5 POINTS ABOUT BACK PAIN

Back pain is a very common complaint.

Back pain is a common reason for absence from work and doctor visits. Although back pain may be painful and uncomfortable, it is not usually serious.

Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years.

1. Causes of back pain

The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones - the segments of our spine are cushioned with cartilage-like pads called disks. Problems with any of these components can lead to back pain.

Strain - the most common causes of back pain are:

 Strained muscles

 Strained ligaments

 A muscle spasm

Structural problems - structural problems may also result in back pain:

 Ruptured disks - each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.

 Bulging disks - in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.

 Sciatica - a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.

 Arthritis - patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases, spinal stenosis can develop, which is the term used to describe when the space around the spinal cord narrows.

 Abnormal curvature of the spine - if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis, a condition in which the spine curves to the side.

 Osteoporosis - bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.

Other causes of back pain:

 Cauda equina syndrome - the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia and thigh. There are sometimes bowel and bladder function disturbances.

 Cancer of the spine - a tumour located on the spine may press against a nerve, resulting in back pain.

 Infection of the spine - if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.

 Other infections - pelvic inflammatory disease (females), bladder, or kidney infections may also lead to back pain.

 Sleep disorders - individuals with sleep disorders are more likely to experience back pain, compared to others.

 Shingles - an infection that can affect the nerves may lead to back pain, depending on the nerves affected.

 Bad mattress - if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing back pain.

 Everyday activities or poor posture.

Back pain can also be the result of some everyday activity or poor posture.

• Bending awkwardly

• Pushing something

• Pulling something

• Carrying something

• Lifting something

• Standing for long periods

• Bending down for long periods

• Twisting

• Coughing

• Sneezing

• Muscle tension

• Over-stretching

• Straining the neck forward, such as when driving or using a computer

• Long driving sessions without a break, even when not hunched.

The following factors are linked to a higher risk of developing low back pain:

 A mentally stressful job

 Pregnancy - pregnant women are much more likely to get back pain

 A sedentary lifestyle

 Age - older adults are more susceptible than young adults or children

 Anxiety

 Depression

 Gender - back pain is more common among females than males

 Obesity and overweight

 Smoking

 Strenuous physical exercise (especially if not done properly)

 Strenuous physical work.

2. Signs and symptoms

If any of the following signs or symptoms accompanies a back pain, please see your doctor:

 Weight loss

 Elevated body temperature (fever)

 Inflammation (swelling) on the back

 Persistent back pain - lying down or resting does not help

 Pain down the legs

 Pain reaches below the knees

 A recent injury, blow or trauma to your back

 Urinary incontinence - you pee unintentionally (even small amounts)

 Difficulty urinating - passing urine is hard

 Faecal incontinence - you lose your bowel control (you poo unintentionally)

 Numbness around the genitals

 Numbness around the anus

 Numbness around the buttocks

The following groups of people should seek medical advice if they experience back pain:

 People aged less than 20 and more than 55 years

 Patients who have been taking steroids for a few months

 Drug abusers

 Patients with cancer

 Patients who have had cancer

 Patients with depressed immune systems

3. Diagnosis

Diagnosing back pain requires a detailed history taking & physical examination.

Some further evaluation may include any or a combination of the following;

• X-rays can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.

• MRI or CT scans - these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.

• Bone scan - a bone scan may be used for detecting bone tumours or compression fractures caused by brittle bones (osteoporosis).

• Electromyography or EMG - the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis (narrowing of the spinal canal).

• The doctor may also order a blood test if infection is suspected.

4. Treatments

In the vast majority of cases back pain resolves itself without medical help - just with careful attention and home treatment.

Pain can usually be addressed with over-the-counter (OTC) painkillers. Applying a hot compress or an ice pack to the painful area may also relieve pain.

Resting is helpful, but should not usually last more than 2 - 3 days. Too much rest may actually be counterproductive by allowing muscles to weaken, which can lead to further episodes of back pain in the future.

Usually back pain is categorized into two types:

 Acute - back pain comes on suddenly and persists for a maximum of three months.

 Chronic - the pain gradually develops over a longer period, lasts for over three months, and causes long-term problems.

A considerable percentage of patients with back pain experience both occasional bouts of more intense pain as well as more-or-less continuous mild back pain.

If home treatments do not give the desired results, your doctor may recommend the following:

 Medication

 Physical therapy

 Cortisone injections

 CBT (cognitive behavioural therapy)

 Surgery - surgery for back pain is very rare.

5. Preventing back pain

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

Exercise - regular exercise helps build strength as well as keeping your body weight down. Before starting any exercise program, talk to a health care professional.

There are two main types of exercise that you can do to reduce the risk of back pain:

 Core-strengthening exercises- exercises that work the abdominal and back muscles, helping to strengthen muscles that protect the back.

 Flexibility - exercises aimed at improving flexibility in your core, including your spine, hips, and upper legs, may help too.

Smoking - a significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height and weight.

Body weight - the amount of weight people carry, as well as where they carry it, affects the risk of developing back pain.

Posture when standing - make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet - keep your legs straight and your head in line with your spine.

Posture when sitting - a good seat should have good back support, arm rests and a swivel base (for working). When sitting try to keep your knees and hips level and keep your feet flat on the floor - if you can't, use a footstool. You should ideally be able to sit upright with support in the small of your back. If you are using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.

Lifting things - the secret for protecting your back when lifting things is to think "legs not back". In other words, use your legs to do the lifting, more than your back.

Keep your back as straight as you can, keeping your feet apart with one leg slightly forward so you can maintain balance. Bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible.

Bending your back initially is unavoidable, but when you bend your back try not to stoop or squat, and be sure to tighten your stomach muscles so that your pelvis is pulled in. Most important, do not straighten your legs before lifting; otherwise you will be using your back for most of the work.

Do not lift and twist at the same time. If something is particularly heavy, see if you can lift it with someone else. While you are lifting keep looking straight ahead, not up nor down, so that the back of your neck is like a continuous straight line from your spine.

Moving things - remember that it is better for your back to push things across the floor, using your leg strength, rather than pulling them.

Shoes - flat shoes place less of a strain on the back.

Driving - it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks - get out of the car and walk around.

Your bed - you should have a mattress that keeps your spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle.

REFERENCE

http://www.medicalnewstoday.com/articles/172943.php

Duke University, NHS, National Institutes of Health, Mayo Clinic, CDC, Spine Health, Medical News Today archives.

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