Spinal Pain. Understanding your condition and learning how to overcome it THE HEART OF

Transcription

1 Spinal Pain Understanding your condition and learning how to overcome it THE HEART OF A L health

2 Contents Page Top Tips for Spinal Pain 3 Introduction 4 Structure of the Spine 5 Causes and Types of Spinal Pain 5 Warning Signs 6 Factors that increase the risk of spinal pain 7 Simple home treatments for spinal pain 8 Remaining active 8 Scans and X-rays for spinal pain 9 Physical Therapies 9 Acupuncture 9 Pain management programmes 9 Spinal surgery 10 Back corsets 11 Weight management 11 Should I get a new bed? 11 What aids and appliances are available? 11 Preventing spinal pain 11 Stretching exercises 12 Strength, stamina and stabilising exercises 13 Bending and lifting 14 Driving and sitting 15 Further information and advice 16 References 17 2

3 Top Tips for Spinal Pain Don t panic most people suffer with back pain at some point in their lives and nearly all get better Exercise, exercise, exercise be sure to include specific back exercises and general exercise Keep going with day to day activities Don t rest too much with back pain - too much rest is not good for you Stop smoking it makes exercising more difficult Posture walk tall with your shoulders back and don t slouch Don t lift anything too heavy THINK before you lift Try to keep your stress and anxiety levels to a minimum 3

4 Introduction This leaflet is for people who have spinal pain and those people who would like to know more about it. This leaflet is not intended to replace professional advice from your GP or another health professional. If you have any concerns or questions please contact your GP. Spinal pain is an extremely common condition with over 80% of people experiencing at least one episode at some point in their lives ( 1, 2 ). For many people recovery from spinal pain begins within a few days, especially if they are as active as possible, as soon as possible. However for some (very few) people spinal pain can last for months or even years ( 5, 3, 7 ). It is important to note that spinal pain caused by more serious underlying conditions is rare and you are unlikely to be affected unless you are very young or very old ( 5, 3, 4 ) Structure of the Spine The spine is a complex structure which helps us to stand and bend. It is made up of the following: 24 small bones called vertebrae, which support the weight of the upper body, plus the sacrum and coccyx shock absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend ligaments that hold the vertebrae and discs together tendons that connect muscles to vertebrae the spinal cord, which carries nerve signals from the brain to the rest of the body nerves muscles ( 5, 4 ) 4

5 Figure One Anatomy of the Spine Side View Back View Neck Neck Mid Back Mid Back Lower Back Lower Back Sacrum Coccyx Sacrum Coccyx The cervical section of the spine is also known as the neck, the thoracic area as the mid back and lumbar area as the lower back. Causes and Types of Spinal Pain Spinal pain can have many different causes. Most cases of spinal pain affect the lower back. This is because this region of the spine is responsible for supporting your whole body weight (and any additional weight if you are overweight). It is also under constant pressure especially when twisting, turning, bending and lifting incorrectly ( 5, 4 ). 5

6 Strained (pulled) muscles and sprained ligaments are a very common cause of spinal pain. This type of injury heals in a short time ( 1 ). Most people (over 85%) have non-specific back pain, which is not caused by any specific abnormality or disease ( 4 ). Back pain can also be described as acute or chronic depending on how long you have had the pain. You may have: acute back pain lasting less than 6 weeks sub-acute back pain lasting 6 weeks to 3 months chronic back pain lasting longer than 3 months ( 3 ) Warning Signs If you have any of the following symptoms you should see your GP immediately: a high temperature redness or swelling on your back pain down your legs loss of control of your bowel and/or bladder inability to pass urine constant pain, especially at night pain that it getting much worse and travelling up your spine to your chest numbness or weakness in one or both legs or around the buttocks, genitals or back passage unexplained weight loss Also seek medical advice if you are having back pain and: you are under 20 or over 55 years old you have taken steroids for a few months you misuse drugs you have or have had cancer you have a weakened immune system as a result of chemotherapy or a medical condition such as HIV or AIDS (3, 5, 6) 6

7 Sciatica Back pain can be localised to the back but you can sometimes have pain in your legs. This is known as sciatica and can affect part or the whole leg. Sciatica usually only lasts for a short time, however, if it lasts for up to 6 weeks this can be a sign of a slipped disc and you should go and see your GP. If you also have weakness in the muscles of your leg, and/or cannot pull your foot up towards you, and/or if you lose bladder or bowel control you should go and see your GP urgently ( 1 ). Other causes of back pain Other causes of back pain are very rare and include: fracture cancer infection ( 1, 3 ) Factors that increase the risk of Spinal Pain Research shows that there are a number of factors that can increase the risk of developing spinal pain: smoking obesity being pregnant older age females report higher levels of spinal pain than males lack of exercise a stressful job job dissatisfaction depression worrying lifting heaving objects incorrectly (see Preventing Back Pain section) driving in the wrong position (see Preventing Back Pain section) previous history of back pain ( 4, 1, 2 ) 7

