Back Pain

The Spine:

Your spine consists of vertebrae which are bones that sit on top of each other with shock absorbers, discs in-between. If you stand sideways they make a long winding “S” with the most pressure going through the lowest curve which is the lumbar region. The spinal chord runs through the centre with all the nerves branching out. You can think of it as a telecommunications network with thousands of wires connecting the brain to all the senses sending and receiving information, and co-ordinating movement. The shock absorbers or discs are held in place by flexible ligaments and your muscles are attached by tendons to the column.

Back pain is one of the main causes of visits to the doctor, and it is one of the main contributors to being absent from work. At some point in your life it is very likely that you will suffer from back pain of one kind or another, the most common of which is muscle strain or ligament strain.

These injuries can occur for many reasons; not lifting correctly, carrying excessive body weight and having poor posture are unquestionably contributing factors.

Strains and Sprains:

This is the most common cause of back pain and is often referred to as “Simple back pain” and when you are suffering from it there is nothing “simple” about it! It can vary in intensity from a dull, constant ache to a sudden, sharp pain that leaves you quite debilitated. This knotting up or spasm of the muscle is the body’s’ way of preventing further damage to the muscle. It can happen at any time and for many reasons:-

Fortunately this kind of injury will usually resolve within a week to 10 days. Once the pain has subsided gentle rehabilitation is suggested without immediately returning to the action which initially prompted the injury. Keeping mobile is important and standing or sitting for more than 30 minutes at a time should be avoided. Frequent breaks from sitting at a desk, even if only for a few minutes will prevent muscles from becoming knotted.

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Getting out of bed:

Now that sounds easier than it is when you are suffering from a bad back! When you go to sleep try to use one pillow and not to sleep on your stomach, try sleeping on your side with your knees slightly bent. If you need to sleep on your back try placing a pillow underneath your knees as it takes the pressure off of the spine.

Ageing really is primarily a matter for the mind we are as young as we feel, unfortunately sometimes our bodies begin to feel older than we do. The spine ages, and the shock absorbing discs that once were so soft and spongy have become dryer and fibrosed; they are not able to take the same levels of activities. This disc degeneration is normal it happens gradually and at a different rate with all of us.

First signs may be stiffness and difficulty with bending or twisting. This leads onto discomfort when remaining in the same position for any great length of time; that is then accompanied by low back pain and difficulty getting in and out of chairs.

This is due to the decreasing amount of calcium in the bones as you age which leaves them more brittle and porous than when you were younger. This is referred to as your bone mass or bone density and having a low bone density means that the bones are more susceptible to fracturing or crumbling and one of the prime victims of this disease are the vertebrae in your spine.

This condition seems to affect far more women than men, but it does affect men. Our bone health is a matter of genetics, which we inherited from our parents and research has shown that if our parents suffered from osteoporosis then it follows it is likely that we will too.
Bone health can be improved by a variety of measures:

Having a good healthy diet rich in calcium- that means less red meat, less salt, reduce carbonated drinks, and not drinking too much caffeine.
It is advisable to consume approximately 1000 - 1200mg of calcium daily.
Dairy foods are the best dietary sources of calcium milk, yogurt, cheeses, greens, broccoli, sardines, and salmon in cans with edible bones, dried beans, peas, and tofu, calcium-fortified orange juice. Eating foods rich in vitamin D helps with the absorption of the calcium.
If you are taking iron supplements, try to take it at a different time to when you are taking the calcium as they tend to hinder each others absorption.
Get active, join a group and go walking, take up swimming, golfing, badminton, anything that will improve you body’s overall strength. Having a strong support of body muscle will help reduce the risk of fractures.

Back pain is not only related to injury it can be part of a disease process or as a result of a problem elsewhere. Some back problems are resolved when the initial problem has been treated. Gynaecological problems in women for instance, who may be suffering from pelvic inflammatory disease or endometriosis which can cause low back pain.
Kidney stones or kidney infections can also cause back pain, fortunately once the stones or infection or conditions are resolved the back pain goes.

Rarer conditions such as congenital (something you are born with) spinal defects, bone diseases or a cancer that may have spread to the spine calls for management treatment of the pain.

This is a long term condition which affects the whole body not just the spine, the term means pain in the fibrous tissues, and the pain and burning feeling emanates from the muscles tendons and ligaments.

