Close to 90% of people experience back pain at some stage in their lives, and half of working-age adults have some back pain in any given year. That is a lot of back pain! (For clarity we are discussing lower back pain or lumbago.)
What causes back pain?
This is a surprisingly difficult question to answer because the truth is that, quite often, we do not know. At least not exactly. Here is the general approach to back pain:
- Non-specific back pain – exact cause is not known but assumed to be spasms, tears, and inflammation (swelling) of the soft tissues (muscles and ligaments) around the spine. This type of back pain usually lasts for less than 6 weeks and does not cause serious complications. It is by far the most common cause of back pain, accounting for 90% + of all cases of back pain.
- Sciatica – back pain that includes signs of nerve pressure. When the nerves that run from the spine to the legs are squeezed or pinched, weakness, numbness, tingling and leg pain can result. The most common cause of this is a “slipped disc” (soft disc between bones of the spine slips out of position and presses on nerve), which can lead to permanent nerve damage (causing weakness or even paralysis) if untreated.
- Arthritis – arthritis can affect any joint in the body and the joints in the spine are one example.
- Secondary back pain – back pain that does not arise in the spine primarily. The most common types are tumours (cancers spread from elsewhere) and infections (also spread from elsewhere).
- Injury – there are many types of spinal injury but falls and car accidents are the most common causes of spinal injury.
Of these, the first is by far the most common, the second important to look out for since it may sometimes require surgery, and the third almost inevitable as we age. The fourth and fifth are often severe and sudden in onset, and the primary cause is usually apparent or easily discovered.
Most cases of (nonspecific) back pain are best treated with:
- Heat – use of hot water bottles, microwave bags etc. does help.
- Pain medication including paracetamol, anti-inflammatories and stronger opioid medications like codeine can be helpful, but the stronger medications should only be used if and as prescribed (risk of dependency and addiction).
- Massage – simple home-massage or professional physiotherapy both help.
- Exercises do help, even in the early stages of back pain, but should be done under the supervision of an expert such as a Physiotherapist or Biokineticist.
Some special points to note:
- Surgery may be necessary if there is evidence of nerve pressure (pinched nerves, slipped disc: signs include leg weakness, numbness and tingling).
- Bed rest often makes things worse by causing stiffness and is rarely indicated except in severe cases and even then, only for an initial period of 2-3 days maximum. The days of recommending prolonged periods of bed rest are largely gone.
- Psychological support and counselling can be helpful in those with chronic (ongoing) pain.
- Cold treatment has not been shown to be effective.
- Ultrasound has not been shown to be effective.
- There is conflicting research regarding manipulation (chiropractic), acupuncture, nerve stimulation, and laser therapy, making these treatments difficult to recommend.
Here are some simple things you can do to avoid back pain:
- Stay slim: being overweight puts real strain on your lower spine and causes a lot of back pain problems.
- Be Active: an active lifestyle maintains muscle tone and strength and this really helps to support a healthy spine.
- Sit up straight: good upright posture, especially when sitting at a desk, helps to avoid back pain. It really is as simple as sitting up straight, for most of us.
- Stand up: there is clear evidence that prolonged sitting can cause back pain. Try to stand whenever you can and be sure to take short mini-breaks (every 30 minutes ideally, at least every hour) from the desk or TV couch.
Lifting – poor lifting technique is a major cause of lower back pain. In simple terms it is essential that you lift with your legs bent and your back straight rather than bending over and doing the lifting with your back. It’s also important to be realistic and to simply avoid lifting very heavy things – countless back injuries result from travellers who fail to pack light and then attempt to lift 20kg + suitcases
Most cases of back pain recover quite quickly with or without treatment, so a fairly simple treatment approach is often best. That said, warning signs (extreme pain, sudden onset, fever and any leg weakness, numbness, or tingling) should be taken seriously and a doctor consulted immediately.
Written by Dr Colin Burns