8 Simple Home Treatments for Spinal Pain Simple painkillers such as paracetamol or ibuprofen can be used for a short time to relieve back pain. Both of these painkillers are available without prescription. Painkillers can be taken in one of two ways: regularly over the first 2-3 days to reduce the overall level of pain experienced just before physical activity is started so that gentle exercise can be undertaken You can also apply hot and cold packs to the affected area of your back. Cold packs can be made by wrapping a packet of peas in a towel. Hot and cold packs should be applied wrapped in a towel and without a towel you can damage your skin). Specially designed hot and cold packs are also available from most pharmacies. If you think your back pain is because of a sprain or strain you may benefit more from hot packs, where as, if your pain is due to inflammation cold packs may be more beneficial. ( 3, 5, 2, ) If your pain is severe your GP may prescribe stronger painkillers and/or muscle relaxants. Take the medication as prescribed by your GP and always read the patient information leaflet contained within your medicine packet. ( 7 ) Remaining Active EXERCISE IS THE MOST IMPORTANT WAY TO EASE AND PREVENT BACK PAIN. If your spinal pain is severe you may need to rest for a few days. However it is important to become active as soon as you can, otherwise you will become weak and your spinal pain could become more frequent. It is vital that the strength and flexibility of your back are restored. Your back may feel sore after the first few days of exercise, however this is completely normal and you shouldn t let it put you off. REMEMBER the more active you are the better. (1) See the Preventing Back Pain section for some exercises you can do to improve back strength and flexibility. 8

9 Scans and X-rays for Spinal Pain The vast majority of people will recover from spinal pain within 4-6 weeks using simple treatments at home. The most up to date research shows that x-rays, MRI (magnetic resonance imaging) and CT (computed tomography) scans are only recommended for a very small number of people with spinal pain ( 4, 1, 7 ). Physical Therapies If your back pain is severe or chronic your GP may refer you for a course of physiotherapy. Treatment courses usually last between 6 and 12 weeks and may be a combination of individual or group sessions ( 3 ). Acupuncture Acupuncture originates from ancient Chinese medicine and is where very fine needles are inserted into your skin at certain points of your body. Acupuncture is known as a complementary therapy ( 7 ). Check with your GP/PCT to see if acupuncture is funded in your area. Pain Management Programme Some peoples back pain can last for many months. In these circumstances a pain management programme may be of benefit. The aim of a pain management programme is for people to learn to live with and control their back pain. This is done through education, coping strategies, exercise, and medication ( 1 ) Pain is an emotional as well as physical response. How pain is perceived can greatly affect the way you respond to pain (5). 9

10 Figure 2 - The Persistent Pain Cycle Back pain can have a negative impact on how you feel, that s why it s so important to keep going with day to day activities and to exercise. Exercise releases the bodies natural endorphins and make you feel good ( 8 ). Spinal Surgery Only a very small number of patients with back pain will require surgery, probably less than 1% (1). Surgery is not recommended if non-specific back pain is the only symptom. 10

11 Back Corsets Back corsets do not do the job they are meant for (i.e. restricting movement and supporting the weight of the upper body) and are not recommended. It is better to strengthen the back through exercise ( 1 ). Weight Management If you are overweight you should lose this extra weight as it will be causing extra stress on the spine ( 1 ). Should I get a new bed? Orthopaedic beds are available but can be expensive. Instead try inserting a board under your mattress to provide more support as this is considerably cheaper ( 1 ). Support your head with a pillow, but make sure that your neck is not at a steep angle ( 5 ) What aids and appliances are available? There are a variety of aids and appliances available to help with back pain, including: long handled gardening tools so that you don t have to bend over supports (not corsets) to lean against when sitting or driving ( 1 ) Preventing Spinal Pain EXERCISE IS THE MOST IMPORTANT WAY TO EASE AND PREVENT BACK PAIN. Exercise and staying active are the two most important factors in preventing spinal pain. Looking after your back can help to reduce the risk of suffering back pain in the future (1, 2, 3, 4, and 5 ). This section of the leaflet will describe a number of stretching and strengthening exercises which can be combined with regular cardiovascular exercise such as swimming, walking, or cycling on a stationary bike (4, 3). 11

