Introduction

Back pain is very common and usually doesn’t have a serious cause. Here we’ll explain a bit more about back pain and its causes, how it’s diagnosed and treated, and the importance of self-help measures.

What is back pain?

Back pain is a common problem, usually caused by a simple soft tissue strain, which affects 80% of us at some point. Fortunately, most periods of back pain get better after a few weeks with simple treatment. Sometimes, however, back pain can continue for longer than expected, or you may have other symptoms besides pain and stiffness. In this case it’s best to seek medical advice to see if there’s a more serious cause of your pain. Many people develop back pain for no obvious reason.

This type of back pain is described as non-specific or mechanical back pain. In most people the pain starts quickly but then reduces after a few days or weeks. (This is called acute back pain.) But for some people pain might last for several weeks or even months and years, and this is called chronic back pain.

When should I see my doctor?

You should see your doctor if your pain:

• is severe or lasts for a long time
• significantly affects your activities of daily living.

See your doctor immediately if you have RED flag signs:

• have difficulty controlling or passing urine
• lose control of your bowels
• have numbness around your back passage or your genitals
• have weakness in your legs or are unsteady on your feet.

How is the back structured?

The spine is one of the strongest parts of the body and gives us flexibility and strength. It’s made up of 24 vertebrae, one sitting on top of the other with discs in between and lots of ligaments and muscles around them for support.  On either side of the spine, running from top to bottom, are joints called the facet joints. The spinal cord passes inside the vertebrae. The spinal nerves pass through spaces between the bones of the spine. These nerves are also known as nerve roots. The structures of your spine usually get stiffer as you get older.

What causes back pain?

In most cases the cause is unclear, but some of it may be caused by a number of factors, including:

• poor posture
• lack of exercise resulting in stiffness
• muscle or ligament strains/ sprains

There are specific conditions which are linked with pain felt in the back. Some common conditions are listed below:

Spondylosis

As we grow older the discs in the spine become thinner and the spaces between the vertebrae become narrower. Osteophytes may form at the edges of the vertebrae and facet joints. In most cases wear and tear is just part of the normal aging process and not really related to any problems with the spine.

Sciatica

Back pain is sometimes linked with pain in the legs, and there may be numbness or a tingling feeling. This is called sciatica. This is due to irritation or squeezing of the sciatic nerve roots in the spine. Pain travels down the leg because of the irritation of the sciatic nerve in the lumbar spine, but there’s actually nothing wrong with the leg itself. In most cases the reason for the nerve irritation is a bulging disc. Fortunately most people recover fairly quickly, although in some cases it might take a number of months. About 60% of all people with sciatica get better within a few weeks to months.

Spinal stenosis

Sometimes back pain is linked with pain in the legs which starts after a few minutes walking and tends to get better very quickly when you sit down. This is known as spinal stenosis. Symptoms often affect both legs. The pain usually eases when you sit down and rest.

Other rarer causes of back pain include:

• Fracture: often linked to thinning of the bones (osteoporosis)
• Infection
• Tumor
• Inflammation, such as in ankylosing s

What can I do to help myself

Painkillers

Simple painkillers such as paracetamol (an analgesic) may help. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

Exercise

Exercise is the most important way that you can help yourself if you have back pain. If you stop being active for a long time, the muscles in your back become weak and you become less fit, and this can make your back pain worse. Research shows that regular exercise leads to shorter and less frequent episodes of back pain. Any regular exercise that helps to make you flexible and stronger and increases your stamina is good, for example:

• swimming
• walking
• yoga or Pilates
• going to the gym

Often people stop exercising once their back pain has cleared up. But if you stop exercising all the improvements you’ve made will disappear within a few weeks. So, it’s important that you continue to exercise regularly and don’t stop when the pain is gone and you’re feeling better.

Posture

Try to maintain good posture when sitting at home, at work or in the car. Staying in awkward postures, if prolonged, will affect the soft tissues in your back’s support structures and will increase your pain or your recovery time. 

Lifting correctly

Learning to lift correctly is important to help prevent further episodes of back pain. Avoid heavy lifting if you can. Bend your knees when lifting and allow your spine to move as necessary, without twisting it. When doing tasks like carrying shopping, try and split the load between both hands. Keeping the weight close to your body also helps.

Heat/ice packs

Applying a heat pack to the affected area can ease pain and stiffness. An ice pack can also be helpful in the first few days of acute pain. Make sure you protect your skin from direct contact with heat or ice packs to avoid burns or irritation of the skin.

Why does back pain become chronic?

Sometimes, back pain may continue after the original problem has settled down. When you’re in pain for a long time your first thought may be to avoid normal activities and movement. But we know that lack of activity can cause the back muscles to become weak. This will mean that your muscles will tire more easily and will be more vulnerable to further strain. This is known as deconditioning. This may affect your work, social life and personal relationships. If you’re anxious or depressed you may not feel like exercising, so your muscles become weaker still, and so it goes on. This creates a pain cycle. This can happen to anyone, and the longer it goes on the harder it’ll be for you to recover your movement and confidence.

How are back problems diagnosed?

You may be sent for tests if you’ve had an injury to your back. You may be asked to have an x-ray. Most back pain involves the soft tissues of the back and these can’t be seen on an x-ray. In this case a magnetic resonance imaging (MRI) scan or computerized tomography (CT) scan may be needed.

What treatments are there for back pain?

Taking some painkillers, staying active and doing some specific exercises are generally the most helpful treatments for people with back pain. However, some

cases will need further medical treatment.

Physiotherapy

Physiotherapy can be useful to improve your strength and flexibility. As mentioned previously, exercise is one of the most effective treatments for back pain. Manual therapy such as mobilization of the spinal joints, and some electro-therapeutic modalities can help to clear up a spell of back pain along with exercises.

Drugs

If standard painkillers or NSAIDs aren’t providing adequate pain relief, your doctor may suggest some additional treatments, such as muscles relaxants, and medications to calm down the nerves.

Steroid injections

The injections are usually of a steroid and may be placed around the nerve roots or into the facet joints.

Surgery

Very few people with back pain (less than 2%) need an operation. Sometimes an operation is needed for spinal stenosis or for severe sciatica to free the nerve. Urgent surgery may be needed if you lose bladder or bowel control or the use of your legs, but this is extremely rare.

Stretching exercises

	1. Back stretch (stretches back muscles)
2. Deep lunge (stretches muscles in front of thigh and abdomen)
	3. One-leg stand – front (stretches front of thigh)
4. One-leg stand – back (stretches hamstrings)
	5. Knee to chest (stretches muscles of bottom – gluteal)

Strength and stabilizing

	1. Pelvic tilt (works the deep muscles around the pelvis)
2. Buttock tone (works the gluteal)
	3. Deep stomach muscle tone (stabilizes lower back). Pull the lower part of your stomach upwards
4. Back stabilizer Tighten your stomach. Raise one arm in front of you. Try to keep your pelvis level and don’t rotate your body. To progress, try lifting one leg behind you

(All information provided is for reference only. Please contact your physiotherapist or physician should you have any enquiry.)

References :

2. BACK PAIN. Versus Arthritis. https://www.versusarthritis.org/media/21786/backpain-exercise-sheet.pdf
3. Back pain. NELFT NHS Foundation Trust. https://www.nelft.nhs.uk/back-pain/
4. Peloza, J. (2017, April 20). Causes of Lower Back pain. SPINE-health. https://www.spine-health.com/conditions/lower-back-pain/causes-lower-back-pain