The spine
Simple back pain
In 95% of cases of back pain, the cause is linked to the way the bones,
ligaments and muscles of the back work together. It can come on suddenly but can also be due to strain over time rather than
the result of overdoing it just once. Usually nothing abnormal shows up in tests such as X-rays, and generally nothing within
the back is permanently damaged.
Most people who suffer from this sort of back pain are adults up to 55
years old who are otherwise healthy. The pain is often based in the lumbar region (lower back), and may also spread to the
buttocks and thighs. It will come and go at different times, and depending on different levels of activity.
Simple back pain triggers include:
- poor
posture,
- lack
of exercise,
- standing
or bending down for long periods,
- sitting
in a chair that doesn’t provide enough back support,
- sleeping
on a mattress that doesn’t provide enough back support,
- lifting,
carrying, pushing or pulling loads that are simply too heavy, or going about these tasks in the wrong way,
- a
trip or fall.
It’s worth bearing in mind that the back is a strong and robust
part of the body designed to perform physical work. Being physically active, in itself, is generally good for the back. Indeed,
exercise is helpful in speeding recovery from simple back pain.
Nerve root pain
Other causes of back problems are much less common than simple back pain.
Nerve root pain is the cause in less than 5% of people. The pain is caused by compression of a nerve root, which is the start
of a nerve as it leaves the spinal cord. It is usually caused when a vertebral disc becomes displaced or bulges out from its
normal position, putting pressure on the nerve root. This is called a slipped disc.
The pain will normally be in the lower back, and there may be pain down
one or both legs to the calves, feet or toes. In this case, the pain is sometimes called sciatica because the nerve that runs
down each leg is called the sciatic nerve.
More serious problems
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 a 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 back pain starts
gradually, gets worse over time, and seems unrelated to the level of activity.
When to see a doctor
Most attacks of simple back pain last only a few days and get better on
their own. But anyone with the following symptoms in addition to back pain should see a doctor as soon as possible:
- fever,
- redness
or swelling on the back,
- pain
down the legs and below the knees,
- numbness
or weakness in one or both legs,
- loss
of bladder or bowel control.
A doctor should also be consulted if:
- pain
lasts longer than a week,
- pain
is the result of an injury, a fall or a blow to the back,
- pain
lasts for more than a few days in someone aged under 20 or over 55.
Diagnosis
In most cases, the doctor will only need to discuss the symptoms and carry
out an examination. The doctor is likely to recommend more tests only if the 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),
- A
myelogram (a special kind of X-ray using an injected dye),
- Blood
tests.
Psychological wellbeing can also play a role in back pain. If the condition
is chronic, the doctor may also recommend psychological and social assessment.
Treatment
Stay active
Research shows that bed rest does not help simple back pain – it’s
much better to return to normal physical activity as soon as possible. Staying active may hurt more at first, but it helps
the back to heal quickly, and reduces the risk of the problem occurring again.
If the pain is so bad that taking to bed really seems the only option,
keep bed rest as short as possible before getting up and about again.
Painkillers
Paracetamol or ibuprofen are usually enough to relieve simple back pain.
Prescription-only muscle relaxants such as diazepam may help with muscle spasms, but they generally shouldn’t be taken
for more than a week as they can cause dependence. A hot water bottle or an ice pack applied to the painful area may offer
some relief.
Manipulation and exercise
Osteopathy and chiropractic are treatments involving manipulation of the
spine. They may provide short-term relief for simple back pain within the first six weeks.. Back exercises and physiotherapy
may be helpful if the pain lasts longer.
Complementary approaches
The Alexander Technique may help improve posture. Some people find that
acupuncture helps with the pain, although there is no definite scientific proof of its effectiveness. And, because back pain
can sometimes be related to emotional problems, counselling may also be helpful.
Surgery
If chronic back pain isn’t helped by manipulation, exercises or
medication, then surgery may solve or help the problem. If the pain is caused by a damaged disc, for instance, this could
be surgically removed.
Managing back pain
Good back care can greatly reduce the 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.
Lifting and carrying tips:
- Lift
only a manageable weight, or ask for help.
- When
lifting things or putting things down, bend the knees, and keep the back straight and feet apart.
- Do
not lift and twist at the same time.
- Lift
and carry objects close to the body.
Further information
http://www.ninds.nih.gov/disorders/backpain/backpain.htm
http://en.wikipedia.org/wiki/Back_pain
http://orthopedics.about.com/cs/backpain/a/backpain.htm
