mr Praveen Inaparthy, Consultant Orthopaedic and Spinal Surgeon at Spire Gatwick Park Hospital. If you wish to book a consultation with Mr Inaparthy, please call on 01293 778 906 to find out more.