Back Pain. Why we understand that pain in the back at times may be more than unpleasant, you are not alone. 8 out of 10 of us will experience back pain within our lifetimes. Due to the amount of pain you feel you may be worried but be reassured by the fact that only 1% of back pain is from a serious cause, and most back pain will completely settle off by itself over a 3 month period. The other important fact to know is that it is common to have a reoccurrence of your neck and back pain, so it is important to identify what may cause the pain and how you can prevent or manage the pains. We also know that how you act can greatly influence your recovery from back pain and how it may be managed in the future. Types of Back Pain Back pain may be referred to as acute or chronic. This simply defines how long you have had the pain. Once back pain has extended over a period of 3 months it is defined as chronic. Acute back pain will tend to settle off by itself. Things that can help are: Try to maintain your day to day life as much as possible. Maintain a balance between activity and rest. Take regular paracetamol to start with. If you find you need greater pain relief you can also take Ibuprofen. Always take note of side effects and precautions and take as directed. You may want to consult your GP or Pharmacist if you concerned about taking medications. Chronic back pain is more likely to need treatments such as physiotherapy, exercise rehabilitation and may be a review in pain medications. The back can also cause pain radiating into the legs and this is often termed as Sciatica Anatomy The back is composed of blocks of bone called vertebrae. Between these are the intervertebral discs, which have a jelly like inner section and a strong ligamentous outer section. Ligaments connect between the bones and discs to make the back even stronger, but at the same time allowing a great range of movement.
As well as the ligaments, the muscles help control movement of the back. The muscles are not only designed to create force to help move the back but also absorb forces and pressure placed on it. Within the blocks of bones there is space where the spinal cord travels sending nerves out of the back to supply the around pelvis and legs. This page is intended to give you information regarding back pain and how to help manage it. For further information leg pains that are caused by a trapped nerve in the back see the page Sciatica. What causes back pain? Interestingly one of the main things that will cause your back pain to not progress well is how you think and act. People who avoid going out and doing their normal activities tend to do badly. People who stop socialising and those who get extremely anxious and down about the pains tend to do badly. We know staying positive is easier said than down when you have pain, but do remember there is help for you and most back pains resolve with time.
From the research into neck and back pain it is now generally thought that not one factor causes these pains, but a combination of factors. These factors include: Genetics twin studies have shown that a certain amount of structural changes that can be associated with back pains are genetic. Lifestyle those with more sedentary lifestyle may be more prone to pains and those with more manual labour may show more structural changes in their back that are associated with pain. Smoking smokers have been shown to have greater disc degeneration in their backs compared to non-smokers and also a higher prevalence of back pain. Obesity those who are overweight have been shown to have greater disc degeneration in their back and also a higher prevalence of back pain. Physical and mental health while it may not effect the prevalence of back pain so much we know that those of poor physical health and who have mental stress and poor coping strategies do not recover as quickly from their pains. Posture while there is little evidence to say that poor posture causes pains it certainly can hamper recovery as certain postures can increase the pressure on the joint, discs, ligaments and muscles leading to an increase in pains. One important thing to remember is that your spine loves movement and staying in any one position for too long is hard work for the spine, so regularly change your position. For more information see the page on Posture and Ergonomics It is also important to realize that structural changes in your spine are normal with age and do not mean you will get pain. Often people are told they have wear and tear in their back and this is why they have pain. Certain age related changes can commonly be seen in the back as early as 18 years old. Certainly studies from Scandinavian countries show that 80% of 21 year olds had change within at least one of the discs of the back. Just because you have some wear and tear in your back doesn t mean you will get pain and while significant arthritic changes have been shown to correlate with pain in the back these have still been shown to respond well to treatment. What can help treat your pain? Fortunately most acute back pain does tend to settle off over 6 weeks by itself with time and the pain can be eased by medications if taken as directed. But sometimes the pain can be really severe or can linger on, so what can help you then? Firstly have you got a strong enough pain tablet. You may want to see your GP about different medications that can be taken to help control your pain.
