Back Pain
Types of
back pain
Backache is most common in the lower back
('lumbago'), although it can be felt anywhere along your spine, from your neck
down to your hips. Sometimes, back pain can be caused by an injury or
disease, such as:
- a slipped disc – when one of the
discs in the spine is damaged and presses on the nerves
- sciatica – irritation or
compression of the sciatic nerve, which causes pain, numbness and tingling
that travels down one leg
- whiplash – neck injury caused by
a sudden impact
- frozen shoulder – inflammation
around the shoulder that causes pain and stiffness
- ankylosing spondylitis – a
long-term condition that causes pain and stiffness where the spine meets
the pelvis
The rest of this information will focus on back
pain that does not have an obvious cause. Doctors call this “non-specific back
pain”.
What to
do
Most cases of back pain get better on their own and
you may not need to see a doctor. If you have only had back pain for a few days or
weeks, the following advice may help relieve your symptoms and speed up your
recovery:
- remain
as active as possible and try to continue with your daily activities
- take
over-the-counter painkillers, such as paracetamol or ibuprofen if you feel you need to
- use
hot or cold compression packs – you can buy these from your local
pharmacy, or a bag of frozen vegetables and a hot water bottle will work
just as well.
Although it can be difficult to be cheerful or
optimistic if you are in pain, it’s important to stay positive because this can
help you recover faster.
Treatments
for long-term back pain
If you are worried about your back or your pain
has not improved by around six weeks, it is a good idea to visit your doctor, who can
advise you about the treatments available. These include:
- stronger
painkillers
- exercise
classes – where you are taught specific exercises to strengthen your
muscles and improve your posture
- manual
therapy, such as physiotherapy, chiropractic or osteopathy
- acupuncture
- counselling,
such as cognitive behavioural therapy (CBT)
- support
and advice at a specialist pain clinic.
Some people choose to see a therapist for manual
therapy or acupuncture without seeing their doctor first. If you want to do this
you will usually need to pay for private treatment, which is likely to cost
around £30-50 for each appointment. Spinal surgery is usually only recommended when all
else has failed.
Preventing
back pain
How you sit, stand, lie and lift can all affect the
health of your back. Try to avoid placing too much pressure on your back
and ensure it's strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing
back pain. Activities such as yoga or pilates can improve your flexibility
and strengthen your back muscles.
Signs of
a serious problem
You should seek urgent medical help if you
have back pain and:
- a
high temperature (fever)
- unexplained weight loss
- a
swelling or a deformity in your back
- it is
constant and doesn't ease after lying down
- pain
in your chest
- a
loss of bladder or bowel control
- an
inability to pass urine
- numbness
around your genitals, buttocks or back passage
- it is
worse at night
- it
started after an accident, such as after a car accident.
These problems could be a sign of something more
serious and need to be assessed as soon as possible.
Causes of back pain
Your back is a complex structure made up of bones,
muscles, nerves and joints. This can often make it difficult to pinpoint
the exact cause of the pain. Most cases of back pain are not caused by serious
damage or disease but by minor sprains, strains or injuries, or a pinched or
irritated nerve. These types of back pain can be triggered by
everyday activities at home or at work, or they can develop gradually, over
time. Possible causes of back pain include:
- bending
awkwardly or for long periods
- lifting,
carrying, pushing or pulling heavy objects
- slouching
in chairs
- twisting
awkwardly
- overstretching
- driving
or sitting in a hunched position or for long periods without taking a
break
- overusing
the muscles – for example, during sport or repetitive movements (repetitive strain injury).
Back pain sometimes develops suddenly for no
apparent reason. For example, you may wake up one morning with back pain and
have no idea what has caused it.
Who is
most at risk?
Certain things can increase your chances of
developing back pain. These include:
- being
overweight – the extra weight puts pressure on the
spine;
- smoking –
this may be due to tissue damage in the back caused by smoking or the fact
that people who smoke tend to have unhealthier lifestyles than people who
don't smoke;
- being
pregnant – the extra weight of carrying a baby
can place additional strain on the back;
- long-term
use of medication known to weaken bones – such as corticosteroids
- being
stressed or depressed.
