Rhythmic Physician: Lower Back Blues
At some point in our lives we all will experience back pain. It is second only to the common cold as the most common reason for seeking a physician. Low back pain (LBP) is the most common and costly medical condition in industrialized societies. Individuals in their mid-thirties are at greatest risk for intervertebral disc herniations. Men are affected slightly less than women with the overall incidence increasing with age.
The first attack of LBP usually occurs in our thirties with 90 percent of complaints resolving without medical treatment in 6—12 weeks. However, when low back pain occurs with sciatica, or leg pain, 75 percent of which becomes asymptomatic within six months, there is a 60 percent recurrence rate over the next two years.
Drummers are not immune to LBP. Sitting in awkward positions for long periods of time, twisting, bending, and on occasion, lifting and carrying heavy, awkward pieces of equipment, can lead to low back injuries. When the supporting muscles of the spine are not prepared to perform these activities for extended periods of time, or if these activities are completed in a mechanically stressful position, injury can occur to individual or a number of supporting structures.
Unfortunately, there are many different structures in the lumbar spine that can generate pain, including the supporting muscles and ligaments, intervertebral discs, nerves, boney structures, and joints. Back pain can also result from infection, be referred from other areas of the body, and be exacerbated by tension and stress.
LBP is most commonly caused by an injury to the supporting muscles or ligaments in the lumbar spine, which hold the vertebrae in proper position. The lumbar vertebrae are bones that make up the spinal column, which the spinal cord passes through. Muscles and ligaments can fatigue, weaken, and tear with repetitive flexion and extension of the spine. When the spine loses that stability it can result in pain.
Discs, on the other hand, can be damaged when the outer lining, or annulus, allows the inner nucleus to escape though the outer layer. The disc can be damaged by a sudden strenuous action such as lifting a heavy object, twisting, or even sneezing. The discs can also be damaged by a fall or accident, repeated straining of the back or, most commonly, by simply bending over and twisting.
The pain associated with disc herniations can range from localized pain in the low back to pain radiating into the buttocks or legs. Lumbar disc herniations that are compressing or irritating a nerve root can cause an electric type pain down the legs, numbness and tingling in the legs, or in more severe cases, weakness in the leg.
When low back pain is associated with changes in bowel and or bladder function, sexual functioning, night pain waking you from sleep, unexplained weight loss, failure of bed rest to relieve pain, or when associated with a febrile illness, medical attention should be sought immediately.
Unfortunately, we all will experience back pain at some time in our lives. With the proper treatment and preventative measures, our exposure as drummers to these debilitating injuries can be minimal.