India, Sept. 20 -- The evolution of upright posture allowed humans to free their arms for skilled work, but it also placed a heavy burden on the spine. The body weight came to be transmitted across the spinal column of five lumbar vertebrae and their joints (discs and small facet joints). The back faces constant stresses and strains due to its integration with lower limbs that transmit the impact from the ground. Gradually, the lumbar spine, because of constant weight-bearing (especially in overweight persons) and mobility, becomes prone to degenerative changes. These changes may occur early in life, usually after 30 years of age, or may occur late. The adoption of upright posture extracts its price in the form of backache. Backache is a universal symptom: a housewife is as liable to suffer as an athlete. With advancing age, the intervertebral discs (the shock absorbers between individual vertebrae) undergo age-related changes. Due to daily stresses and strains, sometimes the jelly like disc material can undergo chemical changes, become weak, and compress one or more nerves. Such nerve compression can cause pain along the back of leg and thigh (sciatica). There may be numbness in the foot or leg. Changes in small joints at the back (facets) cause constant back pain. Young and physically active individuals can have stiff back due to strained muscles or ligaments. Prolonged sitting too can predispose to stiffness of the back, and usually this type of stiffness is resolved with activity and stretching of the spine. Backache can be a common symptom in women during pregnancy, due to stretching of the ligaments of the spine and pelvis. Other conditions like spinal tuberculosis, slippage of the vertebra (spondylolisthesis), weak bones (osteoporosis), benign tumours of spine, and cancer spread to spine too can present with back pain. Backache should be investigated by a neurosurgeon if the pain does not subside, does not get relieved with analgesics, or is accompanied by stiffness, change in posture and sciatica. Management has to be individualised and may require surgical intervention. Mild stresses of the spine are managed by rest, local massages with medication (on prescription), and physiotherapy. Backache due to slipped disc or spondylolisthesis with nerve root compression are cured by surgery. Other conditions require specific evaluation and surgical/non-surgical management for rapid pain relief and enabling the patient to walk. Results of surgery for slipped disc, spondylolisthesis (vertebral slippage), osteoporosis, spine tumours or tuberculosis are excellent. The author of this article is an MCh degree holder, former consultant & professor of neurosurgery, Armed Forces Medical Services, and senior director & head of department of neurosurgery, Max Super Speciality Hospital, Mohali, who is available at 981-087-9786 and www.drhsbhatoe.com...