An Epidemological study on Low Back Ache (Kati Shool)

The prime causative factors for all the disease is faulty life style and dietetics which is being followed frequently, leads to many diseases. Low back pain is one among them. Low back pain (Katishoola) is most expensive & benign condition in industrialized countries. It is one of the most frequent symptoms encountered by adults. The annual prevalence of LBP is 15-45%. Aims and objective-To evaluate the role of dietetics & life style modern era and working pattern in progression of low back ache. Material and methodSurvey work was carried out on working group of Gujarat ayurveda university employees, OPD and IPD patients having low back ache on the basis of specially prepared proforma and questionnaires including present era lifestyle, working pattern and diet pattern. Total 91 patients were surveyed. Maximum numbers of patients were in age between 31-40 yr. The person doing mainly labour and/or clerical work, having shift and night duty, long time sitting on one place with improper posture, excessive walking (>3hr daily), bending posture, Standing type work (>3hr daily), >2hr travelling daily were affected more. Vishamashana, abhishyandi aaharsevan, consuming oily food, stress, irregular bowel habit, disturbed sleep, ratrijagaran, vegdhaarana etc. were observed as nidana. ConclusionFaulty life style and diet pattern leads to accumulation and provocation of respective dosha and development of various life style related diseases and one of them is low back ache. 519 * Corresponding Author: Geeta Vishwanath Sathavane Associate Professor Rog Nidana Department Datta Meghe Ayurveda Medical College and Hospital, Wanadongari, Nagpur, India Email Id: geeta.sathavane@gmail.com Geeta Vishwanath Sathavane et.al., An Epidemological study on Low Back Ache (Kati Shool) Published online in http://ijam.co.in ISSN No: 0976-5921 related with each other, the aggravation Vata particularly in Aasthi hampers the quality of Asthidhatu. (3) The weak Asthidhatu provides to set the disease process & when vitiated Vata gets settled into Katipradesh causes Katishoola. The Etiological factors and pathogenesis of above disease i.e. Katishool are not given separately in classic but being one of the 80 Nanatmaja Vatavyadhis (4) the same Nidana of Vatavyadhies is applicable here.(5) Out of 5 types of Vata, Vyana & Apana are specially vitiated. In this condition many times Katishoola is seen alarming symptom for future disease condition like Grudhrasi, Pakwashayagata Vata(6), Gudagatavata(7) and so on. Aims and objective To evaluate the role of dietetics & life style of modern era and working pattern in progression of low back ache. Materials and Methods Proforma and questionnaires including present era lifestyle, diet pattern and working pattern were prepared to assess the subjects. Special survey work was carried out in working group of GAU Employees. Total 91 patients were surveyed for the study. Selection criteria Inclusion criteria All the subject working in GAU campus and having complaints of backache at least more than 3 months and ready to give their inform consent for the participation were selected for the present study irrespective of their age, gender and work pattern. Patients were having complaints of LBP and came to the IPGT&RA hospital for treatment was also selected for present survey study. Exclusion criteria All the subject working in GAU campus and having complaints of backache for less than 3 month and did not ready to give their inform consent for the participation were excluded for the present study. Patients were not having complaint of LBP. Study period Total 91 patients were surveyed during year 2012. Observations and results Out of 91 patients, 38 (41.76%) patients were laborer, 26(28.57%) patients were doing clerical / computer work. and 27 (29.67%) patients were housewives. (Table1) Table1: Nature of work of 91 patients Katishool (Low back pain) was found in 100% of patients, Stambha (Stiffness in back) (63.74%), Spandana (Radiating pain) (40.66%) Ruka (constant pain in lumber region) (36.26%) Toda (Pricking type of pain) (10.99%) were observed as chief complaints. Gaurava( Heaviness in body) (48.35%), Udaradhmana (Gurgling sound with fullness in abdomen) (41.76%) Tandra (Sluggishenss) (29.67%), Bhrama (16.48%), Arochaka (Loss of taste) (13.19%), Bhaktdwesha (Loss of appetite) (13.19%) were observed as associated complaints. 35.16% patients were having symptoms from 2 m-1yr followed by 32.97% patients was having chronicity of 1 – 2 years. Maximum no. of patients were females (71.43%), from poor socioeconomic status (53.85%) and belonging to age group between 31-40yr (36.26%). 46.15% were of Vatapitta Prakriti. On taking a careful history it was observed that most of the patients were not following the code and conducts described in ayurveda for healthy eating. 48.35 % of patients’ were daily taking fried food items (oily food). 40.66% of patients were daily taking Spicy food, daily potato in diet (26.37%), taking Curd more than 3times in week as it is Abhishyandi in nature was observed in 25.27% and specially taking curd at night in 15.38% of patients, taking Atisheeta Ahara Sevena such as icecream >3times in week. (17.58%), frequently soft drinks (24.18%), frequently fermented food items (18.68%) and Junk food and were observed. Katu Rasa (pungent) dominant diet was taking (56.04%) of patients, Followed by 37.36% were taking Madhura Rasa (sweet).Dietary habits like Vishamashana (irregularity in quantity and time of diet (40.66%), Alpashana (taking less quantity of food) (19.78%) Adhyashana (Taking meal on meal) (8.79%), Viruddhashana (consuming incompatible foods) and Atimatrabhojana (taking more quantity of food than digestive fire) (6.59%) were observed. (Table 2) Table 2: Distribution according to dietary haibts 82.41% of patients were habitual for tea more than thrice a day, while 31.86% of patients were taking tobacco in the form of chewing and smoking. And 3.30% of patients were Alcoholics. Disturbed appetite (Vishamagni) (36.26%), Disturbed sleep (Khandita Nidra) (46.15%), frequent awakening at night (Ratrijagarana) (21.98%), Irregular bowel habit (74.72%) was observed in patients. Diwaswapa (Day sleep) (79.12%) Travelling more than 1hr daily (51.56%) Vegadharana (Suppuration of natural urge) 37.36%, working in AC (Ateesheeta) more than 5hr daily was observed. H/o Laparotomy (29.67), H/0 Trauma (Abhighata) (35%), Chinta (stress) (71.43%), Krodha (angry nature) (28.57%) was observed in patients. Nature of work Number of patients Percentage % Housewife 27 29.67 Laborer 38 41.76 Clerical/Computer 26 28.57 Dietary habits Number of patients Percentage % Alpashana 18 19.78 Viruddhashana 6 6.59 Vishamashana 37 40.66 Atimatrabhojana 6 6.59 Adhyashana 8 8.79


