WHEN you’re angry at someone, "Back off!" sometimes works as a stern warning. And when the air is heavy with the stench of treachery or betrayal, we say to a friend "Watch your back!" Most of the time, these are what we mean. But the doctor can also say "watch your back" and mean just that. Or with a painful back, extending the interpretation of "back off" is probably biomechanical – as in "offloading" or "un-loading" the lumbar area.

Hurting the back. Unless you’re a dog, you will hurt your back at least once in this lifetime. It’s just a given from having evolved from a quadruped to a biped. The weight of the upper body mercilessly passes through the lower spine endangering most commonly the so-called lumbo-sacral region. This is the part of the back that joins the pelvis. You know when this is affected because it is what we instinctively touch when the back hurts on. For example, on getting up from gardening, a person usually holds her back trying to stretch or push it.

The usual suspects. There are four ways to injure the back. The first is force which is selfexplanatory in domestic violence, especially with a shoe print on the wife’s back (seen in a medico-legal examination). The onomatopoeic TV tabloid description of this is: Tadyak! Force also refers to the amount of effort needed to accomplish a physical task. The second is repetition which is the number of times an action is performed. Therefore, the back is hurt when an action is both forceful and repetitive. If work includes regularly lifting heavy objects, there may be a problem if you’re not Mr. Olympia. Posture can also damage the lower back and this includes how one stands, sits, and even sleeps. Finally, stress in general impacts body hotspots or susceptible areas such as the neck and the lower back.

Time to see the doctor? The success of over-the-counter drugs lies in the fact that the garden variety backache disappears in a few days of selfmedicating. But when is back pain a more serious symptom? Consider these:

* Associated with sudden or unexplained weight loss

* Numbness or tingling going down one or both legs

* Constant and worse at night

* Associated with bowel and bladder changes

* Weakness of one or both legs

* Associated with abdominal pain

* Pain from a fall or strike on the back

Screening tests. The doctors to see are any of the following: Family medicine practitioner, rheumatologist, rehabilitation medicine specialist, neurosurgeon, or the orthopedic surgeon. The screening tests most likely to be requested, particularly in chronic low back pain are x-rays (to look for fractures, check spinal alignment, or bone destruction from cancer), magnetic resonance imaging (MRI) or computed tomography (CT) scan usually for disk problems, bone scan for infection or malignancy, and EMG or electromyography to check on the nerves exiting the back.

Treatment. Depending on what the doctor uncovers, the initial treatment for back pain is conservative. Medications include COX-2 inhibitors such as lumiracoxib, etoricoxib and celecoxib; non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, mefenamic acid, and naproxen, and muscle relaxants. Back pain can also be relieved by physical therapy in the form of hot/cold applications, electrical stimulation, as well as controlled exercises for the lower back. Some patients respond to chiropractic manipulation, acupuncture needles, or stress-reduction by meditation, yoga or Pilates. Surgery is a final option should all conservative measures fail.

Saving the back. Work on proper body mechanics to prevent back pain. When standing, keep the pelvis neutral. This means not tilting it to one side or too much to the front or back. If office work demands sitting for long periods, get a foot stool to retain the natural curve of the lower back. The body can tolerate a rigid position for only 20 minutes. So, change your posture or stand up, stretch or walk around. When lifting a heavy object, stand close to it and bend at the knees.

Watch your back! Treachery and betrayal may come from there too.

Billboard. Happy Birthday to my dear Tita Lulu Sicat! She practically raised me in Dimasalang. Belated Happy Birthday too and Congratulations to my uncle Engr. Glicerio V. Sicat! He was recently elected as Vice President of the prestigious Rotary Club of Manila.

Fact/Factoid. Rapid weight loss in the first few days of most diets is due to loss of body water.

Dr. Pujalte is an orthopedic surgeon. E-mail jsp@pldtdsl.net

Webpage http://www.webspawner.com/users/jspujalte/index.html