The condition makes people ache all over and the back is totally involved from neck to hips, with aching shoulders painful neck and lower back pain, the unrelenting nature of this pain can make the condition extremely debilitating.

This condition is often confused with sciatica as it invariably causes similar symptoms such as the tingling, numbness and the pain travelling down the back of the leg. The piriformis is a muscle which runs from the bottom of you spine, the sacrum, to the outer hip bone. When it becomes damaged it can cause low back pain and sciatic like pains down the affected leg. Massage and stretching exercises can improve the condition under the guidance of a physiotherapist

This nerve condition is known as CES and is primarily considered a surgical emergency, the only one of all the back conditions other than trauma injury. It may be caused by trauma, a car crash, a fall from a great height, impact or penetrating injury.
Symptoms can include:

Surgical intervention will be necessary to relieve the pressure on the nerve bundle to re-establish sensation and movement. This is not always achievable leaving the sufferer with a form of spinal injury; nerves which supply the bladder and the bowels are particularly susceptible and may lead to impaired continence control. This condition may also develop progressively from a long term illness such as Multiple Sclerosis.

Isthmic Spondylolisthesis:

This is where one vertebra has a fracture or crack in it; it then slip over another pinching the nerve .This condition causes low back pain with symptoms which may include;

Surgical intervention is not the usual course of treatment, a carefully planned exercise regime and pain relief therapy is the initial course of action and is for the majority of patients successful, only a small proportion will require surgery to stabilise the spine.

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Wear and Tear:

Osteoarthritis:

It is sometimes called degenerative joint disease; it is one of the commonest of all the 100 different types of Arthritis. It affects the cartilage which covers the ends of bones at the joints. Cartilage is a firm smooth tissue that protects the bones and that usually slide smoothly over each other. With osteoarthritis this tissue has been eroded and worn away consequently the ends of the bones begin to rub causing worn areas and bony spurs, swelling and pain, the joint becomes stiff and difficult to move.

The disks we have in our spine are the shock absorbers or cushions between the bones of the spine and allow a full range of movement. As we grow older these disks can become flattened and less bouncy and sometimes a tear can occur through which the disk herniates which means it bulges out. This in turn affects the nerves and causes pressure and pinching. The sciatic nerve is the one most often affected.

This herniation of a disk usually occurs in the lumbar spine between the bottom of your ribs and your hips, and the age group affected is from about thirty years onwards. It can occur in your neck as well affecting your chest, arms and shoulders.
Recovery may take from several weeks to a few months depending on the severity of the herniation. Pain relief and progressive mobilization exercises will be advised by your doctor.

Sciatica:

The large sciatic nerve comes from the lower back region of the spine and travels from the spine through the buttocks and along the back of the legs down to the toes.
Sensations resulting from the compressed or inflamed sciatic nerve might include:

Sciatica is not a diagnosis in itself; it is a symptom of a back problem, and that problem is causing the root of the sciatic nerve to cause pain. Sciatica occurs when the sciatic nerve is pinched, inflamed or irritated and the pain along the sciatic nerve causes other symptoms along the route of this nerve. It is not necessarily a particular event that has produced the problem it can be the result of a progressive condition. It may be due to Isthmic spondylolisthesis, Piriformis syndrome, slipped disk or fractured vertebrae. Treatment of this condition requires a diagnosis of the underlying cause of the pain, as the severity and duration of the pain from sciatica varies. The symptoms vary due to the differing areas of where the sciatic nerve is being compressed.

Symptoms vary and can include:

It tends to affect people between 30 and 50 years of age, and the symptoms for some people can be relentless and debilitating and for others, the pain may be just infrequent and irritating. What ever the variation in the symptoms they usually diminish after a few weeks or months.

In the vast majority of cases symptoms are usually not permanent and improve as the nerve is released from the pressure or inflammation it is suffering from.

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Pregnancy and Back Pain:

Pregnancy and back pain unfortunately seem to go together due to the fact that as your womb and stomach expand you can gain almost a quarter extra of your body weight and your centre of balance becomes offset. This can lead to muscular strain, pain and pressure and is not helped by the fact that a couple of hormones relax the joints in the pelvis. All this typically occurs between the fifth and seventh month of pregnancy, but as in all things it can begin earlier.

There are two common types of back pain in pregnancy:-

Self Care Treatment of Back Pain:

Please note that seeking medical advice prior to commencing heat or ice treatment is advised.