Introduction
In present era, diseases affecting the locomotors system are seen increasingly which considerably reduces the human activity in terms of social and professional life. Now a day's human activities are totally contradictory to Swasthavritta. Regime and rules are opposite. Irregular food habit (Vishambhojana), suppression of natural urges (Vegavarodha), stress (Chinta), lack of proper sleep and relaxation being common part of life. Excessive sitting for longer time at one place, improper sitting posture during work in offices (Vishamaasana), continuous and over exertion (Atishrama), jerky movements during traveling and sports (Vishamcheshta) etc. created undue pressure to the spinal cord. Mostly above said conditions & lifestyle patterns put maximum strain on spine & lower portion of pelvis and play an important role in producing low back pain (Katishool). In this way, this disease is now becoming a significant threat to the working population.
The lifetime prevalence of non-specific (common) low back pain is estimated at 60% to 70% in industrialized countries (one-year prevalence 15% to 45%, adult incidence 5% per year). The prevalence rate for children and adolescents is lower than that seen in adults but is rising. Prevalence increases and peaks between the ages of 35 and 55. (1) Epidemiological data suggests that extreme height, cigarette smoking, morbid obesity, job dissatisfaction, work condition, legal social factor, financial stressor, emotional circumstances heavily influence back disability. Heavy physical work ,weight lifting, prolong static work posture, simultaneous bending & twisting, long time sitting on one place may lead to back pain. Men & women are equally affected, but those female who are >60 yrs complain more than male.(2) In an overall assessment major number of patients presented to the hospital has some symptoms related with pain on low back and legs.
Low back pain can be compare with Katishoola which is listed as one of Vatavyadhi , in which Vata is essential causative factor. As Asthi & Vayu are inversely related with each other, the aggravation Vata particularly in Aasthi hampers the quality of Asthidhatu.
(3) The weak Asthidhatu provides to set the disease process & when vitiated Vata gets settled into Katipradesh causes Katishoola. The Etiological factors and pathogenesis of above disease i.e. Katishool are not given separately in classic but being one of the 80 Nanatmaja Vatavyadhis (4) the same Nidana of Vatavyadhies is applicable here.(5) Out of 5 types of Vata, Vyana & Apana are specially vitiated. In this condition many times Katishoola is seen alarming symptom for future disease condition like Grudhrasi, Pakwashayagata Vata (6), Gudagatavata (7) and so on.

