Back pain is a frequent complaint of everyday modern life––yet, by in large, tackling back pain on a long-term basis is still a topic we could all be far educated in. Live to 100 has gone to Bakpro to find out more about what can be done.
What are some of the most common causes of back pain?
Believe it or not lifting heavy loads is not the most common cause of back pain or injury, though it is a source in some cases. Most people can size up the weight of something as they approach lifting it and subconsciously prepare for the strain. Lifting while reaching forward is definitely a no-no, for example leaning into the boot of a car or twisting while lifting. Repetitive bending and twisting without bracing or supporting yourself are also a common cause of sudden back strain. Occasionally, such loading can cause damage to a disc in your back that bulges like a car tyre and causes extreme pain. If the bulge is large enough it can press on a nerve and cause pain into the leg as sciatica.
By far the most common cause is sitting for prolonged periods, worse still with poor posture and a bad chair and workstation. Long distance driving can also be a culprit, particularly if then getting out and lifting. Sitting causes the discs in the spine to bulge placing a strain on the back of the disc. Over time this can cause weaknesses to develop in them.
This is made worse by 'weekend warrior' unaccustomed exercise which suddenly loads the back e.g. golf, tennis and gardening. Repetitive one-sided activities are also harmful as they cause uneven loading to the spine and adverse patterns of muscle activity to develop. Mums with young children are a good example, as they carry them on their hips as well as bend and twist into cots and buggies.
Emotional stress and stress in the workplace can also cause muscle tension which develops into neck and back pain.
Are there various types of back pain ache and if so what are they?
There are several different types of back pain, most of which are mechanical in nature i.e. they are due to one of the structures in the spine being strained or overused. Most of them will pass eventually with rest and treatment. Deep constant aching is more consistent with inflammatory pain from a joint or disc and tends to feel hot and throbbing. Sharp stabs of pain usually indicate muscle spasm or nerve involvement. Lying down and taking the load off the spine will relieve most mechanical back pain. There are a few conditions which are not of spinal origin but which present with pain in the back (referred pain) e.g. kidney stones, gall bladder stones, ectopic pregnancy, ovarian cysts to name few. The thing to remember is that these causes of back pain usually make you feel unwell in other ways and are not made worse or better by movement of the spine.
If I suffer from a sudden backache at home (without having experienced any such feeling previously), what steps should I take to tackle it?
First, try not to panic! Pain is designed to frighten you and will make you afraid. Most back pain will pass, and although it is painful, it will not harm you. Try to take deep breaths and relax; this will help diffuse any muscle spasm. Where possible, lie down on the floor with your knees up and continue to breathe long and slow through your nose will help with tackling back pain. Try applying ice packs to the affected area and if necessary take an anti-inflammatory (such as Ibuprofen) if it persists. Do not retire to bed as evidence shows that this causes the spine to stiffen and lock. Keeping moving or getting up every half hour is optimum.
What symptoms of back pain would require an immediate hospital visit?
Very few cases of back pain require hospitalisation. One exception is a bad disc herniation, usually in the low back, which is either pressing on the nerve to your leg so badly that it causes weakness in a set of muscles (foot drop, dragging foot). Or even more rarely (less than one percent), if you experience loss of sensation around the genitalia or anus or loss of bowel or urinary control. Only in these cases is urgent A+E attendance necessary.
Which routine exams or tests would a doctor administer to identify the cause of my back problems?
Most of the time doctors will not carry out any imaging of the spine unless there is a history of trauma or any element of the history which would make them concerned that there is another possible underlying cause for the pain which requires urgent attention (e.g. infection or tumour) Doctors should examine you to ascertain which structures are involved...Most commonly they will examine ranges of movement and carry out basic nerve tests and reflexes.
Occasionally, the doctor will refer you for an X-ray or an MRI scan, better to evaluate your injury particularly if it is not resolving.
There is a degree of contention to whether a person with recurring back problems should exercise regularly or not. Is it best to rest your back or is it recommended to stay active?
