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Back pain

Back pain is an extremely common complaint - its estimated that over 60% of people suffer from it at some time in their lives. And its one of the main reasons for taking time off work.

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Back pain can strike anyone at any age, although figures show you are most vulnerable if you are between 45 and 59.

But the seriousness of the condition varies. If the pain lasts for less than three months, you have what is called acute back pain. If your problem goes on for longer, you are suffering from chronic back pain

back pain

If you experience acute back pain, its quite likely to have a simple cause – this is the case with 95% of all cases of acute back pain. Most people who suffer from this sort of back pain are adults up to 55 years old who are otherwise healthy. The pain is short-lived, and has quite a simple physical cause - though it may well be due to strain over time, rather than the result of overdoing it just once. The pain is based in the lower back, and maybe also in the buttocks and thighs. It will come and go at different times, and depending on what you are doing.

You may get simple back pain if:

  • you have a poor posture
  • you do not get enough exercise
  • you stand or bend down for long periods
  • your chair does not provide enough back support
  • your mattress does not provide enough back support
  • you lift, carry, push or pull loads that are simply too heavy for you, or you go about these tasks in the wrong way
  • you trip or fall over

Nerve root pain accounts for fewer than 5% of all cases of back pain. Here the pain is caused by compression of the nerves that run up the middle of the vertebrae in your back. It is usually caused by a damaged disc, or because a vertebra has slipped out of line with the others. The pain will normally be in your lower back, plus more severe pain down one or both of your legs to your calves, feet or toes.

In a relatively small number of cases, back pain may have a more serious underlying cause. This includes abnormality of the spine, an infection or collapse of the vertebrae, fibromyalgia (a condition that affects the muscles), tuberculosis or cancer. These kinds of problem are more likely to be the case if your back pain starts gradually, gets worse over time, and seems unrelated to how active you are. You'll also be very likely to have other symptoms including, for example, incontinence or general tiredness or lethargy. You're also more at risk if you have had certain other conditions, especially tuberculosis or cancer, in the past.

Most attacks of simple back pain last only a few days and get better on their own. But you should see a doctor straightaway if you have any of the following symptoms as well as your back pain:

  • fever
  • redness or swelling on your back
  • pain down your legs and below your knees
  • numbness or weakness in one or both of your legs
  • loss of bladder or bowel control
  • You should also see a doctor if:
  • your pain lasts longer than a week
  • its the result of an injury, a fall or blow to your back, or
  • you are under 20 or over 55 years old, and the pain lasts for more than a few days

In most cases, your doctor will only need to discuss your symptoms and examine you. Your doctor is likely to refer you for more tests only if your pain lasts longer than six weeks, or if he or she suspects there is some underlying cause of the pain.

These tests might include:

  • X-rays
  • CT (computerised tomography) scans
  • MRI (magnetic resonance imaging) scans
  • A myelogram (a special kind of X-ray)
  • Blood tests

Your psychological well-being can also play a role in back pain. If your condition turns out to be chronic, your doctor may refer you for psychological and social assessment.

Activity

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

If you really cant cope, and feel you have no option but to take to your bed, try to limit it to two or three days before you are up and about again.

Painkillers

Paracetemol or ibuprofen are usually enough to relieve simple back pain. Muscle relaxants such as diazepam may help if you have muscle spasms, but do not take them for more than a week. And try applying a hot water bottle or an ice pack to the painful area - these can both offer some relief.

Manipulation and exercises

Osteopathy and chiropractic - treatments involving manipulation of your spine - may provide short-term relief for simple back pain within the first six weeks. However, you should only consult an osteopath or chiropractor who is a registered practitioner. Back exercises and physiotherapy may be helpful if your pain lasts longer.

Complementary approaches

The Alexander Technique may help improve your posture. Acupuncture can help with the pain. And, because back pain can sometimes be a sign of emotional problems, counselling may also be helpful.

Surgery

If you have a chronic back problem that is not helped by manipulation, exercises or medication, surgery may solve or help the problem. If your pain is caused by a , say, damaged disc, this could be surgically removed.

Good back care can greatly reduce your 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

Also, follow these tips for lifting and carrying things:

  • Lift only a manageable weight, or ask for help.
  • When lifting, bend your knees, keep your back straight and your feet apart.
  • Do not lift and twist at the same time.
  • Lift and carry objects close to your body.
  • Bend your knees, not your back, when you put things down

Your spine is made up of many small bones called vertebrae. These 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. Your spinal cord threads through the centre of each vertebra, carrying nerves from your brain to the rest of your body.

1. I do a lot of lifting and carrying at work. How can I prevent back injury in the workplace?

There are a number of things you can do to help prevent back injury from lifting and carrying. Always try to think and plan things through before you attempt any strenuous activities.

Lifting objects (also known as manual handling) is often part of our daily life and can be a common cause of back pain. Workplace activities that are known to cause or aggravate back pain include:

  • stooping, bending over or crouching
  • lifting, pushing or pulling bulky, heavy or awkward objects
  • stretching, twisting and reaching
  • spending prolonged periods in one position, leading to postural strain
  • jobs in which your whole body is subjected to vibration, jolting and jarring (such as drilling)

In order to prevent back pain caused by lifting and carrying, it may be helpful to:

  • stretch your back before lifting heavy objects
  • always bend from your knees, not your back
  • turn using your whole body; don't twist your back
  • carry objects close to your body
  • ·not carry too many things at once
  • ask someone to help you lift particularly heavy objects
  • use mechanical handling equipment to lift things for you whenever possible

As a general rule, it's best to lift with care and not to lift more than you can easily handle. Always think before doing.