Medical
conditions
In a few cases, your symptoms may suggest a
specific medical condition is causing your back pain. For example:
- pain
in your lower back associated with pain, numbness and a tingling sensation
that travels down one leg may be a symptom of sciatica or a slipped or prolapsed disc
- joint pain (including in the
back) when walking and stiffness first thing in the morning are symptoms
of arthritis – if the pain and
stiffness take more than 30 minutes to resolve on waking up, or seem to
start when you stop to rest after exercise, make sure you mention this to
your doctor
- shoulder pain and stiffness,
which makes it difficult to dress, drive or sleep, may be a sign of frozen shoulder
- neck
pain and stiffness, headaches and back pain following
an accident can be symptoms of whiplash
Rarely, back pain can be a sign of a serious
condition such as a spinal fracture, an infection of the spine, or cancer. If you see your doctor with back pain, they will look
for signs of these conditions.
Diagnosing back pain
Most cases of back pain do not require medical
attention and can be treated with over-the-counter painkillers and self-care. However, you should visit your doctor if you are
worried about your condition or struggling to cope with the pain.
Seeing
your doctor
Your doctor will ask you about your symptoms and
examine your back. The examination will usually assess your ability to
sit, stand, walk and lift your legs, as well as testing the range of movement
in your back. Your doctor may also ask you about any
illnesses or injuries you may have had, as well as the type of work you do and
your lifestyle. Below are some of the questions your doctor may ask. It might help
to think about these before your appointment:
- When
did your back pain start?
- Where
are you feeling pain?
- Have
you had back problems in the past?
- Can
you describe the pain?
- What
makes the pain better or worse?
What
happens next
If your doctor thinks there may be a more serious
cause, they will refer you for further tests, such as an X-ray
or magnetic resonance imaging (MRI) scan. Otherwise, your doctor can advise you about things
you can do and treatments that may help reduce your pain and
speed up your recovery.
Preventing back pain
Keeping your back strong and supple is the best way
to avoid getting back pain. Regular exercise, maintaining good posture and lifting
correctly will all help. If you have recurring back pain, the following
advice may be useful:
- lose weight – too much upper
body weight can strain the lower back;
- wear
flat shoes with cushioned soles as they can help
reduce the pressure on your back
- avoid
sudden movements which can cause muscle strain
- try
to reduce any stress, anxiety and tension,
which can all cause or worsen back pain
- stay
active – regular exercise, such as walking and swimming, is an excellent way of
preventing back pain.
Exercise
Exercise is both an excellent way of preventing
back pain and of reducing it, but should seek medical advice before starting an
exercise programme if you have had back pain for six weeks or more. Exercises such as walking or swimming strengthen
the muscles that support your back without putting any strain on it or
subjecting it to a sudden jolt.
Activities such as yoga or pilates can improve the flexibility
and the strength of your back muscles. It's important that you carry out these
activities under the guidance of a properly qualified instructor. Below are some simple exercises you can do several
times a day at home to help prevent or relieve back pain:
- Bottom
to heels stretch – kneel on all fours, with your knees under
hips and hands under shoulders. Slowly take your bottom backwards,
maintaining the natural curve in the spine. Hold the stretch for one deep
breath and return to the starting position. Repeat eight to 10 times.
- Knee
rolls – Lie on your back and place a small flat cushion or
book under your head. Keep your knees bent and together, then roll
them to one side while keeping both shoulders on the floor. Hold the
stretch for one deep breath and return to the starting position. Repeat
eight to 10 times, alternating sides.
- Back
extensions – Lie on your stomach, and prop yourself
on your elbows. Arch your back up by pushing down on your hands. Breathe
and hold for five to 10 seconds. Return to the starting position. Repeat
eight to 10 times.
You must stop these exercises immediately if they make your
pain worse.
Posture
How you sit, stand and lie down can have an
important effect on your back. The following tips should help you maintain a
good posture:
Standing
Stand upright, with your head facing forward and
your back straight. Balance your weight evenly on both feet and keep your legs
straight.
Sitting
Make sure you sit upright with support in the small
of your back. Your knees and hips should be level and your feet should be flat
on the floor (use a footstool if necessary). Some people find it useful to use
a small cushion or rolled-up towel to support the small of the back.
If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.
If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.
Driving
Make sure that your lower back is properly
supported. Correctly positioning your wing mirrors will prevent you from having
to twist around. Your foot controls should be squarely in front of your feet. If you are driving long distances, take regular
breaks so you can stretch your legs.
