Guide to back care

Introduction

Back pain is extremely common and one of the main reasons for sickness absence in the UK. Pain is very difficult to define and it can be frustrating that the exact cause of back pain often can't be explained. Most cases of back pain are caused by strains and minor injuries rather than serious causes, and are often referred to as 'non-specific', 'simple' or 'mechanical' back pain.

Fortunately, although painful, serious or permanent damage is rare and spinal pain and its related problems can usually be managed successfully without the need for surgery. In fact, the most effective way of overcoming back pain is learning how to manage it yourself.

The structure of the back

Your spine is one of the strongest parts of your body. It is made up of 24 small bones called vertebrae. The vertebrae are stacked on top of each other, resting on your hips and topped by the skull. Between each vertebra there are shock absorbing discs that cushion the bones and allow the spine to bend.

The vertebrae and discs are held firmly together in a column by strong elastic ligaments and muscles are attached to the vertebrae by tough cords of tissue called tendons. It's the contractions and expansions of the complex layers of these back muscles that produce the movements of your back and your upper body.

The spine also provides a protective case for the spinal cord which runs from the base of the brain into a hollow canal down through the vertebrae, carrying nerves from the brain to the rest of the body.

The back is divided into 5 regions. The lower part of your back is known as the lumbar region and is made up of 5 vertebrae. This region of the back bares the entire weight of your upper body plus any extra weight you are carrying. It is continually under pressure and bends and twists more than any other part of your back. Not surprisingly, the lower back is the most common area for back pain.

Understanding back pain

Pain can be described as the body's warning system. Most pain starts when part of the body is hurt. Nerves in that part send messages to the brain, alerting the brain that something is damaging the body. The message sent by the nerves is called nociception. What is experienced because of the nociception is pain. Pain is not just the message the nerve sends to your brain, it is also the bad emotion felt because of that damage.

In understanding back pain, it is useful to distinguish between two basic types of pain, acute and chronic.

Acute pain

Acute pain generally comes on suddenly. It gets your attention and prompts you to take action to prevent further worsening of the condition causing the pain. The cause of acute pain can usually be diagnosed and treated, confining the pain to a given period of time and severity. Acute pain is useful because it warns you about harm and tells you to protect yourself while the body heals.

Acute back pain is commonly described as either a very sharp pain or a dull ache. It is usually felt deep in the lower part of the back and can be more severe in one particular area. Sometimes acute back pain can be caused by injury or trauma to the back but just as often has no known cause. Patients with acute back pain, even when severe, will typically improve or completely recover within 6 to 8 weeks.

Chronic pain

Chronic pain, on the other hand, lasts for much longer and is more difficult to treat. It can be described as pain that persists. As such, it loses is value as a warning and instead can result in significant physical and emotional effects.

Chronic back pain is commonly described as deep, aching, dull or burning pain in one area of the back or travelling down the legs. Patients may experience numbness, tingling burning or a pins-and-needles type sensation in the legs and regular daily activities may prove difficult or even impossible. It may become difficult or unbearable to work even when the job doesn't require manual labour. Chronic back pain tends to last a long time and is not relieved by standard types of medical management.

People experiencing chronic pain often report:

• feelings of anxiety and tension
• depression
• irritability and mood swings
• difficulty with relationships
• social isolation
• poor quality of life
• frustration
• despair that nothing can be done.

Causes

It is often difficult for physicians to pinpoint the exact cause of low back pain due to the complex composition of the spine. However, understanding the cause of your back pain is the key to proper treatment.

Lumbar Muscle Strain

Muscle strains are the most common cause of low back pain but the good news is that most episodes of back pain from muscle strains resolve completely within a few weeks.

Ruptured Disc

Another common cause of back pain is the bulging or rupture of one or more of the intervertebral discs, placing pressure on the surrounding spinal nerves. This is commonly known as a 'slipped disc' but is more accurately described as a herniated disc.

Sciatica

Sciatica is pain caused by general compression and / or irritation of one of 5 nerve roots that are branches of the sciatic nerve.

Spinal stenosis

Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves. This is usually due to the natural process of spinal degeneration that occurs with aging. It can also sometimes be caused by spinal disc herniation, osteoporosis or a tumour.

Spondylosis

Spondylosis is spinal degeneration and deformity of the joint(s) of two or more vertebrae. It commonly occurs with aging.

Spondylolisthesis

In simple terms, spondylolisthesis describes the displacement of vertebrae in relation to the vertebrae below. This condition occurs when one vertebra in the spinal column slips forward over another.

In some instances the exact cause of back pain can't be determined.

Diagnosis

In the majority of cases a doctor can diagnose the cause of back pain by discussing the symptoms and doing a physical examination. However, when there is doubt a variety of special investigations can be carried out. Generally, you will only be sent for tests if the pain lasts for longer than 6 weeks, you have had an injury or blow to your back or if your doctor suspects there may a more serious underlying cause for the pain.

X-rays and blood tests

A combination of simple blood tests and x-rays will usually rule out any serious diseases or other conditions requiring urgent treatment. Certain rare disorders affecting the nerves won't show up and sometimes more detailed investigation is needed.

Magnetic Resource Imaging (MRI)

MRI scanning is the most advanced way of producing a picture of the spine, as well as other parts of the body. It relies upon high-powered magnetic fields and radio wave energy and produces high quality images that can be effectively used to diagnose most cases of spinal degenerative disease, as well as ruling out more serious disorders.

CT scanning

CT scans, although rapidly being replaced by MRI scanning, are also a useful means of investigating spinal disorders. In some instances CT scans may be preferred as they give better detail of bone tissue.

Myelography

This involves the injection of a 'dye' into the spine, followed by the capture of radiographic images. This is an invasive technique which is now largely redundant due to modern scanning techniques.

Prevention

The best way to avoid back pain is by ensuring that your back is strong and supple and reducing any excess strains or stresses.

Exercise

Regular exercise has been proven to be an excellent way of both preventing and reducing back pain. Regular, controlled exercise can help build up your stamina, strength and suppleness, helping to prevent back pain as well as easing any pain that you might have. Don't be discouraged if you feel discomfort, start at your own pace and gradually increase the amount you do.

The following exercises are recommended as they strengthen the muscles that support your back without putting any significant strain on them:

• swimming
• walking
• aqua aerobics or hydrotherapy
• yoga
• t'ai chi
• pilates.

Posture

Treatment

Most low back pain can be treated without surgery. Treatment generally involves using over-the-counter pain killers and anti-inflammatory drugs. Muscle relaxants may also be prescribed but only for a short time.

The use of cold and hot compresses may also help to reduce pain and inflammation and allow greater mobility for some individuals.

The goal of treatment is to restore proper function and strength to the back and prevent recurrence of the injury. Continuing with normal activities where possible and exercising is the best way to achieve this. Bed rest is recommended for only 1-2 days at most.

You may also find that the Alexander technique helps. This is a method that works to change movement habits in your everyday activities. It helps make you aware of balance, posture and coordination and aims to help you to relearn the correct way to hold and move your body, releasing muscular tension.

Aside from consulting your GP you may also consider seeing a qualified physiotherapist, osteopath or chiropractor as some of the treatments they provide can prove beneficial.

In the most serious cases, when the condition does not respond to other therapies, surgery may be required.

References

1. http://www.patient.co.uk

2. http://www.backpainexpert.co.uk

If you have any concerns please do not hesitate in contacting your GP. There are also various other sources that you can refer to or contact for further help and information.