The consensus of opinion seems to be that applying ice or heat; or indeed alternating the two to the affected area for 20 minutes at a time and repeated 2-4 hourly will give relief and help reduce the pain. Frozen bags of peas are often used as they are able to mould to the contours of the back. It is important to note that neither hot packs nor ice packs should be applied directly to the skin they should be wrapped in either a light cloth or towel.

If you do not notice a reduction in pain and inflammation after 72 hours of self-care you should consult your doctor. However if you have suffered a fall, experience any numbness or tingling in your legs, have difficulty with weakness or have problems with urinating you will need to be seen by a doctor.

Medication which you can buy over the counter such as Anti inflammatory pain relief and Paracetamol are usually suitable for simple back pain. The trick is to keep what practitioners call a “pain relief therapeutic level” this means that rather than waiting for the pain to come back with a vengeance; if you take the medication as instructed usually either four hourly or six hourly depending on the medicine the pain relief will be more balanced and you will be able to get moving earlier.
If you are taking any other medication you should always consult with either your own doctor or the pharmacist as to the suitability of the pain relief medication.

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Chronic Pain

Chronic or unceasing, constant back pain is miserable, in the past it has been something that people have had to live with, consequently they used to have a very poor quality of life. The cycle of not being able to exercise or move because of the pain led to less movement then more pain.

Pain is something that can only be measured and felt by the individual, it is different in each of us. In the past long term back pain has sometimes been treated with “well we can’t see any further reason for your pain” therefore it was no longer treated. Today fortunately that is no longer the case, research has provided many more avenues for advancement in providing either partial, or total pain relief which has the potential to offer a greatly improved quality of life.

If you do suffer from chronic back pain and are referred to an NHS pain clinic by your doctor it will probably take about three months until you are able to get an appointment. Sometimes earlier cancellations may be available; you are not able to have an appointment unless you have been referred.

If you have been suffering over a long period of time you may be offered an epidural steroid injection which can be effective in providing relief, however they do not always provide the same sort of relief in all patients and it would need to be discussed with your pain management specialist as to the suitability for your specific pain.

Web: http://www.britishpainsociety.org The British Pain Society

Pain Management Teams:

In May 2003 the Royal College of Anaesthetists and the Pain Society set out a document outlining good practise. A multidisciplinary approach for individual patient care is highlighted with the team approach matching the patients’ needs. It is recognised that acute (of short duration) pain can lead onto long term or chronic pain if it is not treated appropriately.

The multidisciplinary team usually consists of a Consultant Anaesthetist, a Clinical Nurse Specialist, who work in conjunction with Physiotherapists, Occupational therapists, Pharmacists and Clinical Psychologists.

The team will review your condition and the pain you are suffering from and will from a multidisciplinary co-ordinated approach suggest options to you which will fit in with your lifestyle and alleviate your pain.

The Chronic Pain Policy Coalition:

The Chronic Pain Policy Coalition was newly formed in June 2006 and is a forum for patients and professionals.
The coalition believes that all people living with chronic pain in the UK must expect and ask for:

If you wish to become involved or have something you would like to share with the coalition you can contact them through http://www.paincoalition.org.uk

Bed rest V Exercise:

Research has come down on the “keep moving” side of this argument, it is often thought that going to bed for a few days can really help but in fact it causes more trouble. Keeping muscle groups working, even if it is at a very slow pace means that you will recover much faster. Inactivity makes muscles go slack and lying in bed even for a few days can mean a longer recovery period. Regular pain relief medication, gentle movement and with ice or heat packs the symptoms should begin to improve within 72 hours.

Reducing the risks:

Lifestyle can have a huge impact on how your back puts up with the day to day strains we put it under.

Eating a well balanced diet – carrying excess bodyweight as we all know is not healthy not only for our backs but for all our body organs . The impact of carrying excess weight leads onto a host of other problems which are being stored up as trouble in later life.
Taking regular exercise ensures your muscles are strong. It is the New Year’s resolution every year, joining the gym taking more exercise. The trick is not to give up trying, start maybe by going for walks as a family, leaving the car behind on short trips, parking it a little bit further away from work, taking the stairs instead of the lift. You will be worn out and tired for a while but in the long run the benefits will be enormous, you will find you have more energy, sleep more soundly, feel brighter and more alert. Joining clubs like badminton or tennis and exercise classes can improve your social life. Stomach strengthening exercises help with the muscle groups that support the lower back. Gentle regular stretching exercises help keep the spine flexible. Low impact aerobic exercise like walking, cycling and swimming are good exercises for not putting undue pressure on the spine and yet increasing body strength.
Don’t push yourself too hard.
Gently increase the level of exercise.
Make sure to do warm up and stretching exercises before and after your exercise routine

