Low Back Pain

Low back pain is pain affecting the lower part of the back. It is described as: 

  • Acute if it has lasted less than 6 weeks. 
  • Sub-acute if it has lasted 6-12 weeks. 
  • Chronic if it has lasted more than 12 weeks.

Low back pain is very common, costing millions in lost work, as well as millions in medical, state and insurance resources every year. Most back pain does not signify any serious underlying problem, and will sort its self out within a few days to a few weeks.

Symptoms

Low back pain means a pain or ache somewhere between the bottom of the ribs, at the back, and the top of the legs. The pain often begins suddenly, and may follow an obvious strain or injury, but may seem to come on "out of the blue", or come on slowly. 

The pain may travel to or be felt elsewhere. It often goes into the buttocks, but may go further down the leg and even into the foot. 

The pain may be worse on bending and is often worse sitting, especially in an easy chair. Sometimes turning over in bed and sitting up are agonising. Coughing or sneezing can often make the pain much worse. The muscles of the back may go into painful spasm. 

Back pain may be combined with pain into the leg, travelling down below the knee, this is otherwise known as sciatica, because the main nerve to the leg (the sciatic nerve) is being irritated by pressure on it. 

In this section I have been talking about what we term simple or mechanical back pain, which is far and away the most frequent cause of low back pain. There are various other symptoms which may go with back pain, some of which suggest problems other than back problems, and some of which point to the need for more urgent action by you and your doctor. 

Causes

Low back pain is common. The main cause for low back pain is a strain of the muscles, or other soft structures (eg ligaments and tendons) connected to the back bones (vertebrae). Sometimes it is the cushion between the bones (intervertebral disc) which is strained, and which bulges out (herniates) and presses on the nearby nerves (as in sciatica).

Exactly what is injured varies from person to person, but you may also get differing theories depending on whom you ask. Thus the poor sufferer may become confused and worried.

Although the experts may not agree on what is causing the problem, there is a surprising amount of agreement on how best to improve the situation.

Various other conditions can cause back pain, and if in doubt about what is causing your pain, you should consult your doctor.

Diagnosis

If in doubt, consult your doctor, a physiotherapist, a chiropractor or an osteopath.

The United Kingdom has guidelines for doctors and other professionals on how best to manage a person with back pain. These guidelines cover many aspects, but there are some main principles which are most important. 

  • The first thing is to rule out any other obvious conditions which also cause back pain.
  • There are a number of "red flags", or warning signs, which are factors which lead the doctor to arrange for more rapid investigation and treatment than would otherwise be necessary. They may point to something more serious going on than simple, or mechanical back pain. If any of them applies to you, you should see your doctor soon:

    • You are younger than 20 or older than 55 when you get back pain for the first time.
    • The pain follows a violent injury, such as a road traffic accident.
    • The pain is constant and getting worse.
    • The pain is in the upper part of the spine.
    • You have had cancer in the past or at present.
    • You are on steroids.
    • You are a drug abuser, or have HIV.
    • You are generally unwell in yourself.
    • You have lost significant weight.
    • You continue to have great difficulty bending forwards.
    • You have developed a number of problems in your nervous system (eg numbness, loss of power, etc).
    • You have developed an obvious structural deformity of your spine.

  • You should also see your doctor (either for a first visit, or for a follow-up) if the pain is continuing for more than 4-6 weeks.

Investigations

  • Most times an X-Ray is unhelpful, and in fact it gives you a high dose of radiation, so do not be surprised if your doctor does not arrange one.
  • Sometimes your doctor will arrange blood tests to rule out the rarer causes of back pain.
  • When the pain has continued for a few weeks, your doctor or a specialist may arrange a CT (Computerised Tomography) or MRI (Magnetic Resonance Imaging) scan. These are more likely to be helpful, as they show up the soft structures in the spine, as well as the bones.
  • Occasionally the doctor will want to do other tests to look for the rarer causes of back pain.

Treatment

  • The main thing about most low back pain is do not worry – it will usually get better on its own, within a few days, or possibly a few weeks.
  • Stay active, and if at all possible, stay at work.
  • The pain may force you to rest, but this is a result of the pain, and not a good treatment for back pain. If you have to take to your bed, limit it, if possible, to a day or two at the most.
  • Use simple pain killers, such as paracetamol or ibuprofen if necessary.
  • Avoid activities likely to put unnecessary strain on your back.
  • See your doctor if you think you are in one of the red flag categories.
  • If it seems to be lasting more than a few days, consider seeing a physiotherapist, chiropractor or osteopath, as it may be that the treatments they use (such as manipulation) will help aid your recovery. You may wish to consult your doctor prior to this.
  • If you do have to be off work, keep this to a minimum, and do not expect to be pain free before you go back.

If in doubt, consult your doctor. 

Chronic Low Back Pain 

If the pain goes on for more than 12 weeks, it is said to be chronic. In these instances, manipulation appears to be less likely to be helpful. Your doctor may arrange for you to have a course of back rehabilitation, to help you get going again.

Prevention 

Stay fit. Regular exercise to keep generally fit is more important than any specific exercises aimed at the back muscles. 

Be aware of the posture and position you are in during your daily activities. If you have to lift heavy objects, share the load with other people, and try to hold the weight in close to your body, bending at the knees when possible rather than your back. 

If carrying shopping, try to carry similar loads on both sides, and make a number of journeys, rather than trying to carry too much at one go. Consider the use of a shopping trolley. 

School bags are typically far too heavy and often worn on only one shoulder. Try to leave books that you do not need that day in your locker or at home, and wear a rucksack type of bag correctly positioned on both shoulders.

Further Information

  • BackCare, the UK charity for healthier backs
  • Exercise beats back pain (BBC News, 30 Jul 1999)

Books 

Back and neck pain: The facts, by Loic Burn

Helpful advice for the sufferer, written by a GP who now spends most of his time treating back and neck problems. (Buy online from Amazon.com: USA, UK, Canada.) 

Beat back pain (52 Brilliant ideas series), by Dr Ruth Chambers 

An excellent book, written by a British General Practitioner, which is easy to read, well laid out, and full of helpful ideas. (Buy online from Amazon.com: UK, Canada.) 

Treat your own back, by Robin McKenzie 

Written by an author well known in this field. (Buy online from Amazon.com: USA, UK, Canada.) 

BMA Family Doctor Series: Backpain, by Tony Smith (editor) 

A useful quick guide to back pain from the British Medical Association. (Buy online from Amazon.com: USA, UK, Canada.) 

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