Back Pain

Sources of back pain:

Pain can come from disc problems, facet joints, nerves, bone, muscle or ligament. Early identification of the sources of the pain helps to provide a focussed treatment plan for short and long-term benefit.

Back pain may be associated with other symptoms - it may radiate into the legs due to nerve irritation. When severe and in certain situations this can be due to a slipped disc.

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), infection or cancer.

When to see a doctor:

Most attacks of simple back pain last only a few days and get better on their own. However if you are having repeated episodes, than a clear identification of the specific problem via a medical assessment is appropriate in order to devise customised treatment.

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.

Additionally, 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 many 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) and 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.

Specific exercises are also important to take the load away from the spine. They are not a quick fix solution, although some exercises can provide quick relief.

Painkillers

Medications of various forms may be appropriate over the short term and may help to keep you active, which is very important.

Injections

Local injection therapies can be very helpful for some specific complaints, but these need to be carefully discussed with your doctor. See Facet Joint Injections for more information.

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. 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. Also, because back pain can sometimes be related to emotional problems, counselling may also be helpful.

Other Methods of Treatment

Denervation Procedures for Spinal Pain

Surgery is necessary only in the tiny minority of cases, for specific situations.

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.

Prevention Tips:

Avoid smoking - Smoking is a risk factor for back pain. It is believed that smoking decreases the circulation to the lower back discs which can cause them to crack and rupture.

Maintain a healthy weight - obesity may contribute to back pain by causing the lower back curve to arch too much.

Minimise your stress - Stress can cause or aggravate back pain. Try these strategies:

· Take a break every 20 minutes when studying or working on the computer.

· Practice time management.

· Try relaxation techniques like the following:

1. Lie on your back, eyes closed, knees bent and arms resting at sides.

2. Inhale through your nose, and then exhale through your mouth.

3. Concentrate on breathing slowly and deeply for a couple of minutes.

4. While continuing the breathing pattern, slowly press your lower back against the floor, hold 2-3 seconds, and then relax.

Practice breathing and tensing/relaxing lower back muscles until you feel relaxed.

Cardio Exercise for a Healthy Spine:

Aerobic exercise is recommended in addition to stretching and strengthening. In fact, a sedentary lifestyle is often a cause of back/neck pain. Aerobic exercise utilises large muscle groups (i.e. legs) or multiple muscle groups (i.e. legs, arms and trunk), is rhythmical in nature, and is performed continuously over a period of time. Try to commit to an active lifestyle that extends into all aspects of your day, such as

Walking or biking instead of driving or taking the bus,
Taking the stairs,
Parking your car a few streets away from your destination and walking,
Taking a walk every 30 minutes, instead of sitting for long periods of time studying or working.

Exercise Formula for Healthy Living & Healthy Spine:

Activity:

Exercise doesn't need to be vigorous or continuous, so try to increase the activities that you do on a daily basis. Biking, walking or upright water exercise is less stressful on the back, so they are preferred over swimming, stair climber machines and jogging if you have back problems.

Daily:

Do at least 60 minutes of physical activity. Activities can last for one minute 60 times a day or any other combination totaling 60 minutes.

Ideas for Daily Living:

Be mindful of your posture during daily activities like standing, sitting, and sleeping. Your posture habits can cause some muscles to tighten and others to weaken.

Ideal sitting posture promotes a normal "S" shaped curve. Use a pillow or towel roll to support the lower back. In a car, sit with your knees slightly higher than your hips.

Slouch Posture grossly increases and/or flattens the spinal curves, resulting in soft tissue tightening or weakness.

Sleeping:

A firm mattress promotes proper sleeping posture. Place a 3/4 inch plywood board under a soft mattress to increase its firmness.

Lying on your side, with knees bent, supports the natural curve of the back. Use a flat pillow to support the neck, especially if your shoulders are broad.

Sleeping on the stomach can increase the lower back curve and stress the neck and shoulders. If you must sleep on your stomach, place a pillow under your hips to support the lower back.

Sleeping on your back is restful and correct when the knees are properly supported.

Packs and Sore Backs - Wearing heavy backpacks or placing them over one shoulder can add to back pain. It can also increase your risk for upper back and shoulder pain. Keep the load light and carry the pack over both shoulders.

Bicycling and Your Back - Adjust bicycle handlebars and seat to support correct posture. Upright handlebars, rather than racing types will place less stress on the lower back.

Footwear - Wear flat-soled shoes with firm arch support. High heel shoes increase the forward curve of the lower back. Don't stand in one place too long; shift your weight and change positions. When walking or standing, remember the three curves of the back and practice correct posture.

Neck Tips - Do not lean over your work, hobbies, projects, etc. Angle your work so that you can look straight ahead, or sit closer to your work area. Do neck exercises throughout the day. Try frequent "mini-breaks" to relieve tension. Avoid overhead reaching, use a ladder or stepstool instead.

Pregnancy - During pregnancy, hormones slightly loosen tissues that hold the vertebrae together. The added weight can also cause strain. Consult your doctor if you experience back problems.

Caring for your Back or Neck:

While dull aches can be annoying and even ignored, severe pain or pain present with other symptoms may indicate a more serious condition.

Call a doctor if your pain involves…

An accident
Fever - may indicate an infection
Frequent, painful or bloody urination - may indicate a kidney problem
Shooting pain down the back of a leg, from the hip down to or below the knee - may indicate a disc problem or pinched nerve
Numbness or tingling in arm(s) or leg(s) - may indicate a nerve or disc problem
Weakness or paralysis in an arm or leg - may indicate a nerve or disc problem
Persistent pain that can't be relieved - may indicate a serious back disorder or injury
Changes in bladder or bowel function - may indicate an internal organ problem
Changes in menstrual cycle
Changes in skin color (yellow) - may indicate an internal organ problem.

Self-Care for Back or Neck:

If you haven't experienced any of the above symptoms, you can try self-care to ease pain and promote healing.

First 48-72 Hours

After 72 Hours

Ice (15-20 minutes, 3-4 times per day
Paracetamol
Rest from painful activities
Walk or perform other low stress exercise
Minimal bed rest

·         Moist heat 15-20 minutes, before exercising

·         Back, abdominal, and hip stretching exercises

·         Back and abdominal strengthening exercises

·         Paracetamol or Ibuprofen

Using Ice and Heat:

To relieve initial pain, you can use an ice pack for 15-20 minutes every two hours for the first 72 hours. Avoid lying on the ice pack, as it could freeze the skin. After the first 72 hours, moist heat, such as a hot shower, bath, wet towels, or hot water bottle, may help relax muscles prior to stretching exercises. Apply 15-20 minutes every few hours.

Massage:

Massage helps increase the blood flow to your muscles and helps muscles relax. You may want to consult a massage therapist for assistance.

Medication:

Paracetamol, ibuprofen, and aspirin can help reduce pain. Follow the label for recommended dosages and frequency. Inform your doctor of any drug allergies or adverse reactions. Further information on NSAIDs can be found by selecting the download at the bottom of this page.

Rest:

Rest from painful activities, but resume daily activities such as walking as quickly as possible. Muscles and other tissues will stiffen and weaken if you avoid exercise for too long.

Exercise:

As pain decreases, try the exercises listed in the information sheets (available for download). Slight discomfort is normal. Gradually increase the amount, intensity, and frequency of exercise as tolerated.