Back Pain
Back pain is a very common problem with around eight in 10 people in Western countries suffering from backache at least some of the time. Back pain is usually not due to any serious disease. Most episodes of back pain get better quickly. Simple analgesics (pain killers) and modification of activity is all that is needed.
However, about 50 per cent of people who get back pain will have further episodes. The first step to manage back pain is to rule out the possibility of any medical problem, such as infection or fracture (although these are rarely the cause).
The structure of the back
The spine is the main structure of the body, it provides support for the pelvis, legs, ribcage, arms and skull. The spine is made up of bones called vertebrae that are stacked together to form a loose ‘S’- shaped column. Each vertebra is cushioned by spongy tissue or cartilage called intervertebral discs. The discs have a flat structure with a jelly-like centre.
Each vertebra is also joined at the back by pairs of small joints known as ‘facet’ joints. A mesh of connective tissue called ligaments holds the spine together. Complex layers of muscle provide structural support and allow movement. The spinal cord runs through the centre of the vertebral stack and connects the brain to the rest of the body.
Common causes of back pain
Most people with back pain do not have any damage to their spine. The pain comes from the muscles, ligaments and joints. More persistent back pain may be associated with arthritis of the facet joints and degeneration of the discs. People with this condition may however not experience any pain. Some common causes of back pain include:
Arthritis - osteoarthritis and ankylosing spondylitis are two forms of arthritis linked to back pain.
Muscle and ligament strains - weak muscles and ligaments are unprepared for sudden or heavy loads and are easily injured. Lifting a heavy load the wrong way, an unusual bout of exercise, or even bad posture over a period of time can hurt soft tissue.
Osteoporosis - vertebral fracture due to osteoporosis. Osteoporosis is a disease characterised by thinning of the bones. The vertebrae can become so porous and brittle that they easily fracture. Pain is due to the fracture.
Sciatica - the nerve that runs from the lower back into the leg is compressed by a bulging intervertebral disc, causing pain.
Stress - one of the side effects of stress is increased muscle tension, which can lead to fatigue, stiffness and localised pain. Constantly tight muscles can create postural imbalances that may cause misalignment of the spine.
Lifestyle factors contribute to back pain
Most cases of back pain are exacerbated by lifestyle factors, including:
Lack of exercise
Being overweight or obese
Leading a sedentary life
Poor posture
Stress
Bad work practices.
Reducing and preventing back pain
In most cases, back pain can be reduced or prevented by making a few lifestyle changes, including:
Exercises regularly - to improve posture and increase muscle support of the spine. Try walking instead of using the car. Work towards doing 30 minutes of gentle exercise each day. This can be broken into shorter periods for equal benefit.
Lifting and carrying - when picking up a heavy load, squat down, hold the object as close to your body as practical and lift by using your legs, keeping your back straight. Get some help from another person or use equipment (such as a trolley) if the load is too heavy to manage comfortably on your own.
Maintain a healthy body weight - being overweight or obese puts extra strain on your back.
Be aware of your posture - consider your posture, particularly in seated positions, such as when driving or sitting at a desk for long periods of time. Don’t slump, keep your back upright and use support where necessary (such as a lumbar support cushion or footstool).
Take regular breaks - when driving, standing or sitting for long periods of time, take a break at least every hour to change the position of your joints and loosen your muscles. Include a short walk and a few stretches as part of your break.
Relaxation and pain management - learn some relaxation techniques to reduce stress levels and subsequent muscle tension. Try massage, heat or cold applications and gentle exercise. Seek advice from a physiotherapist.
Change your mattress - surfaces that are too soft or too hard can aggravate a sore back. Avoid sleeping on your stomach.
When to see your doctor
Most back pain can be managed at home, however, there are times when it is important to see your doctor to exclude any medical problems that may be contributing to the pain. See your doctor if you have back pain and any of the following warning signs:
You have severe pain which gets worse instead of better over time
If you are unwell with back pain
If you have difficulty passing or controlling urine
Numbness around your back passage or genitals
Numbness, pain and needles or weakness in your legs
You are unsteady on your feet.
Treatment
Treatment depends on the cause, but can include rest, exercise, medication and manipulation.
Where to get help
Your doctor
Other health professionals, such as physiotherapists, chiropractors, exercise physiologists or osteopaths.
Things to remember
Back pain is a common problem.
Back pain most often comes from muscles, ligaments and joints. It can be caused by injury, inflammation, tension or spasm in the muscle, ligament, cartilage or bone.
Staying active plays an important role in management.
Seek advice from a doctor if any warning signs exist.
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