Back pain is very common. Most people will have one or more bouts of back pain at some time in their life. Most bouts of back pain ease quickly and are not due to serious back problems.

What are the causes of low back pain?

Simple backache - is the most common. About 19 in 20 backaches are classed as 'simple backache'. Typically, the pain is in one area of the lower back but sometimes it spreads to the buttocks or thighs. The cause is thought to be 'mechanical' in most cases such as a sprain or minor tear to a ligament or muscle. Heavy lifting, an awkward twisting movement, prolonged or repeated bad posture may strain a back muscle or ligament. Minor problems with the discs between the vertebrae or the small 'facet' joints between the vertebra may also cause pain. Often, the exact site and cause of the pain is not clear.
Nerve root pain - occurs in less than 1 in 20 cases of backache. This means that a nerve coming out of the spinal cord is irritated or compressed (trapped). Irritation may be due to inflammation from a ligament or muscle sprain. The irritated nerve causes pain to be felt along the course of the nerve even though the problem is in the back. Therefore, pain is felt down the leg to the calf or feet and is often worse than the back pain. A common example is 'sciatica' where the main nerve to the leg, the sciatic nerve, is irritated or compressed. Sometimes a 'slipped disc' is the cause. A disc between two vertebrae (the circular bones making up the spine) does not actually 'slip'. What happens is that the outer part of a disc can tear and part of the inner softer part of the disc bulges out. This can press on nearby structures such as the sciatic nerve and cause pain.

Uncommon back conditions - such as bone disorders, arthritis or ankylosing spondylitis occasionally cause back pain.

What are the symptoms of low back pain?

Pain can range from mild to severe. Simple backache and nerve root pain is typically eased by lying down flat and made worse by movements of the back, coughing and sneezing. Nerve root irritation may also cause pins and needles or numbness in part of the buttock or leg. Many back pains ease quickly within a week or so. Symptoms have either gone or are very much eased within 4 weeks in 3 out of 4 bouts of acute (sudden onset) back pain. About 9 out of 10 pains have gone or eased within 6 weeks. However, it is common to have further bouts of pain some time in the future. Also, it is common to have minor pains 'on and off' for quite some time following an initial severe bout of pain. A minority of people have troublesome regular symptoms that persist for several months or longer (chronic back pain).

Back pain with any of the following symptoms may indicate a more serious problem and should be reported to a doctor: weakness of leg or feet muscles; problems with bladder or bowels; weight loss; pain that developed gradually - in particular if you have other conditions such as arthritis, AIDS, cancer or are taking steroids.

What are the treatments for low back pain?

The following advice is common for a sudden 'acute' episode of simple backache. Most people recover quickly. Treatment may vary and the situation should be reviewed by a doctor if the pain persists beyond 4-6 weeks, becomes worse or if symptoms change.

Exercise and 'keep going'
Continue with normal activities as far as possible. This may not be possible at first if pain is severe but as soon as the pain eases, get back into normal activities. As a rule, anything that causes a lot of pain should be avoided but some discomfort may have to be accepted when trying to do normal activities. In the past, advice had been to rest until the pain eases. It is now known that chronic (ongoing) back pain is more likely to develop in people who rest compared to people who keep on with normal activities.

Setting a new goal each day may be a good thing to try. For example, walking around the house on one day, a walk to the shops the next, etc. When the pain is easing, an exercise programme may help. Sleep in the most naturally comfortable position.

Medication
Painkillers are often helpful. It is best to take painkillers regularly. This is better than taking them now and again just when the pain is very bad. Taking them regularly may prevent pain getting severe and enable exercise to be taken.

Paracetamol - taken regularly at full strength is often sufficient.
Anti-inflammatory painkillers - such as ibuprofen, diclofenac, naproxen, etc, may be stronger than paracetamol. However, some people get stomach problems with anti- inflammatories. People with a history of peptic ulcer should not take these.

Codeine - alone or in combination with paracetamol, is a stronger painkiller. It may be an option if anti-inflammatories don't suit. Constipation is a common side effect from codeine and may make back pain worse if you need to strain to go to the toilet. Lots to drink and a high fibre diet will usually prevent constipation.

Muscle relaxants - are sometimes prescribed for a few days in addition to painkillers if the back muscles become tense and aggravate the pain.

Physical treatments
Many people with back pain will visit a physiotherapist, chiropractor or osteopath for manipulation and/or other physical treatments. The effectiveness of such treatments is debatable. However, it seems that physical treatments do quicken recovery in some people, particularly if the onset of the pain was recent.

Preventing back pain
After recovering from back pain, efforts should be made to prevent recurrences.

Exercise - the aim is to give strength and suppleness to the supporting back muscles. Swimming is good but other regular back exercises will also help.

Posture - avoid standing or walking in a stooped position. Wherever possible, walk or stand with the shoulders and head slightly back. When sitting at a desk to work, make sure that the chair is at the right height for the desk and the feet should be able to rest flat on the floor with the knees bent at 90 degrees. Sleeping on a bed with a firm mattresses is best.

Lifting - avoid bending the back when lifting. Bend at the knees keeping the back straight. Do not lift with the back in an awkward twisting posture.
If overweight - the extra stress on the back can be harmful and losing weight will help prevent recurrences.

Be 'back aware' - it may not be so much heavy work that causes recurrences of back pain. More likely it is due to bad posture or bad lifting techniques at work or home.

Further information

Backcare (The National Back Pain Association)
16 Elmtree Road, Teddington, Middlesex TW11 8ST
Tel: 020 8977 5474 Web: www.backcare.org/
They produce various leaflets including 'Basic back care' and 'Better back care for office workers'. (Please enclose a large stamped addressed envelope for a catalogue).

Extract from Mentor Plus copyright OUP, EMIS and Authors 1999