Lower back pain is one of the most common of pain disorders encountered in practice: Surveys indicate that 70 per cent of the population suffers from low back pain at some time in their lives. The highest rate of back pain occurs among the 45 to 64 year age group. The incidence of low back pain is greater among women. In 90 per cent of patients, low back pain resolves within six weeks, i.e., it is self-limited. In another 5 per cent the pain resolves by 12 weeks.
Symptomatology & Etiology
Known to Ayurveda as Katigrahama or Prishtasula, the condition is characterized by a chronic, persistent pain ranging from a dull ache to a sharp stab-like pain to a burning sensation affecting the lower back. It may also present with stiffness and loss of motility, numbness or tingling with pain shooting down the buttocks, back of the thighs and the legs and feet.
Low back ache is often precipitated by moving, lifting objects or twisting of the waist. Severe pain in the low back can be quite debilitating to patients. Pain in the lower back restricts activity and reduces work capacity and quality of enjoyment of everyday living and turns daily life into a misery. The source of low back pain may be also due often to pushing oneself beyond physical or emotional capacity. The spine needs stability and, therefore, the mind must also be steady; emotional and mental perturbations thus also may play a part in this condition’s etiology.
One of the common causes for the backache is a poor posture habit. Balanced posture decreases stress on your back by keeping the muscles, bones and other supporting parts in their natural position. Any change from normal spinal curve can stress or pull muscles. This leads to increased muscle contraction, which causes pain. Low back pain can result due to health problems like osteoporosis, scoliosis, and spinal stenosis. Sprain or strain of muscles or ligaments in the area can also manifest in low back pain. Other possible causes include fibromyalgia and benign or malignant tumors. A fall or blow to the back can strain or tear tissues around the spine, or even break a bone leading to back pain. Lack of exercise or incorrect exercise can also lead to low back pain. Too much weight or overweight also is a cause of low back pain. Less than 5 per cent of back pain account for true nerve-related pain.
Conventional Western Approaches
Conservative treatment is the most likely course of action for most patients. Conventional Western treatment options include rest, traction, short wave diathermy, oral steroidal and non-steroidal anti-inflammatory medications, weight control, and steroid injections in step by step order.
Pharmacotherapy and surgery are only rarely completely effective, as the overwhelming majority of instances of the disease are not the result of structural injury, but rather of the mind-body response to stress. Additionally, the prospect of spinal or nerve damage resulting from surgical intervention is so frequent in occurrence that it has given rise to the diagnostic category of Failed Back Surgery Syndrome (FBSS) and the prospect of liver and kidney damage from long-term use of even the more innocuous of orally-administered NSAIDS is not remote.
Ayurveda holds that low back pain is a result of vitiation of one of the three principal 'doshas'. 'Katigrahama'/'Prishtasula' or low back pain is most often an indication of Vata aggravation and bone and muscle weakness (asthi dhatu kshaya or mamsa dhatu kshaya.
Treatment in Ayurveda aims to bring the vitiated dosha back to the state of equilibrium and thereby to the state of health. One thus pacified, the balanced doshas will allow treatment efforts to be directed to the dhatus (tissues) involved.
For treating low back pain, internal as well as external treatments are undertaken. Herbal preparations like 'Asthakvargam,' are administered internally. Herbal drugs like Yogaraja guggulu, Lakshadi guggulu, Triphala guggulu, Dashmul or Dashmularishtam, Ashwagandha and Brahmi and topical applications of Mahanarayana tailam are useful in this condition. Daily purgation is recommended to restore the vitiated 'dosha' to the state of normalcy.
Ayurvedic physical treatments like abhyanga (oil massage) and basti (meditated enema) are very much helpful in relieving backache and correcting abnormalities.
Kati basti is a special technique aimed at providing relief to the lower back using warm medicated oils, ghee or herbal decoctions when bathing the lower back (isolated by a “dam” of moist flour – black gram flour being preferred) for 20 to 50 minutes. The dough ring is about four to five inches in diameter and is placed on the back around the painful area. Usually it is applied to the lumbar-sacral area of the spine, which is a major site of vata. The warmed liquid is poured or swabbed onto the lower back in the dough ring. When the oil cools down, it is squeezed out with cotton gauze and the procedure is repeated several times. The indications for this therapy are backache, degenerative spine changes, compressed discs, osteoporosis, sciatica, hip pain, shoulder pain, and spinal cord compression. Most of the time, vata dosha is the cause of pain in this area, thus warm castor oil, or dashmula oil, work best for kati basti. Brahmi oil will heal nerve damage. St. John’s wart is not a typical Ayurvedic herb, but its nerve and connective tissue healing infused oil is ideal for kati basti. The healing properties of herbal oils used for this basti deeply clean and fortify the blood, strengthen muscle and connective tissues, and lubricate the joints. Kati basti is likely to alleviate most types of low-back pain.
The first step in the treatment of Low Back Pain is for the patient to learn to relax the mind and focus on the specific areas of back pain. Among the Yogasanas, when there is pain, it is advised start with simple back-bends, such as Locust, Cat, and Sunbird. To keep the spine aligned, practice Hero Pose. In some cases, Mandukasana (frog pose) can be useful.
Article provided by William Courson, BVSA, D. Ayur., an Ayurvedic Practitioner, faculty member and the College Dean of Institutional Development at Sai Ayurvedic College & Ayurvedic Wellness Center.