Sleeping
Your mattress should be firm enough to support your
body while supporting the weight of your shoulders and buttocks, keeping your
spine straight. If your mattress is too soft, place a firm board
(ideally 2cm thick) on top of the base of your bed and under the mattress. Your
head should be supported with a pillow, but make sure your neck is not forced
up at a steep angle.
Lifting
and carrying
One of the biggest causes of back injury,
particularly at work, is lifting or handling objects incorrectly. Learning and
following the correct method for lifting and handling objects can help prevent
back pain. You should:
- Think
before you lift – can you manage the lift? Are there any
handling aids you can use? Where is the load going?
- Start
in a good position – your feet should be apart, with one
leg slightly forward to maintain balance; when lifting, let your legs take
the strain – bend your back, knees and hips slightly, but do not stoop or
squat; tighten your stomach muscles to pull your pelvis in; do not
straighten your legs before lifting as you may strain your back on the way
up.
- Keep
the load close to your waist – keep the load close to
your body for as long as possible with the heaviest end nearest to you.
- Avoid
twisting your back or leaning sideways, particularly when
your back is bent – your shoulders should be level and facing in
the same direction as your hips; turning by moving your feet is better
than lifting and twisting at the same time.
- Keep
your head up –once you have the load secure, look
ahead, not down at the load.
- Know
your limits – there is a big difference between what
you can lift and what you can safely lift; if in doubt, get help.
- Push
rather than pull – if you have to move a heavy object across
the floor, it is better to push it rather than pull it.
- Distribute
the weight evenly – if you are carrying shopping bags or
luggage, try to distribute the weight evenly on both sides of your body.
If your child needs to carry a bag to school,
they should use a well-designed backpack that is worn over both shoulders.
Avoid putting anything unnecessary in their bag to keep the weight to a
minimum.
Treating back pain
Treatments for back pain vary depending on how long
you have had the pain, how severe it is, and your individual needs and
preferences. The various treatments for back pain are outlined
below.
Short-term
back pain
Initially, back pain is usually treated with
over-the-counter painkillers and home treatments. Most people will experience a
significant improvement in their symptoms within six weeks.
Keep
moving
It used to be thought that bed rest would help you
recover from a bad back, but it's now recognised that people who remain active
are likely to recover more quickly. This may be difficult at first if the pain is
severe, but try to move around as soon as you can and aim to do a little more
each day.
Activity can range from walking around the house to
walking to the shops. You will have to accept some discomfort but avoid
anything that causes a lot of pain. There is no need to wait until you are completely
pain-free before returning to work. Going back to work will help you return to
a normal pattern of activity, and it can distract you from the pain.
Painkillers
Paracetamol is often one of the first
medications recommended for back pain, although some people find non-steroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen, more effective. A stronger
painkiller, such as codeine, is also an option and is sometimes taken in
addition to paracetamol. Painkillers can have side effects, some can be
addictive and others may not be suitable, depending on your health and medical
history. For example, the long-term use of NSAIDs can affect how well your
kidneys work.
Your pharmacist or doctor will be able to give you
advice about the most appropriate type of medication for you. If over-the-counter medications are not controlling
your pain, your doctor may be able to prescribe something stronger. They may also
recommend a short course of a muscle relaxant, such as diazepam, if you
experience muscle spasms in your back.
Hot and
cold treatments
Some people find that heat – for example, a
hot bath or a hot water bottle placed on the affected area helps ease the pain. Cold, such as an ice pack or a bag of frozen
vegetables, placed on the painful area can also be effective. Don't put
the ice directly on to your skin though, as it might cause a cold burn.
Wrap an ice pack or bag of frozen vegetables in a cloth before
putting it on your skin.
Another option is to alternate between hot and cold
using ice packs and a hot water bottle. Hot and cold compression packs can be
bought at most pharmacies.
Relax and
stay positive
Trying to relax is a crucial part of easing the
pain because muscle tension caused by worrying about your condition may
make things worse. Although it can be difficult, it's also important
to stay optimistic and recognise that your pain should get better because
people who manage to stay positive despite their pain tend to recover quicker.
Change
your sleeping position
Changing your sleeping position can take some of
the strain off your back and ease the pain. If you sleep on your side, draw your legs up
slightly towards your chest and put a pillow between your legs. If you sleep on
your back, placing pillows under your knees will help maintain the normal curve
of your lower back.
