Back pain is by far the most common musculo-skeletal complaint affecting Western society today, costing the economy and society in the UK millions of pounds. Approximately 80% of adults will experience back pain at some point in their lives and it is a leading cause of sickness absence, not to mention the affect it can have on people’s day-to-day lives. It is also the most common reason people attend our clinic.
The good news is our spines are hugely resilient structures and the vast majority of these back pains will recover in a normal healing time of 6 weeks or so, given the right management. Just a very small percentage – around 1% – are due to more serious conditions such as infection, fracture or cancer.
What Causes Back Pain?
Most of the reasons for why you have back pain are unknown. It could be due to any of the soft tissues surrounding the spine – ligaments, tendons, muscles, joints, discs. At the end of the day, it doesn’t really matter what is causing the pain, treatment is always the same. Sometimes there can be irritation of a nerve root in the back leading to referred leg pain, commonly known as sciatica but not always involving the sciatic nerve. Again, the vast majority of leg pain originating from the back will settle down.
Often back pain occurs due to a tipping point. It is an accumulative affect and rarely down to that time you bent down to tie your shoe laces or reaching out to turn off the bedside light. You will have done these things many many times before without any issue, but this time it will be due to other factors that have preceded this, sometimes even factors you have been unaware will be related such as stress, fatigue and having had a bad cold.
For information on preventing back pain, have a look at our recent blog post.
Do I Need an X-Ray or a Scan?
Very unlikely. Because most back pains are soft tissue issues, scans and x-rays are often not necessary. They will not show the cause of the back pain and will not change management, particularly in the early days. There is no need to dose you with radiation when it will not change management. A diagnosis can more often than not be made on your history, your symptoms and how you present to the clinician – how you move, what causes you pain etc – and an effective treatment programme can be devised from this.
Kate discusses early management of acute back pain on our You Tube channel. Below is a little more detail.
- Move. This is the most important piece of advice. Don’t sit still and definitely don’t take to your bed. Movement is vital for healing to take place. In the past, people were told to have bed rest but evidence has proven this to be absolutely the wrong thing to do and can prolong your pain and stiffness. I don’t mean stay on your feet 24/7, but move around at least every hour or so. Try to move as normally as you can – sitting and standing by bending your back (nose over toes) and walking with normal strides and swinging arms. Try to go outside for a short walk each day.
- Pain killers. Do not be afraid to use tablets, as long as you haven’t any contraindications. Paracetamol is an extremely effective medication. Pain relief will enable you to move which will enable the healing process to take place. Other forms of pain relief are the use of heat or ice (whichever you prefer), gels and TENS machines.
- Gentle mobility exercises. Gentle back movements, perhaps initially lying down, to allow muscle spasm to relax and soft tissues to move and heal. Our You Tube channel has 3 exercises to try.
- Relax! Easier said than done, I know! But be reassured that this is highly likely to get better in a few weeks and will not leave you with a “weak back”. Tension and anxiety are more likely to keep the muscles tight and prevent normal movement and that all important healing process.
- Sleep. Again, easier said than done! Sleep is when the restoration and recovery of our bodies occurs, healing happens now. Find a comfortable position, this may be with pillows between your legs. Pain killers will help if you are struggling to sleep as will going to bed with a hot water bottle. Don’t go to bed too late when you are over-tired and try not to use your phone/tablet/computer until late at night as this will stimulate your brain and struggle to switch off. Have a look at our blog post on sleep and download an advice sheet on sleeping positions when experiencing back pain.
- Graded return to work, exercise and every day function. As your back heals it needs to be challenged slightly more each day. Gradually increase the distance you are walking, return to work on a phased return if possible, return to exercise and sport gently at first and then build up.
- Physiotherapy. Physiotherapists can help guide you through this process with the right exercises for you, manual techniques to help the soft tissues and advice on rehabilitation. We can also advise on why this may have occurred and how to prevent it occurring again, perhaps by correcting abnormal movement patterns that may be putting increased strain on your back. Physiotherapists are highly trained professionals and can diagnose if there is a more serious problem and when further investigations may be necessary.
Signs To Look Out For
If you experience any of the following signs or symptoms then you must seek urgent medical advice (bearing in mind, these are very rare):
- Loss of control or change in habits (not associated with pain killers eg constipation from codeine) of your bladder or bowel
- Numbness in between your legs – in your “saddle area”
- Sexual dysfunction
- Inability to co-ordinate your legs or know where they are underneath you
- Unexpected weight loss
A physiotherapist will ask you about any of these symptoms when you first visit them.
A small proportion of the population who experience this “non-specific back pain” will go on to develop long term pain. The reasons why this happens are unclear but pain is hugely complex and can be related to stress, anxiety, depression, our immune system, fatigue and fear of movement. Living with long term pain can be difficult but also manageable, and physiotherapists are experts in helping guide you through this. If you are interested in attending one of our presentations on Persistent Pain then please contact us.
For more information you can visit the Chartered Society of Physiotherapists website and download further advice sheets.
As ever, if you are unsure then please do contact us and we can advise if a consultation with one of our experienced physiotherapists would help you.