Back pain causes more people to seek professional advice than any other single complaint.
- Persistent aching or stiffness anywhere along the spine, from the base of the neck to the hips.
- Sharp, localised pain in the neck, upper back, or lower back, especially after lifting heavy objects or engaging in other strenuous activity.
- Chronic ache in the middle or lower back (lower back pain is sometimes referred to as lumbago).
- Symptoms of a slipped disc include severe backache and painful muscle spasms; the pain is worse with movement, and better when the patient is lying flat.
Backache is sometimes due to a physical defect of the spinal column or another part of the body (for example, if one leg is shorter than the other the spine will try to compensate for the imbalance). However, most cases of back pain last no more than a few days, and are caused by strain, sprains or bad posture.
Many back problems are related to postural issues such as standing in a slumped position, sitting hunched over a computer or steering wheel, or sleeping on a mattress that is too soft. Over time, poor posture causes strain of the bands of muscle surrounding the spine (particularly in the curve of the lower back). Those whose job involves a lot of walking or physical labour develop good muscle tone in their backs and legs. People who sit most of the day lose that muscle tone, and their backs are the first place to show it.
The most common form of backache is lumbago, which can occur quite suddenly or develop over hours or even days. Lumbago is generally triggered by a lifting or twisting action, or may develop following an injury or over use of the back muscles.
The bones of the spine (vertebrae) are cushioned from each other by discs (pads of tissue made up of a tough, fibrous outer layer and a softer, jelly-like inner layer). A slipped disc occurs when the tough outer layer cracks open and the softer inner layer protrudes out through the crack. The disc protrusion happens where the outer layer of the disc is weakest (usually just in front of the nerve roots which emerge from the spinal cord at each vertebrae level). The painful symptoms occur when the protruding disc material presses on the nerve in the spinal column, and will sometimes also be referred to the area of the body that is supplied by that particular nerve. Most affected discs are in the lower back region.
Spinal discs can be subject to normal wear and tear and can actually wear away, removing the shock absorbing characteristics of the spine and leading to strong pain and reduced mobility. This is usually a result of normal ageing processes, but is more likely to occur in those who have experienced back injury in the past. In some cases this will develop into osteoarthritis.
Stress or tension can also create or aggravate back pain. Fibrositis is the term used to describe chronic backache resulting from localised muscle tension, which may in turn be psychosomatic in origin. In some people with depression or anxiety, backache will develop as a symptom of their mental state.
Cancer of the vertebrae is very rare, but it can spread to bones from other sites in the body. This disease is extremely serious and makes the patient feel very run down and unwell and should be confirmed by an X-ray or bone scan.
Back pain can also be due to an extensive range of other causes from pregnancy to infection and, if persistent, should always be discussed with your healthcare professional.
Consultation with your practitioner will help to determine the cause of your back pain and the extent of its impact on your life. Diagnostic tests may include stretches to assess your range of mobility, blood and urine tests (to detect infection) and X-rays. Treatment will focus on rest, pain relief and slowly restoring mobility, with the first stage of treatment for strain or minor injury generally involving immediate bed rest with an ice pack. When the inflammation has subsided, applying heat may soothe and restore the injured muscles. Physiotherapists can give advice as to which exercises are appropriate for your individual case. Massage therapy is frequently used by natural therapists for the relief of back pain, and is particularly appropriate for conditions caused by stress or long-term postural issues. Exercise therapy is also important to help strengthen weak muscles and stretch tight ones. Your practitioner may recommend taking up classes in yoga or Alexander technique (in which the body is taught to use better posture). Your chiropractor or osteopath is also able to assist with spinal adjustments to relieve the pressure on your spine and the surrounding connective tissue.
- Glucosamine is the building block for cartilage repair and is particularly useful for wear and tear problems such as osteoarthritis
- Magnesium is essential for muscle relaxation and may help to relieve muscular pain and spasm
- Calcium is required for bone repair and strength, and deficiency leads to osteoporosis
- Devil’s claw and white willow bark are herbal analgesics which help to relieve back pain
- Anti-inflammatory herbs such as turmeric and ginger may assist in the treatment of inflamed back tissue
- Relaxant herbs such as passion flower and valerian are indicated to relieve muscular spasm and nervous tension
Regular strength and flexibility exercises help to improve muscle tone and relieve back pain. Being overweight can contribute to back pain by increasing the load on the muscles and joints, and can also lead to poor posture. Speak to your healthcare professional about an appropriate weight loss and gentle exercise programme to help relieve the pain and improve strength and posture.
Regular exercise is essential to maintain strong back muscles and a healthy body weight. Non-weight bearing exercise such as swimming is ideal.
Postural assessment may reveal areas that should be stretched or strengthened to avoid back pain and injury in the future. Speak with your physiotherapist, chiropractor or osteopath.
Remember to stretch regularly throughout the day – sitting or standing at work for a long time can contribute to back and muscle tension.
Pay attention to the action you use when lifting things – remember to use your legs not your back. Bending at the waist increases the likelihood of injury.
Use a cushion to support your lower back whilst sitting at your desk or driving. This helps to relieve the pressure on the lower back muscles.
Ensure that your mattress and pillow are firm and supportive, and try to sleep on your side. (Remember that sleeping on your stomach causes pressure on your neck).
If back pain is severe or persistent, consult your healthcare professional. It is also essential to seek help if you experience the following symptoms:
Numbness, tingling or a loss of control in the arms or legs
Pain in the back extending downward along the back of the leg
Pain increasing when you cough or bend forward at the waist
Pain accompanied by fever (you may have a bacterial infection)
Dull pain in one area of the spine when lying in or getting out of bed
Spasmodic or throbbing muscular pain