Sleeping in a bed which supports you well - having a sagging mattress means a poor uncomfortable troubled nights sleep, leading to you waking up feeling tired and drained before the day has begun.
Not sitting properly can cause bad posture problems – it is amazing how often we slouch in chairs, twist our legs up on the sofa, sit hunched over the steering wheel of the car. When slouching in chairs is mentioned the majority of people suddenly sit up straight, if that describes you then maybe it is time you looked at your furniture at home and at work, these may be exacerbating your back problem. There are things that you can do to help maybe a lumbar cushion whilst driving or at your desk, is your chair to high too low is your back properly supported? Addressing these issues can go a long way to alleviating your problem.
Lifting correctly – it is so often the thing we do wrong without even thinking about it; it is such a quick decision and the damage is done. Habit is something we form over time and if we get into the habit of bending at the knees rather than the waist and checking the weight of something before attempting to pick it up less back problems will occur. If you feel your back is being put under excess strain because of the type of work you undertake; you can ask your employer to review your working conditions. Correct lifting techniques are often taught in industry and often there are aids or adjustments which can be made that will improve your circumstances.

Physiotherapists:

What do they do?

Physiotherapists’ offer a wide range of help and treatments to patients who are referred to them, who are often in need of assistance with mobility. They identify the problem areas and through planned therapeutic exercise programmes help maximise the potential of the patients. They advise on lifestyle adjustments, health promotion and can recommend professional aids which may be useful to maximise quality of life.

Your physiotherapist will have either of these letters after their name and be registered with the HPC:-

MCSP (Member of the Chartered Society of Physiotherapy)
FCSP (Fellow of the Chartered Society of Physiotherapy)

Health Professions Council (or HPC). - “We are a regulator and our job is to protect the health and wellbeing of people who use the services of the health professionals registered with us”.

You can check your health professional is registered using the link on this site. http://www.hpc-uk.org

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Chiropractors:

What do they do?
They specialise in the diagnosis, treatment and general management of conditions that are due to malfunctioning joints. A large proportion of their work is with back pain but, neck pain, headaches and sports injuries are just a few of the other areas covered.

The profession has a regulatory body and it is illegal for anyone to practise without being registered.
http://www.gcc-uk.org – the General Chiropractic Council if you wish to find a registered practitioner in your area.

Osteopaths:

What do they do?
Osteopaths specialise in the detection and treatment of the muscular framework of the body this includes ligament, nerve and joint damage. Through controlled specialist movements and manipulation the symptoms should improve.
The profession have a register, The General Osteopathic Council (GOsC) and it is illegal to describe oneself as an osteopath if not registered. It is a four year degree or diploma qualification. Your osteopath will have either DO or BSc (Ost) after their name.

You may check if your osteopath is registered here www.osteopathy.org.uk
Most osteopaths are self employed and are not normally employed by the NHS. The hourly rate is approximately £25-£50 per session.

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Massage:

Massage has always been considered relaxing and certain forms can be beneficial for people who are suffering from back pain. The induced muscle relaxation and increase blood supply to the area can have a therapeutic effect. The release of the bodies own endorphins which are naturally occurring pain relievers that we have will aid relaxation of muscle spasm. Therapeutic massage can be a great relief as long as it is not causing pain.

Acupuncture:

Acupuncture is a system of healing which has been practiced in China and other Eastern countries for thousands of years. Medical acupuncture is a more recent development and is based on a medical diagnosis and is performed by doctors.
A number of fine needles are inserted through the skin and left in position for a varying period of time, sometimes with manual or electrical stimulation. Acupuncture stimulates the nerves in skin and muscle layers and can produce different effects, such as the increase in the body's release of natural painkillers, endorphins and serotonin.

Acupuncture is available in most hospital pain clinics and if your local Doctors surgery has a link with an acupuncturist sometimes a course of six treatments can be arranged under the NHS.

Private cost of treatment is approximately £20- £40 per session
The British Medical Acupuncture Society is a nationwide group of family doctors and hospital specialists who practise acupuncture alongside more conventional techniques.


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