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Acute back painBack pain

Back Pain is very common and causes a great deal of misery but, fortunately, serious or permanent damage is rare. There has been a revolution in thinking about back care and we now deal with it actively, using the best and most up-to-date evidence.

This Cripps Health Centre site sets out the facts and tells you what we know about how to get better as quickly as possible.

Causes of back pain

Your spine is one of the strongest parts of your body. It is made of solid bony blocks joined by discs to give it strength and flexibility.

It is reinforced by strong ligaments and surrounded by large and powerful muscles that protect it. Most simple back strains do not cause any lasting damage.

Back pain is most commonly mechanical back pain, which is pain originating from muscles, ligaments and small facet joints when they are strained. This can follow injury, poor posture or inactivity.

Although uncommon, back pain can be caused by more serious conditions and you should seek urgent help from your doctor if you have any of the following: -

  • Lower limb weakness
  • Difficulty passing or controlling urine
  • Numbness around your back passage or genitals

You should also consult a medical professional if you are aged < 20 or >55, or have: -

  • Unremitting pain
  • Weight loss
  • Temperature symptoms / fever
  • Systemic illness
  • Weakness or numbness in the legs
  • New bladder or bowel symptoms
  • Thoracic (upper back) pain
  • Osteoporosis
  • Long-term corticosteroid prescriptions
  • HIV

Back facts

  • Most back pain is not due to any serious disease
  • The acute pain usually improves within days or a few weeks and the long term outlook is good
  • What you do in the early stages is very important. Rest for more than a day or two does not help and may actually prolong pain and disability
  • Your back is designed for movement: it needs movement – a lot of movement.
  • The sooner you get moving and doing your ordinary activities as normally as possible, the sooner you will feel better
  • Sometimes aches and pains can last for a long time, but that doesn’t mean it’s serious.
  • It does usually settle eventually – even though it is frustrating that no one can predict exactly when. Most people can get going quite quickly even when they still have some pain. 
  • The people who cope best with back pain are those who stay active and get on with life despite the pain

Mechanical Back Pain

Despite what you may have heard only a few people with back pain have a slipped disc or a trapped nerve. Even when they do it will usually heal by itself. Very few back problems ever need surgery.

X-rays and MRI scans can detect serious spinal injuries, but they don’t usually help in ordinary back pain. They may even be misleading. Doctors sometimes mention ‘degeneration’ which sounds frightening, but it is not damage or arthritis. These are the normal changes with age, just like grey hair.

Most back pain comes from the working parts of your back – the muscles, ligaments and small joints. Your back is simply not moving and working as it should. You can think of it as being ‘out of condition’. What it needs is to get moving and working properly again which stimulates its natural ability to recover.

Good posture

  • Good posture when sitting, standing and lifting reduces painful stresses on the back.
  • If we take the stress on your lower back when standing to be 100%, it’s about 140% when sitting and can be up to 185% if sitting in a poor posture.
  • When you are slouched in your car or slumped at your desk the supporting ligaments running down your spine stretch and ‘creep’ so that when you stand up, twist or lift the very ligaments designed to support you spine can no longer give their support. Instead all the forces act on your spine, its small joints and the intervertebral discs.
  • The simple movement did not cause the strain – the lax ligaments caused it from the poor posture that went before.

Dealing with an attack of Mechanical Back Pain

Most people manage to deal with most attacks by themselves. What you do depends on how bad your back feels. However, because there’s no serious damage, you can usually: -

  • Use something to help control the pain
  • Modify your activities for a time, if necessary
  • Stay active and get on with your life
  • These principles apply to persistent pain as well as shorter spells

Control of Pain

Do not be afraid of simple painkillers. You should not hesitate to use them if you need them. You can safely reduce the pain in order to get and stay active. As we have seen, you are far more likely to do yourself harm by being in pain and unable to move than by taking a simple and safe easily-available painkiller to help reduce pain, help your muscles to relax and thereby get a better blood circulation and enable you to move more freely.

  • Paracetamol – adult dose is 2 x 500mg tablets four times a day (tip – take it regularly, its more effective that way and far more comfortable)
  • Ibuprofen – adult dose is 2 x 200mg three times a day

So long as you have no medical reason to avoid it, ibuprofen is both a painkiller and an anti-inflammatory and works especially well if taken with paracetamol. You may like to alternate one with the other throughout the day so as to avoid breath-through pain, perhaps take both together at night for a better night’s sleep.

Do not take ibuprofen or aspirin if you are pregnant, have indigestion or an ulcer, or are someone with asthma who has found these tablets make it worse.

'First Aid’ treatment for Back Pain

  • Lie flat on your front on your bed 
  • Take 5-10 minutes to relax the muscles in your neck, shoulders and back 
  • Gently bring yourself up on to your elbows, feeling your back bend backwards 
  • Maintain this position as a gentle stretch for 30 seconds, and lie back down 
  • Repeat this exercise several times 
  • If you are able, and as your pain improves, try this stretch by raising your upper body by taking your weight on your hands and looking up at the ceiling

Manipulation

Most doctors agree that manipulation by a qualified professional can help back pain. Osteopaths, chiropractors, a few physiotherapists and specially trained doctors can offer this. There are risks but they are small and the procedures are safe in good hands. You should feel benefit after a few sessions and it is not a good idea to have treatment for months on end.

Acupuncture and Alternative Treatments

Many treatments such as acupuncture, electrotherapy machines and alternative medicines are used for back pain and some people feel that they help. Being realistic, whilst these may help discomfort in the short term it is far more important that you get active, start some regular exercise and look at improving your posture long term. 

Dr Tim Baker

University of Nottingham Health Servic

Don't Rest

Rest for more than a few days means: -

  • You get stiff
  • Your muscles weaken
  • You lose physical fitness
  • You feel depressed
  • The pain feels worse
  • It is harder and harder to get going again

Activity

Regular physical activity

  • Develops your muscles
  • Keeps you supple
  • Gives you stronger bones
  • Makes you fit
  • Makes you feel good
  • Releases natural chemicals the reduce pain

Preventing Back Pain

To avoid back pain you must reduce excess stresses and strains on your back, and ensure your back is strong and supple.

The following advice also applies to those with persistent, recurring bouts of back pain: 

  • lose any excess weight,
  • do strengthening exercises to improve your back and stomach muscles,
  • improve your body posture,
  • practise the Alexander technique
  • sleep on a bed with a firm, comfortable mattress,
  • sit in chairs that support the spine, with your feet flat on the floor or on a foot rest,
  • correct lifting and handling,
  • avoid sudden movements or muscle strain,
  • when driving, have a seat that supports the back and neck,
  • try and reduce your stress, anxiety and tension,and
  • take regular exercise

Exercises like walking, swimming, yoga and stretching movements are especially good for those with back pain.

Back pain in secondary school age children has been linked to heavy schoolbags and backpacks as well as ill-fitting classroom seating. Nearly half of all teenagers in the UK have experienced occasional backache from carrying overloaded bags, poor posture and an unhealthy lifestyle.

Take care when carrying shopping bags, luggage, backpacks or any heavy loads. Try to distribute the weight evenly on both sides of your body and carry any heavy items close to your waist with the heaviest end nearest to you and look straight ahead.

When lifting, let your legs take the strain - bend your back, knees and hips slightly but don’t stoop or squat. Tighten your stomach muscles to pull your pelvis in. Don’t straighten your legs before lifting as you may strain your back on the way up.

Stand firm your feet should be apart with one leg slightly in front to hold your balance. Try not to lean to the side or twist your body. If you need to change direction then let your feet do the work.

Where to find out more