Evidence has shown that short term relief of pain can be gained by: Keeping as active as you can. Bed rest has been proven to be a bad thing for managing back pain, but with the initial onset 1 day may be helpful. After that try and get back to your normal activities as quickly as possible. You may need to undertake what we call relative rest in the first week or so. What we mean by this is avoiding things that may overstrain the back such as lifting heavy weights or slumped sitting. To help with this you may want to look at the pages on Posture and Ergonomics Exercise, but just pace it up gradually. See our pages on exercises for your back that you could start with. Manual therapy such as massage and spinal manipulation Acupuncture Be warned that treatments like massage, manipulation and acupuncture only give a very short term relief and are not recommended as a treatment by themselves but should be combined with exercise and keeping moving. But more importantly what can help in the long term is: Staying fit and healthy, especially staying flexible and strong through the neck, arms, back and legs Managing your stress levels If you find certain postures or work practices create pain and then changing the way you do these activities can help. Our departments are staffed by therapists trained in the assessment of neck and back pain and up to date evidence for the most effective management of these conditions. They can work with you to develop a plan to help you get going again. We also have classes designed to help you start exercising effectively. We can access programmes designed to help those who have ongoing long term pains and again develop a plan to help you manage. If pain is resistant to normal treatment then it may be worth getting further assessment by a specialist to see if further investigations may be required. Again our departments have specialist physiotherapists that work within Rheumatology and Orthopaedic Clinics and can help in this assessment. When to get help? If you feel your pains are not getting better or you wish to try any of the treatments above you can ask your GP or you can self-refer to your local physiotherapy departments at:
Whittington Hospital Magdala Avenue N19 5NF Tel: 020 7288 5660 Holloway Community Health Centre 11 Hornsey Street N7 8GG Tel: 020 3316 8840 St Ann s Hospital Block C St Ann s Road Tottenham N15 3TH Tel: 020 8442 6272 Hornsey Central Neighbourhood Health Centre 151 Park Road Hornsey N8 8JD Tel: 020 3074 2720 Finsbury Health Centre 17 Pine St Islington EC1R 0LP Tel: 020 7530 4222 Lordship Lane Primary Care Health Centre 239 Lordship Lane Tottenham N17 6AA Tel: 020 3224 4111 Bounds Green Health Centre Gordon Road Bounds Green N11 2PA Tel: 020 8881 6834
The Myths My back pain is very bad so it must be something serious Unfortunately the severity of pain is a very unreliable indication of what is wrong, but be reassured that 99% of back pain is not from a serious cause. For more about the symptoms of back pain go to NHS Choices at http://www.nhs.uk/conditions/backpain/pages/symptoms.aspx/. If you are concerned see your doctor or physiotherapist. I need to have ongoing treatment to keep me aligned. There is not any evidence to say that massage, manipulation or acupuncture is very helpful much past a bout of 6 to 8 sessions. Many people get told that they have a twisted pelvis or one leg is longer than the other. This is a common finding in people who have no neck and back pain and hence may have nothing to do with your pain. Evidence tends to suggest that any leg length difference under an inch (2.5 cm) is not really significant and will not require treatment. So please don t be talked into spending all your hard earned cash on repeated treatments to align your spine. Spines do go out of place and people can not push them back into place. Lie down, don t move when you have the pain or you will damage it more. Gentle, paced movement is actually helpful in treating the neck and back when painful and it is actually assist in the healing process and may help reduce pain and muscle spasm. What we know is too much time in bed tends to make the pain last for longer. Certainly if you have recurrent pains in the neck and back exercise has been shown to be very beneficial in managing pains, reducing the occurrence and severity of pains. I hurt my back lifting and bending so I should never lift or bend again Lifting and bending are part of life and if avoided completely you will find your back will probably get weaker and stiffer and your pain will get worse. Usually the problem is not lifting something as much as not lifting properly. See our pages on Ergonomics. I can t go back to work until my pain is completely gone Actually the evidence shows those people who get back to work quicker, get better quicker. Activity is good for your back as it helps stimulate proper healing and remodelling in the tissues of the back that may have been injured and helps reduce muscle spasm and pain. The key is to gradually increase your activity levels. You may get the odd flare
up of pains in your return to work or sport but these will decrease with time. You may want to speak to your physiotherapist about techniques to help manage your flare ups. I need an x-ray or MRI scan to work out what is wrong An x-ray gives us little information that will help in treating your back pain. An MRI scan is usually only used when we are thinking of surgery or injection therapies into the spine for if your pain is not getting better. It is really only to confirm what is wrong, rather than to find out what is wrong. I am going to end up in a wheelchair due to back pain As stated only 1% of back pain is from a serious condition and virtually all of these will not leave you in a wheelchair. I have been told I have arthritis in my back, my spine is crumbling No it is not. Arthritis in the spine is part of the normal ageing process and not a sign that your back is falling apart.