When is surgery needed for back pain?

The first thing that we must do when we have severe back pain is to obtain a thorough evaluation by our local doctor or even better, an orthopedic surgeon. This will include a detailed medical history, clinical examination and possibly investigations such as a blood test, X-ray, CT or MRI scan. These investigations may show that the back pain:

  1. Is due to a serious spinal or other disorder that requires surgical management. These are known as “Red Flags.” Remember that ONLY 1% of all back pains come under this category
  2. Is due to a spinal or other disorder but can be managed with conservative treatments. It accounts for 10 – 15% of back pain cases.
  3. Does not have an identifiable spinal or other cause. Most back pains (85 – 90%) fall in this category.

Back pain does not mean surgery

Just because you see your physician or orthopedic surgeon does not mean surgery. Surgery has been found to be helpful in only 1 in 100 cases of low back problems. In fact, surgery may do more harm than good.

This is why we need some strong indicators for surgery. These indicators are known as “Red Flags” and tell us that surgery must definitely be done if permanent damage is to be avoided and that the benefits of surgery far outweigh the complications that may arise due to the procedure.

Red Flags

So what are these Red Flags?

  1. Difficulty in urination or loss of bladder and/ or bowel control
  2. Saddle anesthesia – numbness around the genital area and buttocks
  3. Numbness/ tingling in one or both feet/ toes
  4. Difficulty in moving the ankle upward or downward or raising the great toe
  5. Gait disturbance – difficulty in walking
  6. Changes in reflexes in the legs (this can be detected by the physician).

If you have one or more of the above symptoms you definitely have a condition that may need surgery. The timing of surgery will depend on how severe the symptoms are.


  • Excerpt from “Say Goodbye to Back Pain” by Dr. V. Ranjan. Available at http://www.amazon.in/Say-Goodbye-Back-Pain-Ranjan-ebook/dp/B004S7BAO6

Why women suffer more from back pain

Women tend to suffer more from back pain than men. Physiological reasons for this disparity are:

  1.  Periods – Backache is common during periods but is usually cyclical and disappears once the periods are underway or end. However, there is a condition called endometriosis where cells from the lining of the womb implant abnormally in the pelvis and back. This can give rise to excruciating pain many days before the period starts and persist long after the period ends.
  2. Pregnancy increases women’s vulnerability to back problems. During pregnancy, hormonal and other body changes result in:                    a. Loosening and weakening of ligaments                                                b. Abnormal lordotic posture with the tummy jutting out in front and the      buttocks thrust backwards.                                                                c. Progressively increasing weight due to increase in fat and the growing        baby                                                                                                               It is estimated that between 40% and 60% of pregnant women get back pain due to these changes.
  3. Caring for babies and young children – breast feeding, bathing, picking up, etc. adds to the risk of back pain. These acts involve lifting the baby at a time when the ligaments and muscles of the back are still lax. Incorrect lifting may result in severe back pain.
  4. Menopause and peri-menopause – Estrogen is essential for Vitamin D3 formation in the body. In turn, Vitamin D3 is required for calcium absorption from the food in the intestine and its uptake in bone. As estrogen levels decline at and around menopause, the bones start becoming brittle, a condition known as osteoporosis. Neck and back pain often begins or increases with age.

Social causes

  • Domestic:

There are also social reasons as to why women are at greater risk of back pain than men. Women still undertake the majority of domestic tasks that places them at high risk of back pain:

  • Shopping – carrying heavy loads
  • Cleaning – bending, twisting, pushing and pulling
  • Ironing – standing and twisting
  • Carrying heavy objects
  • Gardening
  • Vacuuming

Thus while back pain in men is often a result of an injury, women suffer from back pain as part of their everyday lives, a result of long-standing conditions or activities, including domestic work and child care.

  • At the workplace:

The kind of jobs women do in the workplace also contributes a great deal to the increased incidence of back pain amongst them. Women are generally given tasks that involve:

  1. Repetitive tasks such as pushing, pulling or twisting of the body in jobs such as those performed by supermarket check out staff, production line workers, cleaners and machinists
  2. Sitting or standing for long periods. Women are more likely to get back pain if they work in the health services, retailing, hotel and catering, banking, finance and insurance industries. Shop and factory floor workers, keyboard and telephone/call centre workers and bank tellers who stand or sit for long periods are especially prone to get back pain
  3. Lifting, bending, stretching and reaching in jobs such as child and social care workers, nurses, teachers of small children and counter staff. Nurses often get back pain when lifting patients from the bed or chair.

Lifestyle causes

Women have additional lifestyle demands that lead to back pain:

  1. High heels to make the legs look longer and tilt the back
  2. Tight clothes to emphasize slimness – this also restricts easy movement
  3. Breast implants that increase breast size and strain the back
  • Excerpt from “Say Goodbye to Back Pain” by Dr. V. Ranjan. Available at http://www.amazon.in/Say-Goodbye-Back-Pain-Ranjan-ebook/dp/B004S7BAO6

SITTING !!! The commonest cause of back pain

Back pain commenced the day we humans decided to spend our lives sitting down and stop using our back muscles. A fixed posture such as bending forwards while sitting stresses the spinal joints, discs and ligaments and as time passes, the body reacts to this stress resulting in loss of joint mobility and degenerative changes in the joints and intervertebral discs.

