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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 56061
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I have had back pain since I was a little girl but the pain

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I have had back pain since I was a little girl but the pain seems worse art the moment, in my lower back and hip and thighs
JA: Have you had any recent injuries? What seems to make the pain better or worse?
Customer: No recent injuries. Struggling to get up and down but moving around helps a bit. When I lie down the pain is quite bad
JA: Is there anything else the Doctor should know before I connect you? Rest assured that they'll be able to help you.
Customer: I have diabetes and bipolar dusorder

I am sorry about your symptoms.

What is your age?

What are the investigations/treatments done?

Customer: replied 18 days ago.
I am 46 and have had an MRI scan which showed a bulging disc. I am on zapain tablets but the pain is still very intense.

Thanks for the further information.

I am writing the answer for you and will get back to you in 5 minutes.

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Thank you.

You may consult any of the following specialists (apart from your GP);

a) Orthopedist

b) Neurologist

c) Specialist in Physical medicine and rehabilitation.

The following measures would be helpful;

1) Backcare in the activities of daily living, which is an integral component of the treatment of back problems. Back education is one of the most important things which teaches the basic body mechanics, like correct posture for standing, standing at a desk or drawing board, sitting, brushing teeth, washing the face, pushing and pulling a weight, lifting a weight, getting in and out of bed, sleeping, getting into and sitting in a car. The training for these routine activities helps in preventing the spasm of the muscles. One needs to consult an occupational therapist or physical therapist which can educate about the proper and improper behaviors when the back is painful in case they have to sit, bend forward, lie down, walk, cough, or sneeze.

You need to practice postural hygiene by avoiding bending your back forward. If you have to pick anything from the floor you should bend your knees while keeping the back straight.

You should also avoid sitting for long periods as intradiscal pressure, that is the pressure inside the disc is maximum during sitting posture and that can aggravate your symptoms. If you have to sit, you must take regular breaks every 15 to 20 minutes even if for a couple of minutes. When sitting, try using a footstep to support your feet so that the thigh body angle remains 90 degrees or less than that for most of the time.

You should also use the full length of the chair when sitting in a chair so that your buttocks are in contact with the back support and the deep of your back is supported by a chair or a cushion placed between the deep of the back and the chair.

You should also consider strengthening the core and the back muscles that play an important role in supporting the vertebral column.

Two excellent exercises for strengthening core and back muscles are swimming and yoga, once you are significantly better and these can be done without the pain.

The following more need to be done:

a) Avoid activities that increase pain.

b) Rest intermittently

c) Avoid bending at 90 degrees

d) Pushing and pulling should be avoided until the pain subsides

f) Avoid prolonged sitting and standing

g) Avoid sitting or sleeping on the floor

2) Anti-inflammatory analgesics like ibuprofen, other analgesics, and muscle relaxants

3) Local analgesic gels or sprays/ointment

4) Hot fomentation

5) Electrotherapy like transcutaneous electrical nerve stimulation: done by the physical therapist. Other things are ice packs, heating pads, electrical stimulation, phonophoresis, iontophoresis, relaxation, and biofeedback.

6) Well supervised physiotherapy: The exercises consist of abdominal bracing, modified sit-ups, double-knee-to-chest or low back stretches, seat lifts, mountain and sag exercises, knee-to-elbow exercises, hamstring stretches, extension exercises, and extension flexibility exercises. Swimming exercises (pool exercises) are best for back pain. Initial stretching and later strengthening exercises are taught.

7) Lumbosacral corset or support or back brace.

8) If obese or overweight, reduce weight for long-term benefits.

9) Epidural steroid shots

10) Surgery is usually the last resort when the above conservative measures fail.

You may start these exercises;

1) Straight leg raising: Lie on the bed with your back and remain in a relaxed position. Slowly raise one of your legs upward and keep it as straight as possible. Count up to ten, and slowly bring down the leg. Do the same with the other leg. Repeat this exercise ten times.

2) Curl-ups; lie on the back with knees bent, fold arms across the chest, tilt the pelvis to flatten the back, and curl-up lifting the head and shoulders from the bed/couch. Hold for ten seconds, then slowly lower to the starting position. As strength builds, aim to complete one set of ten curls. The exercise should be done twice a day (both sets).

This is a slide show for the exercises (you can pick up your own set, which suits you);

https://www.mayoclinic.org/healthy-lifestyle/adult-health/multimedia/back-pain/sls-20076265

https://southtees.nhs.uk/content/uploads/MICB4088-Spinal-Exercises.pdf

I wish your symptoms resolve soon.

I would be happy to assist you further if you need any more information.

Thanks for using Just Answer.

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