The Back Pain Battle

Fundamental Strategies for Managing Back Pain

IF YOU SUFFER from low back pain, you are in good company because most people experience back pain at least once in their lives. Over any given one year period, more than one third of the population will experience back pain. Of these people, most who experience activity-limiting back pain will go on to have recurring episodes.

Risk Factors

The most common ages for patients to suffer back pain is between 20 and 30 years and again in the 60s. Females tend to suffer from low back pain more than males. Being overweight increases the risk of someone developing back pain. Psychological factors such as stress, anxiety and depression are factors linked to back pain. Interestingly, degeneration of the lower spine (lumbar spine) is more related to heredity (genes) than heavy physical loading, which was thought to be a major contributor.

Causes of Back Pain

There are a multitude of causes of low back pain. It may arise from numerous anatomical locations such as bones, intervertebral discs, joints, ligaments, muscles, nerves and blood vessels. In each of these locations, conditions such as degeneration, infection, tumour and trauma may result in back pain.

Assessment of Back Pain

The aims of assessment of back pain by healthcare professional include:

• Ruling out potentially serious spinal conditions such as fractures, tumours and infection
• Identifying the cause of the back pain
• Detecting significant nerve damage caused by the disorder

In order to achieve these aims, in addition to obtaining a history of the pain and examining the patient, the doctor may need X-rays and specialised tests such as a MRI scan may be required.

Managing Back Pain

Specific causes of back pain require targeted treatment (which is beyond the scope of this article). As such, we will highlight general measures used to control back pain.

REST

While rest is intuitively enforced with a patient suffering from back pain, prolonged bed rest is associated with a longer recovery period. Current recommendation is for bed rest to be limited to 48-hours. Normal activities should be resumed as soon as possible.

MEDICATION

Anti-inflammatory medications are commonly prescribed for the control of back pain. Paracetamol is similarly effective. Topical medications such as heating rubs have not been proven to be useful.

ICE/HEAT TREATMENT

Although there is no conclusive evidence that the use of these measures reduce back pain, because the potential for harm is low and some patients do find that they give relief, ice/heat treatment can be attempted.

BACK EXERCISE

No specific back exercise improves pain during the episode of acute pain. In fact, stretching and other activities that put an additional strain on the back are discouraged. Back exercises, though, help patients with chronic back pain (lasting more than 3 months).

Preventing Back Pain

GENERAL EXERCISE

exercise is important for general health and need not be avoided. High-impact activities, though, can aggravate back pain. Low-impact activities such as swimming, cycling and walking are recommended. Regular exercise has the added benefit of reducing obesity, which is a risk factor for back pain.

SPECIFIC EXERCISE / PHYSIOTHERAPY

Exercises that strengthen the core muscles (abdominals and back muscles) may decrease the tendency for one to suffer back pain. Specific exercises can be recommended by a physiotherapist. Pilates and yoga help with back pain by strengthening these muscles.

LUMBAR SUPPORT BELTS

Workers who frequently perform heavy lifting wear these belts but there is no evidence that they work to prevent back pain. On the contrary, there is evidence to suggest that they may increase the risk of a back injury!

STANDING

While standing, the head should be kept upright and the stomach pulled in. High heels should be avoided.

SITTING

Chairs should be at an appropriate height for working. In addition, they should have good lumbar support, as should car seats. If this is found to be lacking, a rolled-towel or small pillow should be employed.

SLEEPING

Individual needs vary but an excessively soft or hard mattress can cause back pain. In general, a moderately firm mattress is recommended but some trial and error may be required.

LIFTING

Avoid lifting objects that are too heavy. Good lifting technique is paramount whatever the weight of the object. The back should be kept straight and upright while the lifting is performed with the knees. The object is close to the body to reduce stress on the spine.

Dos for Back Pain Sufferers

Do see a doctor immediately (these are emergencies) if:

• There is sudden bladder or bowel dysfunction.
• Back pain is associated with fever and chills.
• Back pain is caused by a severe injury.
• There is a history of cancer with recent weight-loss associated with the back pain.

Don’ts for Back Pain Sufferers

Don’t neglect a back pain. If a back pain lasts longer than two weeks, the back muscles start to weaken.

Since using the muscle hurts, there is tendency to avoid using them. This leads to muscle wasting and weakness. This, in turn, causes more back pain because the muscles are not able to hold up the spine.