In people who sit hunched in front of computer and TV screens for long hours, the muscles on either side of the spine weaken due to disuse. Disuse leads to wasting of muscle tissues. Disuse and wasting of the back muscles is also seen in the case of taxi and truck drivers and desk jobbers like accountants and clerks, call centre and data entry employees, check out staff in supermarkets, accountants, software engineers and just about everyone in the IT industry. WOW!! That’s half or more of the entire working human population!

We have only ourselves to blame, since the most common causes for back pain are:

Slouching in chairs

Sitting puts almost twice the pressure on intervertebral discs as standing. Since the muscles and ligaments are the main components holding up the vertebrae, the loss of power means that the weight bearing responsibility is shifted to the bony parts of the spinal column. This poses a tremendous strain on the spine and is responsible for disc problems such as disc degeneration and disc prolapse.

When you sit in any chair, a number of important postural control muscles are inactivated, while others are being asked to work overtime. This leads to the following muscle problems:

  1. Shortening of the hamstring muscles
  2. Overworking of the Erector Spinae muscle group
  3. Overworking of the Iliopsoas muscle

Hamstring Muscle Shortening

When we sit down, the hamstrings are pulled and maintained in that position for as long as we are sitting, which could be hours. Although the hamstring muscles are inactive, they are held at a shortened length. This is a probable cause of tight hamstrings. Tight hamstrings are associated with back pain. The reason is that tight hamstrings stop the hips from flexing during forward bending. This forces the lower back to bend beyond its strong middle range. Rounded shoulders and a hunched (forward curved) back due to shortened hamstrings are typically seen in those who sit for long hours.

Overworking of the erector spinae muscle group

Chair sitting is unique in that the gluteus maximi (buttock muscles) are totally relaxed at the same time as having an upright torso, and they are therefore not able to contribute to extension of the lower back and stabilization as they usually do. It is the erector spinae muscles alone that are holding up the back without the help of the gluteal muscles. Prolonged sitting tires out the erector spinae muscles which give up the struggle to maintain the correct “hollow” in the lumbar spine. This again contributes to the forward curved lower back and a stooping posture when the person stands up.

Iliopsoas Muscle Strain

Assuming you are using a chair whose backrest slopes backwards or is too far behind, your iliopsoas muscles must continuously pull your body forward to stop you falling backward. If you are sitting for a long time, the iliopsoas muscle has to remain contracted for that period of time. That is a sure fire recipe for iliopsoas muscle shortening. Ten to fifteen percent of back pain is due to a tight iliopsoas muscle.

When we sit for a prolonged period, all these muscles are starved of blood supply and oxygen because they are constantly in a state of contraction.When we finally get up, the same muscles are unable to support our backs. Our entire body weight is now supported by the spinal column alone. No wonder we, the so-called modern human race, suffer from backache.

Other self-made mechanical causes of back pain

  1. Standing badly with rounded shoulders and/ or the pelvis thrust out
  2. Lifting heavy loads incorrectly
  3. Sleeping on sagging mattresses
  4. Being generally unfit and not bothered about regular exercise
  5. Obesity: Obesity per se can cause back pain due to the weight being carried by the spine and lack of exercise. In addition, once an obese person develops back pain, he/ she is caught in a vicious cycle since he/ she finds it difficult to move and without movement, the ability to burn calories and reduce weight is severely restricted. Hence both weight and pain will increase with time.
  • Excerpt from “Say Goodbye to Back Pain” by Dr. V. Ranjan. Available at http://www.amazon.in/Say-Goodbye-Back-Pain-Ranjan-ebook/dp/B004S7BAO6

Say Goodbye to Back Pain

Welcome to one of the commonest health problems on earth. At my age (and I have batted for a good many decades now) hardly a day goes by when someone or the other does not complain of back pain. It is a popular conversation starter and a condition that everyone seems to empathize with.

The problem with back pain is that it comes back (excuse the pun please!) again and again with increasing severity. It can affect our work and our daily routines to such an extent that we begin to live in perpetual fear of suffering another attack of back pain that could leave us bed-ridden. Wouldn’t it be wonderful therefore if we could say goodbye to back pain and be able to carry on with our lives as before?

YES YOU CAN provided you have access to the right information and are able to understand how back pain occurs. There is no review that provides a unified approach to the management of back pain. Newspaper or magazine articles or even books on back pain discuss a variety of options and then leave it to you and me to make up our mind as to which course of action to follow. At the end of it all, the vast majority of us simply soldier on, clutching at various therapies, in the vain hope that one day something will work and we will be all right.

Over the next few blogs you will learn precisely why you have backache and how to tackle it. You will have access to a flow chart that will enable you to take control of your back pain and GET RID OF IT, ONCE AND FOR ALL.

Excerpt from “Say Goodbye to Back Pain” by Dr. V. Ranjan. Available at http://www.amazon.in/Say-Goodbye-Back-Pain-Ranjan-ebook/dp/B004S7BAO6