Back Pain

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What is it

Back pain can occur anywhere from the base of the skull to the tailbone. It may be sudden or persistent and is an extremely common complaint. An estimated 60 - 80% of people in the UK are affected at some time in their lives. It's also one of the main reasons for sickness absence. Each year, close to 120 million working days are lost due to back pain.

Acute and Chronic back pain

Back pain can strike anyone at any age, although studies show people are most vulnerable between the ages of 45 and 59.

If the pain lasts for less than three months, it is called acute back pain, where acute refers to the duration rather than the severity of the symptoms. If the problem goes on for longer, this is known as chronic back pain.

How the back works

The spine is made up of many small bones called vertebrae and are separated by discs, which allow the spine to bend. This structure of vertebrae and discs is supported along its length by muscles and ligaments. The spinal cord threads through the centre of each vertebrae, carrying nerves from the brain to the rest of the body.

Simple back pain

In 95% of cases of back pain, the cause is linked to the way the bones, ligaments and muscles of the back work together. It can come on suddenly but can also be due to strain over time rather than the result of overdoing it just once. Usually nothing abnormal shows up in tests such as X-rays, and generally nothing within the back is permanently damaged.

Most people who suffer from this sort of back pain are adults up to 55 years old who are otherwise healthy. The pain is often based in the lumbar region (lower back) and may also spread to the buttocks and thighs. It will come and go at different times, and depending on different levels of activity.

Back pain can be triggered by:

poor posture
lack of exercise
standing or bending down for long periods
sitting in a chair that doesn't provide enough back support
sleeping on a mattress that doesn't provide enough back support
lifting, carrying, pushing or pulling loads that are simply too heavy, or going about these tasks in the wrong way
a trip or fall

It is worthwhile remembering that the back is strong and designed to perform physical work. That is why it is important to remain physically active and keep the back healthy. Exercise is a good way of helping to speed up recovery from simple back pain.

Nerve root pain

Other causes of back problems are much less common than simple back pain. Nerve root pain is the cause in less than 5% of people. The pain is caused by compression of a nerve root, which is the start of a nerve as it leaves the spinal cord. It is usually caused when a vertebral disc becomes displaced or bulges out from its normal position, putting pressure on the nerve root. This is called a slipped disc.

The pain will normally be in the lower back, and there may be pain down one or both legs to the calves, feet or toes. In this case, the pain is sometimes called sciatica because the nerve that runs down each leg is called the sciatic nerve.

Diagnosis

In most cases, the doctor will only need to discuss the symptoms and carry out an examination. The doctor is likely to recommend more tests only if the pain lasts longer than six weeks, or if he or she suspects there is some underlying cause of the pain.

Psychological wellbeing can also play a role in back pain. If the condition is chronic, the doctor may also recommend psychological and social assessment.

Treatment

Stay Active

Research shows that bed rest does not help simple back pain - it is much better to return to normal physical activity as soon as possible. Staying active may hurt more at first, but it helps the back to heel quickly, and reduces the risk of the problem occurring again.

If the pain is so bad that taking to bed really seems the only option, keep bed rest as short as possible before getting up and about again.

Painkillers

Paracetamol or Ibuprofen are usually enough to relieve simple back pain. Prescription only muscle relaxants such as diazepam may help with muscle spasms, but they generally shouldn't be taken for more than a week as they can cause dependence. A hot water bottle or an ice pack applied to the painful area may offer some relief.

Manipulation and exercise

Osteopathy and chiropractic are treatments involving manipulation of the spine. They may provide short-term relief for simple back pain within the first six weeks. Consult an osteopath registered with the General Osteopathic Council or a chiropractor registered with the British Chiropractic Association. Back exercises and physiotherapy may be helpful if the pain lasts longer. Consult a physiotherapist registered with the Chartered Society of Physiotherapy.

Complimentary approaches

The Alexander Technique may help improve posture. Some people find that acupuncture helps with the pain, although there is no definite scientific proof of its effectiveness. And, because back pain can sometimes be related to emotional problems, counselling may also be helpful.

Osteopathy and Chiropractic can be used to treat all types of back problems and injury. Practitioners can also advise on exercises to strengthen the back.

Massage relieves tension and improves circulation. Various approaches including shiatsu, Tui Na, Swedish massage and aromatherapy massage are helpful

Hydrotherapy - hot and cold compresses, or alternating hot and cold water, improve local circulation and can help mild backache.

Nutritional Therapy - Supplements of glucosamine sulphate, chondroitin, magnesium and essential fatty acids are sometimes useful. Bromelian can reduce inflammation.

Herbal Medicine - Anti-inflammatory herbs such as Devil's Claw can ease pain.

Acupuncture and Acupressure can be very effective for relieving back pain. Acupressure to local areas eases pain and inflammation.

Homeopathy - Arnica taken every 30 minutes for up to 6 doses and then every 4 hours, can ease swelling and pain.

Magnetic Therapy - Devices giving pulsed magnetic frequencies may offer some relief by improving local circulation and tissue healing.

Exercise Therapies - Can be used to treat some types of back pain and are very effective as a preventive measure. Yoga therapy often help.

Surgery

If chronic back pain isn't helped by manipulation, exercise or medication, then surgery may solve or help the problem. If the pain is caused by a damaged disc, for instance, this could be surgically removed.

Managing back pain

Good back care can greatly reduce the risk of back pain. To look after your back, make sure you:

take regular exercise
use a chair with a backrest, and sit with your feet flat on the floor or on a foot rest
sleep on a firm mattress

Lifting and carrying tips:

lift only a manageable weight, or ask for help
when lifting things or putting things down, bend the knees, and keep the back straight and feet apart
do not lift and twist at the same time
lift and carry objects close to the body

Self-help

Regular back stretches will improve muscle tone and prevent injury. Yoga and Pilates are ideal. Alexander technique also improves posture.
Before getting out of bed, bring both knees to the chest one by one - and then together while lying on your back. Then roll both knees from side to side. This stretches and warms up the muscles.
Eat your breakfast standing up. This lessens the pressure on the spine.
Lengthen the spine when sitting and standing. If using computers ensure that the centre of the screen is straight in front and level with your eyes to prevent stooping.
Regular swimming and walking keep the spine flexible and the muscles toned.
Avoid standing or sitting for long periods.
Have neck and shoulder or back massages to ease stiffness and improve circulation.
Applying a packet of frozen peas wrapped in a towel to the affected area for several minutes and repeating this every half hour will reduce swelling
Quarterly back maintenance treatments with an osteopath or chiropractor can prevent injury and keep the spine balanced and flexible.
Acupressure techniques are easy to learn and can ease stiffness and pain
Sleep on a good mattress and use small pillows under the knees or small of the back for extra support.
Reduce muscular tension at the end of the day with gentle stretches, relaxation exercises and deep breathing.

Further Information

BackCare
020 8977 5474
http://www.backpain.org

The Chartered Society of Physiotherapy
http://www.csp.org.uk

General Osteopathic Council
http://www.osteopathy.org.uk

British Chiropractic Association
http://www.chiropractic-uk.co.uk

Posted on 21st December 2007