A B C D E F G H I J K L M N O P R S T U V W

BACKPAIN / STRAIN

What is Back Pain ?

This is pain occurring in the lower part of the spine (the lumbar spine). Each vertebra in the spine is connected to the one above and below by an intervertebral disc (made of tough gristle-like tissue containing a soft shock-absorbing centre). In front, the vertebrae are also connected by small joints on each side, and behind by strong ligaments and spinal muscles. The vertebrae create a flexible bony tunnel through which the spinal nerves run from the spinal cord to the legs. A variety of conditions may affect any of these structures and give rise to pain in the back.

How does Back Pain occur ?

Symptoms may occur at any age and may be triggered either by minor or major injuries. Pain may occur after lifting heavy weights (such as heavy luggage) or sudden bending or twisting movements. It may also occur after sitting for long periods (in a car or airline seat) or lying awkwardly. This is more likely to be a problem if the seat is poorly designed or if there is an underlying disorder of the spine. The pain itself may arise by a number of mechanisms. Tearing of muscles and ligaments releases chemicals which may irritate the nerves and cause pain. With increasing age, the discs between the vertebrae wear out, losing their shock absorbing qualities, and develop splits. These allow the in-growth of pain-sensitive nerve fibres. The splits also may allow ordinary and everyday movements to cause the disc to rupture or tear. Part of its previous soft centre will then leak out. This may cause sudden back pain. If the soft centre presses directly on one of the spinal nerves, pain may be felt in the buttocks and down the back of the leg (sciatica). With ageing the small joints between each vertebra develop arthritis and become less mobile. These joints may develop swelling and damage to their ligaments, which lead to back pain. This is made particularly bad by sitting for long periods.

Why does Back Pain occur ?

Back pain is common. Unaccustomed physical activity may lead to aches and pains following the exercise. Twisting movements may damage the discs or cause inflammation and swelling of the small joints leading to pain. Bad posture or seating may cause pain by creating abnormal pressure on discs and spinal joints. There are several other conditions that make it more likely to develop back pain. After the menopause, women may develop osteoporosis, where the amount of bone decreases. This can lead to crush fractures of the lumbar vertebrae and low back pain. Osteoporosis may also occur in both sexes due other medical conditions which affect bone. It can also result from certain medications, especially anti-inflammatory steroids. Some athletic adolescents have a weakness in the structure of the lowest vertebra of the lumbar spine. In its mildest form, this appears on X-ray as a small gap in the bone (called spondylolysis). In its more severe forms the vertebra (usually the lowest lumbar) slides forwards on the one below (usually the sacrum). This is called spondylolisthesis. The symptoms caused by this vary with the amount of slippage but may include leg pain and leg weakness. Some patients have a certain gene in one of their their chromosomes (HLA-B27) which makes them more likely to develop a condition called ankylosing spondylitis. This causes a progressive hardening of the ligaments leading to back pain and stiffness. Being overweight places an added strain on the spine. This makes the development and persistence of various types of back pain more likely.

Treatment Involved for Back Pain

Most attacks of acute back pain get better in 2 to 4 weeks. The pain can be helped by simple painkillers and anti-inflammatory tablets (such as ibuprofen) available from your chemist (but make sure that you read the precautions contained in the packet). It is best to keep mobile if possible. Avoid sitting in low seats or for prolonged periods. If the pain fails to settle, it may be necessary to visit your doctor, who may prescribe stronger painkillers or anti-inflammatory drugs. In some cases a muscle relaxant drug may also help. The doctor may recommend a course of physiotherapy. Very occasionally, a period of rest in bed may be helpful. It may be worth visiting a physiotherapist, osteopath or chiropractor before visiting the doctor. They are well qualified to assess and treat the condition and will make an appropriate referral if it is required. You will only need referral to an orthopaedic surgeon if the pain fails to settle after treatment, or if the attacks become increasingly frequent. Once the attack of back pain has settled, it is important to make efforts to try to prevent further attacks. This will involve losing weight, if appropriate, and getting advice from the physiotherapist about sensible exercises to improve back strength and posture. It is also sensible to take advice on seating at home and work, the positioning of work equipment, such as VDUs and keyboards and also the quality of your bed. Techniques such as the Alexander technique, massage and acupuncture may help but it is often a matter of trying various approaches until you find one that suits you.

During Treatment for Back Pain

Most attacks of acute back pain settle within a 2 to 4 week period. Stiffness in the back, however may well take longer to resolve and may last for up to 6 weeks. Taking some painkillers may lead to constipation and you should make sure your diet contains cereals, vegetables and fresh fruit. Anti-inflammatory tablets may cause indigestion and if this happens you should stop taking them and contact your doctor. The pain, either before or during treatment, may become severe and go down the leg into the foot. Especially if it is accompanied by numbness, tingling or weakness in the leg or foot, pressure on one or more of the spinal nerves is the likely explanation. Although this is usually due to a prolapsed (slipped) intervertebral disc, it may be caused by other conditions. It is therefore important that you contact the doctor should these additional symptoms develop. Furthermore, if you develop pain down both legs, have difficulty in passing water or with bowel movements, or develop loss of feeling in the buttocks you should seek medical help urgently.

After Treatment for Back Pain

Back pain often recurs. If the attacks can be quickly controlled with painkillers, anti-inflammatory drugs and physiotherapy, then referral is not necessary. If attacks increase in frequency and/or severity, and do not settle with simple treatment, then referral to a specialist may be required.

If Back Pain is Left Untreated

Most attacks of back pain eventually get better. Medicines, physiotherapy and other treatments simply shorten the length of the attacks. Urgent treatment is only required for attacks of sciatica which have the additional symptoms of numbness or weakness in the legs, numbness in the buttocks or difficulty in passing urine.

Effects on Family of Back Pain

Acute back pain is often very disabling and the sufferer may need help in carrying out the normal activities in daily living. If bed rest is prescribed the provision of a urine bottle, bed pan or commode may help avoid the discomfort of walking to the bathroom. People in contact with a chronic back pain sufferer need to be understanding:: chronic back pain is a major cause of irritability and depression.