Exercise
and lifestyle
Try to address the causes of your back pain to
prevent further episodes. Common causes include being overweight, poor posture
and stress. Regular exercise and being active on a
daily basis will help keep your back strong and healthy. Activities such as walking, swimming and yoga are popular choices. The
important thing is to choose an enjoyable activity that you can benefit from
without feeling pain.
Long-term back pain
If you have had back pain for more than six
weeks (known as chronic back pain), your doctor will advise you about which
painkillers to take and may recommend:
- Exercise classes –
group classes supervised by a qualified instructor, where you are taught
exercises to strengthen your muscles and improve your posture, as well as
aerobic and stretching exercises.
- Manual
therapy – therapies including manipulation,
mobilisation and massage, usually carried out by chiropractors, osteopaths or physiotherapists (although
chiropractic and osteopathy aren't widely available on the NHS).
- Acupuncture – a treatment
where fine needles are inserted at different points in the body. It's been
shown to help reduce lower back pain, although it's not always available
on the NHS.
These treatments are often effective for people
whose back pain is seriously affecting their ability to carry out daily
activities and who feel distressed and need help coping. There is also some evidence that a therapy called
the Alexander technique may help people
with long-term back pain, although the National Institute for Health and Care
Excellence (NICE) does not currently recommend this treatment specifically. Some of the other treatments that may be
recommended are described below:
Antidepressants
If painkillers do not help, you may be prescribed
tricyclic antidepressants (TCAs), such as
amitriptyline. TCAs were originally intended to treat depression, but they are also effective at
treating some cases of persistent pain. If you are prescribed a TCA to treat persistent
back pain, the dose is likely to be very small.
Counselling
If the treatments described above are not
effective, you may be offered psychological therapy to help you deal with your
condition.
While the pain in your back is very real, how you
think and feel about your condition can make it worse. Therapies such as cognitive behavioural therapy (CBT) can
help you manage your back pain better by changing how you think about your
condition.
Pain
clinics
If you have long-term pain, you may be able to
attend a specialist pain clinic.
Pain clinics help people manage their pain and
provide advice about things such as increasing your activity level and how to
have a better quality of life despite being in pain. Your programme may involve using a combination of
group therapy, exercises, relaxation and education about pain and the
psychology of pain.
Surgery
Surgery for back pain is usually only recommended
when all other treatment options have failed or if your back pain is so
severe you are unable to sleep or carry out your daily activities. The type of surgery suitable for you will depend on
the type of back pain you have and its cause.
Two procedures sometimes carried out include:
- a
discectomy – where part of one of the discs between
the bones of the spine (the vertebrae) is removed to stop it pressing
on nearby nerves (known as a slipped or prolapsed disc)
- spinal
fusion – where two or more vertebrae are
joined together with a section of bone to stabilise the spine and reduce
pain.
These procedures can help reduce pain caused by
compressed nerves in your spine, but they are not always successful and you may
still have some back pain afterwards. As with all types of surgical procedures, these
operations also carry a risk of potentially serious complications.
In some
cases, nerves near the spine can be damaged, resulting
in problems such as numbness or weakness in a part of one or both legs or,
in rare cases, some degree of paralysis. Before you agree to have surgery, you should fully
discuss the risks and benefits with your surgeon.
Treatments
not recommended
A number of other treatments have sometimes
been used to treat long-term back pain, but are not recommended by The National
Institute for Health and Care Excellence (NICE) because of a lack of evidence
about their effectiveness in treating non-specific back pain (back pain with no
identified cause).
These include:
- low
level laser therapy – where low energy lasers are focused on
your back to try to reduce inflammation and encourage tissue repair
- interferential
therapy (IFT) – where a device is used to pass an
electrical current through your back to try to accelerate healing while
stimulating the production of endorphins (the body’s natural painkillers)
- therapeutic
ultrasound – where sound waves are directed at
your back to accelerate healing and encourage tissue repair
- transcutaneous electrical nerve stimulation (TENS) –
where a machine is used to deliver small electrical pulses to your back
through electrodes (small sticky patches) that are attached to your skin;
the pulses stimulate endorphin production and prevent pain signals
travelling from your spine to your brain
- lumbar
supports – cushions, pillows and braces used to
support your spine
- traction – where a pulling
force is applied to your spine
- injections –
where painkilling medication is injected directly into your back.
Source: NHS Choices.