Aims and objective
To evaluate the role of dietetics & life style of modern era and working pattern in progression of low back ache.

Materials and Methods
Proforma and questionnaires including present era lifestyle, diet pattern and working pattern were prepared to assess the subjects. Special survey work was carried out in working group of GAU Employees.
Total 91 patients were surveyed for the study.

Selection criteria Inclusion criteria
All the subject working in GAU campus and having complaints of backache at least more than 3 months and ready to give their inform consent for the participation were selected for the present study irrespective of their age, gender and work pattern.
Patients were having complaints of LBP and came to the IPGT&RA hospital for treatment was also selected for present survey study.

Exclusion criteria
All the subject working in GAU campus and having complaints of backache for less than 3 month and did not ready to give their inform consent for the participation were excluded for the present study.
Patients were not having complaint of LBP.

Study period
Total 91 patients were surveyed during year 2012.  From Working pattern , working by sitting more than 3hr continuously (53.13%) and improper sitting posture (91.18%), long standing work more than 3hr (60.94%), Bending type of work more than 1 hr (29.69%) walking more than 2hr (42.19%) was noticed in patients. These are known risk factors for spine problems.25% of patients having shift duty while 20% having night duty 3times per week. (Table 3)        Lying down position (67.03 %), sitting position (23.08%), to have Analgesics (9.89%) and application of medicated oil, hot fomentation locally (Snehan Swedan)(3.30%) were observed as relieving factors in patients. (Table 12)  (15). Daily Travelling >1hr, continuous jerks during travelling result in instability within intervertebral joints which causes spine problems. Sitting type of work > 3hr continuously and improper sitting posture, long time working in standing position >3hr, (60.94%), Bending type of work>1hr continuously (29.69%) was noticed. These are known risk factors for spine problems. Working in abnormal posture for long duration was the major cause of musculoskeletal morbidity (16) it put strain on ligaments and disturbs stability of intervertebral joints. (17) H/o Laparotomy such as Hysterectomy, LSCS, and Appendectomy was observed in patients. For such kind of surgery spinal anesthesia is given, Khavaigunya is created by local trauma in the form of inject able lumber anesthesia which leads to causation of disease. Chinta, Krodha, Shoka Bhaya were observed as Manasikanidana. These are the causes for Vataprakopa (18) researches shows that stressful condition of person increase 27% of pressure on the spine, it is more than enough to sub-luxate a spine and chances of occurrence of disease increases. ( Prolong standing, walking, Squatting, lifting weight etc. was seen as aggravating factors. Above said posture put more strain on the spine and increase pressure on the vertebrae and discs result in disc degeneration, low back pain and sciatica.(23) Lying down position was observed as relieving factor in maximum Patients. This posture relaxes the muscle of lumber-sacral area and the strain on lumbar spine is relieved for some time and patient feels better. (24) Chronicity of 2month-2yr was seen, this shows that patients neglect the disease in initial phase and seek medical advice when it becomes unbearable or of higher intensity. chronicity is directly proportional to the prognosis of the disease i.e. if chronicity is less prognosis is good. The prognosis of a disease depends on many factors such as the strength of Nidana the strength of aggravated Dosha the Sthana of the disease, severity of signs and symptoms, duration of the disease etc.

Conclusion
Faulty lifestyle, diet and Dietary habits Plays an important role in manifestation of Katishool. In Present study more Vayu dominant causative factors were observed, that provoked Apana and has shown symptoms of LBP. Employee and Laborers have more risk of low back pain due to their pattern of work. To