Back Pain - Modern Management




Back pain is very common. Most people will have one or more bouts of back pain at some point in their life. Most bouts resolve within a few weeks, and serious or permanent damage is rare.


Understanding the back

Your spine is one of the strongest parts of your body. It is made up of solid bony blocks (called vertebrae) joined by discs of strong rubber-like tissue which allows the spine to be flexible .It is reinforced by strong ligaments, and surrounded by large and powerful muscles that protect it.

Most cases of back pain that develop suddenly are due to ‘simple back pain’ rather than any serious disease. 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 ‘being out of condition’. What you do about back pain yourself is usually more important than the exact diagnosis or treatment.


What are the treatments for simple back pain?

What you do in the early stages is very important. Rest for more than a day or two usually 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. The people who cope best with back pain are those who stay active and get on with life despite the pain.

Even when your back is painful, you can make a start without putting too much stress on it:

  • Walking
  • Swimming
  • Exercise bike
  • Dancing/yoga/keep fit
  • In fact most everyday activities and hobbies - don't stop doing things, just change the way you do them
  • Either stay at work or return to work as soon as possible

Try to avoid staying in one position for too long – particularly sitting and standing. You may need to adjust your chair/desk and computer, and take regular breaks. You should also look at the NHS advice on Computer Ergonomics, as poor posture when using computers is a common source of back and neck pain.

Anxiety and stress can increase the amount of pain we feel. Tension can cause muscle spasm and the muscles themselves can become painful. Many people feel anxious about back pain – but remember that serious damage is rare and that the long-term outlook is good .Do not let fear and worry hold back your recovery.


Pain relief

Regular pain killers may be needed initially to help control the pain and let you get started:

  • Paracetamol is often effective if taken regularly – for an adult this is usually 1000mg ( two 500mg tablets) taken four times a day
  • Ibuprofen ( anti-inflammatory painkillers) can be taken in addition to Paracetamol if necessary, usually in a dose of 400mg taken three times a day. Some people with asthma, stomach ulcers, high blood pressure, kidney failure or heart failure may not be able to take anti-inflammatory painkillers
  • Stronger painkillers such as Codeine  are an option if anti-inflammatories do not suit you. Codeine can be taken in addition to Paracetamol. Codeine may cause constipation which can aggravate back pain if you need to strain to go to the toilet – have plenty of water & fruit in your diet to prevent this

All these pain killers are available from a pharmacy without a prescription.


When do I need to see a doctor?

Most people manage to deal with simple back pain themselves by following the advice in this leaflet. However if you have severe pain that gets worse over several weeks instead of better, or if you are unwell with back pain you should see your doctor.

Your doctor will normally be able to diagnose simple back pain from the description of the pain, and by examining you. In most cases no tests are needed. X-rays or scans of the back are not usually helpful in simple back pain.

Here are a few symptoms, which are all very rare, but if you do have back pain and suddenly develop any of these you should see a doctor straight away:

  • Difficulty passing or controlling urine
  • Numbness around your back passage or genitals
  • Numbness, pins and needles, or weakness in both legs
  • Unsteadiness on your feet

Getting on with your life

People who cope with the pain by being positive, staying active and getting on with life tend to get better faster and have fewer problems in the long run. Regular exercise and staying fit helps your general health and your back.

Source: Adapted from The Back Book - A reliable source of information for people suffering from low back pain [Roland et al, 2002]. It is written by a team consisting of a GP, orthopaedic surgeon, physiotherapist, osteopath, and psychologist and provides comprehensive advice.


Laptop users

Laptop users should purchase a laptop stand (can be purchased for £15 from stationers, computer shops, Argos), so that the keyboard and screen are elevated to a more suitable height and position. If possible attach a separate keyboard and mouse (can be purchased for £10 from computer shops, Argos), so that you are best able to position the keyboard, mouse and screen. Laptop use is a major source of musculo-skeletal problems, and using a laptop for any length of time without a laptop stand, and separate keyboard and mouse, will cause poor posture which is likely to cause neck, back, and arm pain.


Organise your working day

Try and ensure your computer work is interspersed with other jobs. Rotate activity to avoid long periods of time in front of the screen. Short frequent breaks are much more effective in reducing muscle fatigue than taking longer breaks less often. During your breaks: DO - Get out of your seat, stretch your legs, arch your back, walk around for a couple of minutes, try Pause Gymnastics (see below). DON'T - remain seated at your desk.


Pause Gymnastics

These are simple movements designed to move joints and stretch the muscles and nerves, will stimulate the circulation, lubricate the joints and relieve muscle and nerve tightness. They can be done sat at your desk, and take only a few minutes to do:

  • Stretch your head from side to side (i.e. ear to shoulder)
  • Breathe in, pull the chin in to make a double chin, hold for 5 seconds then relax
  • Stand up, put the palms in the small of the back, and gently bend backwards
  • Interlock the fingers; turn the palms to face away from you and lift the arms up so the palms face the ceiling Now stretch the arms back behind the head
  • Stretch the arms back to each side at about hip height Keep the elbows straight and then bend the wrists back (palms facing out). Try to get the arms as far back behind the body as possible You may feel some pulling in the arms and hands
  • Gently curl the fingertips of the right hand into the palm. Keep the right elbow straight and with the left hand passively bend the right wrist so that the palm side of that hand moves towards the inside of the forearm. Repeat on other side

You need to do these movements regularly, one or two stretches every 20 minutes are better at relieving fatigue than longer exercise breaks taken less frequently. Make the exercises automatic so you do not have to think about doing them.

Source: ULTH