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Medical Scribblings - 12 March 2009

One of the great joys of general practice is the constant flow of new problems and new ideas about what should be done about them. Some problems are constantly with us such as back and spinal pain. I’m sure that many of you suffer from backache as I have done myself in the past. There are endless cures on offer but to be honest most people with back pain will be better in a few weeks whatever. It’s a good idea to avoid xrays if possible unless the problem is long lasting as the dose of xrays to see the back is very high.

The problem of backs fascinates me.Why should it be so common and why do we seem to be so disabled by it? There have been suggestions that it is becoming more common possibly since we stopped walking everywhere and took to driving comfy cars. The theory is that we fail to build up the muscles round our spine and thus lose the support that it needs to function properly.

The really interesting thing is that we, as humans, stand up on two legs instead of four as most of the rest of the animal kingdom. Fossil records suggest that we branched off from a chimp-like animal about 5 million years ago. As you will have seen on the TV, chimps can stand upright but they find it really hard work if they do it for too long. Maybe our ancestors started to try and reach food that was higher up in the trees rather like a giraffe or maybe they could more easily see a lion coming. Once our hands were no longer needed for walking they came in useful for all sorts of clever things. You can see it all in babies who take a year or two to be able to balance on their two legs without holding on. Indeed to get a robot to run and jump on two legs is still impossible.

The downside as far as our backs are concerned is that instead of our spines being in a nice curve like a suspension bridge it is more like a skyscraper with all the weight falling on the bottom. Having freed our hands and arms up we then proceed to use them to lift and pull causing further pressure at the base. The discs should be like buffers on an old train bouncing backwards and forwards. Instead of course they are just squeezed between the bones. The outcome is inevitable, they tend to give way in time.

An interesting recent finding is that women and men have different vertebrae (back bones). Those of women can somehow better cope with a large baby sitting infront though I must say many pregnant mums complain bitterly of lower backache.

If having an upright spine was not bad enough, humans grew a great big brain and a big skull to put it in. To have a good look round they then allowed the head to turn well to the sides. The inevitable results is that lots of us get bad neck ache together with aches down the arms. You also get pains down the legs with lower backache (sciatica). It is fairly easy to work out which nerve is being trapped by checking the area of the arm or leg with a chart.

I wish that I had some easy solution to your problems but unfortunately, no I don’t. Probably the best advice is to get out of your car and have a walk round regularly as a preventative measure. Stop smoking – smokers have a 70% higher rate of back problems – very likely due to poor blood supply. If you should be afflicted try and keep as active as you can, take some pain killers in the acute phase and avoid lifting and pulling. I’m rather wary about taking strong painkillers in the longer term as people tend to do this and then feel able to start doing heavy jobs again which then turns an acute short term problem into a long term recurrent disability.

There are lots of other problems with standing upright but maybe we can get round to them another day.

John Schofield