12 Stretching Exercises 1 2 Back stretch (stretches back muscles) Lie on your back, hands above your head. Bend your knees and, keeping your feet on the floor, roll your knees to one side, slowly. Stay on one side for 10 seconds. Repeat 3 times each side. NB: Upper knee should be directly above lower knee. 3 Deep lunge (stretches muscles in front of thigh and abdomen) Kneel on one knee, the other foot in front. Lift the knee up; keep looking forwards. Hold for 5 seconds and repeat 3 times each side. 4 One-leg stand front (stretches front thigh) Steady yourself with one hand on something for support. Bend one leg up behind you. Hold your foot for 10 seconds and repeat 3 times each side. 5 One-leg stand back (stretches muscles at back of leg) Steady yourself, then put one leg, straight, up on a chair. Bend the other knee forward to stretch the hamstrings. Repeat 3 times each side. Knee to chest (stretches muscles of bottom gluteals) Lie on your back. Bring one knee up and pull it gently into your chest for 5 seconds. Repeat for up to 5 times each side. 12

13 Strength and stamina stabilising exercises 1 Pelvic tilt Lie down with your knees bent. Tighten your stomach muscles, flattening your back against the floor. Hold for 5 seconds. Repeat 5 times. 2 3 Stomach tone ( transverse tummy ) Lie on your front with your arms by your side, head on one side. Pull in your stomach muscles, centred around your tummy button. Hold for 5 seconds. Repeat 3 times. Build up to 10 seconds and repeat during the day, while walking or standing. Keep breathing during this exercise! Buttock tone (gluteals) Bend one leg up behind you while lying on your front. Then lift your bent knee just off the floor. Hold for up to 8 seconds. Repeat 5 times each side Deep stomach muscle tone (stabilises lower back) Kneel on all fours with a small curve in your lower back. Let your stomach relax completely. Pull the lower part of your stomach upwards so that you lift your back (without arching it) away from the floor. Hold for 10 seconds. Keep breathing! Repeat 10 times. Back stabiliser Kneel on all fours with your back straight. Tighten your stomach. Keeping your back in this position, raise one arm in front of you and hold for 10 seconds. Try to keep your pelvis level and do not rotate your body. Repeat 10 times each side. To progress, try lifting one leg behind you instead of your arm. 13

14 Bending and Lifting Bending and lifting correctly are also important in preventing spinal pain. Following the correct method of lifting and handling can help to prevent back pain: Think before you lift Start in a good position with your knees bent Keep the load close to your waist Avoid twisting your back or leaning sideways Keep you head up Know your limits don t lift anything too heavy Push, don t pull Distribute the weight evenly (6) The following image shows the correct way to lift. RIGHT WRONG 14

15 Driving and Sitting People who sit or stand in the same position for a long time should change position frequently or take brief but frequent breaks to walk around will also help prevent spinal pain ( 1 ) Correct posture when seated at a desk RIGHT WRONG (a) Good posture when seated at a desk: Adjust the chair or table, and position of the computer screen, so that you don t have to slump. Have your work in front of you, not to the side. Consider trying a tilted stool. (b) Bad posture when seated at a desk Correct posture when driving RIGHT WRONG (a) Good posture when driving: Use cushions to experiment if you need a higher seat or support in the small of your back. (b) Bad posture when driving. 15

16 Further information and advice Arthritis Research Campaign Backcare British Pain Society Pain Relief Foundation The British Association of Spine Surgeons The Pain Toolkit Arthritis Research Campaign 16

17 References 1 Arthritis Research Campaign (n.d.) Back Pain, An Information Leaf let Arthritis Research Campaign, Derbyshire, UK 2 Backcare (n.d.) available at (accessed 18/01/2011) 3 BUPA Information (2010) About back pain available at backpain (accessed 18/01/2011) 4 Chou, R. Altlas, S. J. and Eamranond, P. (2010) Low back pain in adults, available at (accessed 18/01/2011) 5 NHS Choices (n.d.) available at Back-pain/Pages/Introduction.aspx (accessed 18/01/2011) 6 NHS Clinical Knowledge Summaries (n.d.) Back Pain available at (accessed 18/01/2011) 7 NICE (2009) Early Management of non-specific back pain, NICE available at 88NICEGuideline.pdf (accessed 18/01/2011) 8 Pain Toolkit (n.d.) available at (accessed 18/01/11) 17

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