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Watch your back

Most back and neck pain is not caused by spondylitis, say doctors. So don’t moan that you have a fancy medical condition. Hit the treadmill instead, says Colleen Braganza.

health-and-fitness Updated: Feb 07, 2009, 20:41 IST
Colleen Braganza
Colleen Braganza
Hindustan Times

Most back and neck pain is not caused by spondylitis, say doctors. So don’t moan that you have a fancy medical condition. Hit the treadmill instead, says Colleen Braganza.

Most of us never go through a single week without hearing someone announce seriously, ‘I have spondylitis.’ We nod sympathetically, knowing vaguely that it has something to do with the back and we think ‘aren’t there an awful lot of people who suffer from it’?

If not spondylitis, it’s ‘cervical’. This is a word many of us confuse with having something to do with the uterus (because of the cervix) and wonder why so many women don’t hesitate before announcing to the world that they have a problem with the uterus. In fact, your neighbourhood gossip would probably have confided in you at least once in the past that she feels dizzy all the time because of ‘cervical’.

An epidemic?
So what is spondylitis and ‘cervical’? And since everyone and his second cousin claims to suffer from either
condition, is there an epidemic sweeping India?

Spondylitis is the term used to describe age-related degenerative changes in the joints of the spine, say doctors. It is part of the ageing process and is caused by wear and tear. It is as normal as getting white hair or a cataract. ‘Cervical’ is nothing but a short form for cervical spondylitis that affects the neck.

The problem is that the term spondylitis is now freely used to refer to any kind of neck or back pain. “It is important for people to realise that neck / back pain is not spondylitis in most cases. The cause of the pain is often weak muscles or ligamental fatigue,” says Dr Sanjeev Dua, senior consultant, neurosurgery, at Fortis Hospital, Noida.

Agrees Dr H N Bajaj, head, spinal surgery, Max Super Specialty Hospital, Saket, “Any issue of neck pain is very often labelled spondylitis. The lay public and even doctors confuse this. Not all neck or back pain is spondylitis and not all spondylitis cases cause pain.” The neck and back pain most young people suffer from has its origins elsewhere, in their lifestyle for one.

A sedentary lifestyle where one does not exercise and / or overeats is the main cause of most back and neck pain, says Dr Bajaj. “Look at labourers at construction sites. They don’t get these problems because they eat frugally, live a simple lifestyle and don’t have soft, luxury beds to sleep on; they sleep on the hard floor. If you touch their spines, they feel like iron,’ says Dr Bajaj.

Doctors go on to say that this muscle and ligament weakness that causes back pain can easily be dealt with if you indulge in some form of exercise every day.

Wear and Tear
Now back to spondylitis. The degeneration of the spine started as humans evolved from four legged mammals whose legs supported the spine to two legged mammals whose spine supports the body.

With age and wear and tear, little calluses are formed around the vertebrae of the spine that push outwards and can press on the surrounding nerves.

That’s how you get cervical spondylitis (of the neck) or lumbar spondylitis (of the lower back.)

Spondylitis only develops as we grow older because in most young people, the body’s natural repair mechanism can compensate for any wear and tear. As we grow older the body’s repair work cannot keep pace and this results in spondylitic changes in the spine.

“Up to our teenage years, our body’s repair mechanism can compensate for any wear and tear. After that, wear and tear is not so well compensated by this repair process,” says Dr Sanjay Agarwala, head of the orthopaedic department at Mumbai’s P D Hinduja Hospital.

Though spondylitis occurs with age, there are some people whose spines are prone to faster degeneration than others. “It depends on the structure of the spine. Some people have an exaggerated curvature of the spine. They show degeneration earlier in life,” says Dr Dua.

A lot of muscles support the spine to align it in the right direction, so people who work long hours in one position, say, sitting at the computer, tend to strain these muscles and this accelerates the degeneration of the spine too.
“When the muscles get fatigued, the bones start touching, there is pressure on the joints and the degeneration is faster,’ says Dr Dua.

This gradual build up finally leads to spondylitis. Now spondylitis doesn’t always cause pain. “All spondylitis is not painful. One need not have pain just because one has spondylitis,” says Dr Bajaj. That means if you are on the wrong side of 30 it is possible for you to show signs of spondylitis in an X-Ray without showing any symptoms of pain. So that’s nothing to get worried about.

But in some cases, the changes in the spinal joints – small bony outgrowths – start growing in the direction of nerves and put pressure on them. “Initially, nothing happens because the nerves are pushed to one side and realign themselves. But sometimes, these small, bony outgrowths put pressure directly on the nerves and this leads to spondylitic pain,” says Dr Dua. This pain may manifest itself in the neck or back or along the nerve that travels to a particular part of the body like the hand or leg. “Usually a combination of neck pain and nerve pain will signal you have a spondylitis problem. Neck pain alone is no signal of a spondylitic disorder,” says Dr Dua.

What to do:
All doctors reiterate again and again that most often, the main cause of back or neck pain is weak muscles and an improper posture and not spondylitis.

But dealing with that is prevention. What do you do when you get neck or back pain?

“The first thing you do is get immediate relief by applying muscle relaxant and alternate hot and cold fomentation. Once the pain is gone, you need to exercise to strengthen your neck muscles,” says Dr Dua.

However, doctors say there are warning signs or red flags that signal the need for further investigation. If you have any of these signs, you should see a doctor immediately.
* When the pain is progressively growing worse. It doesn’t wane.
* You have weakness in hands or legs.
* You find it difficult to walk.
* You have a history of injury.
* You spot swelling in the neck or other areas.
If you have been diagnosed with spondylitis, that is the ‘real’ and not imagined condition, the most common way to treat it is through physiotherapy and muscle strengthening exercises.

Surgery is also an option but only when the nerve compression causes weakness and numbness that cannot be treated via conservative methods like a neck collar, drugs, fomentation etc. “However, less than one percent of people require surgery to fix a spondylitis problem,” says Dr Dua.

It's a Myth:
Many, many people feel dizziness is a sure sign of cervical spondylitis. That is a myth, says Dr Sanjeev Dua, senior consultant neurosurgery, at Fortis Hospital, Noida.

“Cervical spondylitis is not the cause of vertigo. If at all, it will be the cause in one out of 2,000 cases,” he says. “However, if vertigo accompanies other symptoms like nausea, vomiting or difficulty in speech, spondylitis could be the cause because of pressures on an artery near the affected area.”

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