Back pain

Back pain is common condition and in most cases, it is not usually caused by a serious problem.

Back pain usually gets better within a few weeks. During this time, it is important that you stay active, and limit bed rest.

What can cause back pain?

In most cases of non-specific back pain, it is not possible to identify one specific structure as the source of the pain. This does not necessarily mean that there is damage to the spine.

While it can be painful and upsetting, this type of back pain usually gets better quickly. It can be managed through  advice and remaining active.

Many physical or psychological factors can cause back pain and often a combination of these are involved.

They could be:

• Physical factors, such as ‘protecting’ the back and avoiding movements, or a simple strain.
• Psychological factors, including a fear of damage or not getting better, feeling down or being stressed.
• More general health and lifestyle factors, like being tired and rundown, not getting enough good quality sleep, being overweight or not getting enough physical activity
• Social triggers, such as difficult relationships at work or home, low job satisfaction or stressful life events, like a family death or illness.

Crucially, it’s important to know that all pain is 100 per cent real and never ‘all in your head’, even when factors like stress or mood are involved.

Each of the factors can turn up the volume on your pain and gaining a greater understanding of when that can happen puts you in a stronger position to recognise them and learn how to turn down the dial again.

Sometimes there are specific causes for back pain, especially when there is leg pain, pins and needles or numbness too. This can be caused by irritation or compression of the nerves in the back.

Is back pain caused by a ‘slipped disc’?

The short answer is no. Whilst the term is widely used, it is not accurate and it can be very unhelpful for people with back pain or back and leg pain and make them more fearful of moving and doing normal activities.

Discs are designed to help the spine take loads and transfer pressure as we move around. The term ‘slipped disc’ is commonly used, but it can be misleading. Discs do not literally slip out of place. Disc problems can occur when the tissues of a spinal disc become irritated or disrupted, and these may sometimes contribute to back or leg pain.

A disc can be strained under sudden or repetitive overload, in the same way as other joints in our body. This can cause pain locally in the back or referred pain into the buttock and legs.  It usually gets better without doing anything.  It can also respond well to taking simple painkillers and keeping active, doing as much of your normal activity as possible.

Some people find that their back pain returns from time to time, which can be frustrating. However, a physiotherapist can help you plan how to manage these occurrences.

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Taking care of stress for back pain

Stress can exacerbate existing back pain, so if you able to, identify and manage the causes of your stress.

Keeping active and healthy

Keeping active can also help with dealing with life stressors, so ensure you are finding ways to stay active regularly.

The importance of sleep in tackling back pain has become increasingly clear in recent years.

This is because it reduces stress and improves your overall feeling of well-being, making you less susceptible to the triggers of pain in the first instance and helping you to cope when it does occur.

Aim for 7.5-8 hours a night and try to aim for a regular routine, as far as possible.

It is also very important to know that there is no best position or type of mattress – whatever feels most comfortable for you is best.

 10 Things you need to know about your back-Chartered Society of Physiotherapy guidelines

1. Your back is stronger than you may think
   Most people worldwide will experience back pain during their lifetime. It can be disabling and worrying but it is very common and rarely dangerous.  

The spine is a strong, stable structure and not easily damaged so in most instances it is a simple sprain or strain.

The vast majority of people with non-specific back pain improve with time and appropriate self-management.

Some people experience repeat episodes, which can be distressing, but again these are rarely dangerous.

• You rarely need a scan and it can do more harm than good
  This is because seeing perfectly normal changes to their spine can cause people to avoid the activities they should be doing to get better, such as exercise and movement in general. 

In very rare cases, there may be something more serious or underlying that requires medical advice.

A scan may help with your diagnosis and symptoms to be aware of are at the bottom of this page.

However, these account for just two per cent of cases so if your physio or GP does not send you for one, you should take it as a good sign that there is nothing concerning going on.

• Avoid bedrest, stay in work and gradually resume normal activities
  Scientific studies now indicate prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work. 

In the first few days of a new episode of low back pain, avoiding aggravating activities may help to relive pain.

However, staying as active as possible and returning to all usual activities gradually is actually important in aiding recovery – this includes staying in work where possible.

While it is normal to move differently and more slowly in the first few days of having back pain, this altered movement can be unhealthy if continued in the long-term.

• You should not fear bending or lifting
  Bending and lifting are often portrayed as causes of back pain and while an injury can occur if something is picked up in an awkward or unaccustomed way, it’s most likely to just be a sprain or strain. 

The important thing is to practice and get your body used to carrying different loads and weights in a way we find comfortable and efficient.

We all run differently, and it’s perfectly normal for us to find our own technique for lifting.

• Exercise and activity reduce and prevent back pain
  Exercise is shown to be very helpful for tackling back pain and is also the most effective strategy to prevent future episodes. 

Start slowly and build up both the amount and intensity of what you do.

It is possible to experience some discomfort when returning to exercise or increasing activity. This does not necessarily mean that you are causing harm, but activities should be introduced gradually and adjusted according to your symptoms and individual circumstances.

 

No one type of exercise is proven to be more effective than others so just pick an exercise you enjoy, that you can afford to maintain in the long-term and that fits in with your daily schedule.

• Painkillers will not speed up your recovery
  There is no strong evidence on the benefits of painkillers and they do not speed up recovery. 

They should only be used in conjunction with other measures, such as exercise, and even then just as a short-term option as they can bring side effects.

Exercise, which is safer and cheaper, is considered the preferred option.

• Surgery is rarely needed
  There are some uncommon back conditions where there is pressure on the nerves that supply the legs and the patient gets leg symptoms, such as pain, pins and needles or numbness. 

For these conditions, surgery can help the leg symptoms but it is important to understand that it is not always required.

You also need to know that on average, the results for back surgery are no better in the medium and long term than non-surgical interventions, such as exercise.

So a non-surgical option, which includes exercise and activity, should always come first.

• Get good quality sleep
  The importance of sleep in tackling back pain has become increasingly clear in recent years. 

This is because it reduces stress and improves your overall feeling of wellbeing, making you less susceptible to the triggers of pain in the first instance and helping you to cope when it does occur.

Aim for 7.5-8 hours a night and try to aim for a regular routine, as far as possible.

It is also very important to know that there is no best position or type of mattress – whatever feels most comfortable for you is best.

• You can have back pain without any damage or injury
  Many physical or psychological factors can cause back pain and often a combination of these are involved. 

Many factors can cause back pain and often a combination of these are involved.

9. They could be:

• Physical factors
• Psychological factors
• More general health and lifestyle factors
• Social triggers

10. If it doesn’t clear up, seek help but don’t worry

Physiotherapists provide expert advice, guidance and treatment for back pain.

This is to help reduce your chances of future episodes, while improving your overall health and wellbeing.