If you have back pain and have been off work, it's important to try to get back to work as quickly as possible as this may actually help your recovery. Talk to your employer about making a gradual return to work and whether your duties can be adapted to prevent further back injury.

Also, if your job involves a lot of lifting, you can attend a lifting and manual handling course. These are usually offered by most large employers.

2. I have seen many different kinds of mattresses, back supports and insoles advertised for sale. Are any of these effective at preventing or curing back pain?

There are a number of support aids available for people with back problems. Some of these can be useful, others are of no benefit and some may even do more harm than good. You shouldn't use any products to try and treat your back pain until you have talked to your GP or an occupational therapist (a health professional who can give practical assistance to help you manage with everyday tasks and increase your independence).

The following are examples of different support aids available.

  • Medium-firm mattresses. Ideally, your mattress should be soft enough to support and conform to your body shape, yet firm enough to allow you to turn from side to side easily, without twisting your back. Evidence suggests that a medium-firm mattress may give better support than a firm surface for people with chronic low back pain.
  • Back supports, corsets and braces. Some people use these when driving or sitting for long periods of time. Evidence suggests, however, that these types of aid may not provide any benefit to people with chronic low back pain. As different types of support are used for different types and causes of back pain, it's important to remember that using the wrong type might actually make your back pain worse.
  • Insoles. These are support aids that people place in their shoes to help with their posture. There is limited evidence to show that using insoles will prevent or treat back pain.

3. What are pain-management programmes for back pain?

Your GP may recommend you try a pain-management programme if you have lived with persistent back pain for some time. You can attend a pain clinic or, if you prefer, get in contact with a self-help group.

If you have non-specific, ongoing low back pain, a pain-management programme may be able to help you find ways of controlling and living with your symptoms. Exercising and regaining your physical confidence are important parts of the pain-management approach, as are learning about the physical and psychological factors that contribute to pain.

Pain-management programmes are usually provided as an outpatient service. You may attend the sessions with a group of people and will be led by a team of health professionals, including a physiotherapist.

Alternatively, you may decide to try a self-help group who can provide further support and information.

4. When I have back pain, I just want to lie down. Why is it important to keep active?

There is clear evidence that bed rest or being inactive won't help back pain.

It was once thought that staying in bed would ease a painful back. Now the advice is to keep as active as you can and get back to your normal activities as soon as possible. Evidence shows that staying in bed can cause your joints to stiffen, your muscles to lose strength and generally cause you to take longer to recover. Staying active can reduce the time you need off work and can reduce the chances of ongoing, chronic problems.

5. Are there any easy and safe exercises I can do to help relieve my back pain or prevent it returning?

Yes. Doing regular exercise can help to reduce and relieve your back pain, and even prevent it from returning. Always speak to your GP or physiotherapist before starting a new exercise programme.

There's a whole range of physical activities you can take part in to keep your back healthy. Research suggests it may help if you have back pain that lasts for longer than six weeks. You may be able to try:

  • walking, jogging or running
  • yoga, pilates or tai chi
  • swimming
  • cycling
  • hydrotherapy (exercises in water)
Always remember to speak to your GP or physiotherapist before starting a new training programme, especially if you haven't done any regular physical activity for some time.

Further Information

Sources

  • Back pain. Arthritis Research UK. www.arthritisresearchuk.org, accessed 17 August 2010
  • About back pain. BackCare. www.backcare.org.uk, accessed 17 August 2010
  • Back pain - low (without radiculopathy). Clinical Knowledge Summaries. www.cks.nhs.uk, published November 2009
  • Musculoskeletal lower back pain. Best Practice. http://bestpractice.bmj.com, accessed 24 August 2010
  • Low back pain: Early management of persistent non-specific low back pain. National Institute for Health and Clinical Excellence (NICE). May 2009. http://guidance.nice.org.uk/CG88
  • Furlan AD, Imamura M, Dryden T, et al. Massage for low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 4. doi: 10.1002/14651858.CD001929.pub2
  • Furlan AD, van Tulder MW, Cherkin D, et al. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews 2005, Issue 1. doi: 10.1002/14651858.CD001351.pub2
  • Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007; 146:478-91
  • van Duijvenbode I, Jellema P, van Poppel M, et al. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2010, Issue 2. doi: 10.1002/14651858.CD001823.pub3
  • Sahar T, Cohen MJ, Ne'eman V, et al. Insoles for prevention and treatment of back pain. Cochrane Database of Systematic Reviews 2007, Issue 4. doi: 10.1002/14651858.CD005275.pub2
  • Dahm KT, Brurberg KG, Jamtvedt G, et al. Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database of Systematic Reviews 2010, Issue 6. doi: 10.1002/14651858.CD007612.pub2
  • Hayden J, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews 2005, Issue 3. doi: 10.1002/14651858.CD000335.pub2

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