It is always best to keep moving where possible but remains within the limits of pain. Exercise is different to mobilising gradually. If small movements are possible then use these. Slowly the ranges will get bigger. Keep pushing the size of the movements in small increments. Pace yourself and learn the limits of how much exercise/movement is possible before fatigue or aggravation of symptoms sets in. Use your breathing to relax muscles as you move them and stretch them.
Use painkillers (Paracetamol, Ibuprofen) to block pain to allow you to feel freer to exercise. In most cases as the movement returns you will need less medication. It is a fallacy that medication simply blocks pain so that you injure yourself further. When used wisely they aid recovery.
Use gentle stretching to release shortened stiff muscles.
Ultimately stretching and core muscle strengthening is always the key to tackling back pain.
What is a slipped disc?
A 'slipped disc' is a layman's term for an injury to one of the cartilage discs in your spine. It is technically known as a herniated or prolapsed disc.
Your spine is made up of 33 spinal segments. Each of the bony vertebrae has between them a rubbery disc, which is rather like chocolate with a soft centre. The 'chocolate' is made of rings of cartilage, laid down like the steel wires in a car tyre. The soft centre has the consistency of toothpaste.
As we get older and depending on what we do with our backs the discs (which are sixty percent water) dry out and form very small cracks. This allows the 'chocolate' to slump and bulge. Sitting jobs particularly encourage this, as they place greater pressure on the back of the disc over time.
Eventually, the bulge in the disc can give way (herniation), and in the worst cases the soft centre can leak out onto a nerve (prolapse). This is commonly associated with bad pain down the back of the leg(sciatica).
What is repetitive strain injury (RSI) and how can it be prevented?
A condition in which the prolonged performance of repetitive actions, typically with the hands, causes pain or impairment of function in the tendons and muscles involved.
It is also known as work-related upper limb disorder or non-specific upper limb pain.
The condition mostly affects parts of the upper body, such as the:
Forearms and elbows
Wrists and hands
Neck and shoulders
Technically activities which recurrently use the back such as lifting or rotating, particularly in an unchanging fashion can cause similar symptoms in the spine.
It is often a complex condition to treat, as it also involves the relationship between the muscles and the central nervous system which establishes a pain pathway. There is often very little to be seen on x-rays or MRI despite it being a debilitating condition.
The Bakpro programme contains all the exercises and advice you need to help prevent such conditions from developing.
Do relaxation exercises have an effect on back pain if so are there any you can recommend?
Absolutely. The 'vicious cycle' which can develop between pain, tension and stress are one of the maintaining factors in all back pain. Using breathing exercises with or without mindfulness can be hugely beneficial to release internal tension in the muscles. This tension is also what can reduce the effectiveness of stretching exercises which should also always be part of your recovery. They are also very effective in reducing spikes of pain which can set off a 'fear' response and make us anxious. Finding time in the day to carry out formal breathing exercises is vital and can be done almost anywhere.
The Bakpro programme contains a full explanation of how to carry out diaphragm breathing and how to spot when you are breathing badly. Usually sighing, yawning and breath holding are signs of poor breathing.
What are the varying types of treatment and how do they differ in their effectiveness?
The best way to treat back pain is to stop it developing in the first place. Set in place the various things you need at home or in the workplace which will prevent its onset.
Lifestyle changes are key, basically;
Do core exercises regularly
Breathe well always
Keep your weight down
If back or neck pain does develop and lasts for more than two weeks, despite your best efforts- get help!
Don't let it get established. Follow a guided programme and include advice from a physical therapist (physio, osteopath chiropractor). Good therapy should involve manual techniques to release painful tissues, home exercises to stretch contracted muscles and core exercises to strengthen weak abdominal muscles.
Eighty to ninety percent of back pain can be treated conservatively.
A very few need unique pain relieving injections to help the process along, and almost no one should need surgery.
Surgery is usually carried out either to fuse vertebrae together or to decompress pressure on nerves causing terrible pain. It is always a last resort!
The Bakpro programme has been specially devised and designed, containing elements of education, as well as pain relief, self-mobilisation, breathing and sleep hygiene. Back Pain in the U.K. costs £5 billion annually and causes suffering to so many. Bakpro offers a one-stop-shop answer to a difficult and complex problem