Our Experts: MR NICK BIRCH, spinal surgeon and director of Spinal Rehabilitation as the Chris Moody Centre, a state-of-the-art neuromuscular rehab centre
PROFESSOR PHILIP CONAGHAN, Professor of Musculoskeletal Medicine, University of Leeds, and medical advisor to Arthritis Research UK
Back pain blights most of our lives at some time or other. A wrong move, sleeping awkwardly, carrying too heavy a load, as well as age-related changes in the spine or a slipped disc are all triggers. For most of us, the pain subsides fairly quickly. And for those who need medical help, a new NHS national care "pathway" is being rolled out this autumn.
'Anyone with back pain will be referred to a specially trained nurse, physio or other medical professional, who will assess and advise on self-help, offer treatment or refer you on,' explains consultant spinal specialist Mr Nick Birch.
There are also new, effective self-managment programmes such as Yoga for Backs, Pilates-based Back4Good and CBT-based techniques that can help you keep your back healthy.
Is This Your Problem?
- Eight out of ten of us will suffer backache, especially low back pain (LBP), at some time in life.
- LBP is the third most commonly reported symptom of any kind.
- It usually occurs between ages 30 and 60. And for one in seven people, it becomes chronic.
What Causes Back Pain?
According to Professor Philip Conaghan, these are the commonest and related causes...
Disc Degeneration - From around age 30, the spongy, shock-absorbing discs between vertebral bones begin to dry out and lose resilience.
Arthritis - In the small stabilising joints (facet joints) of the spine. Cartilage thins and the fluid that lubricates the joints is reduced. In addition, bony spurs called osteophytes may form, resulting in intermittent paint, tenderness and stiffness.
Nipped nerves - Disc degeneration, arthritic changes or a bluging disc can causes narrowing of the spinal canal. This can pinch nerves, causing pain, numbness, tingling or weakness. When this radiates to the leg it is known as sciatica.
Injury from a major trauma - Such as a car accident of fall or the accumulated effects of minor traumas. These can include post-menopausal weight gain, lifting and carrying children or heavy bags or, if you already have back problems, something minor like bending to pick something up without bending your knees. As a result, surrounding the muscles and tendons tighten to protect against further injury, and inflammation may occur - a perfect recipe for pain.
When should you see the doctor?
Try self-help if: You have straightforward back pain for less than three or four days.
See the GP if: Pain hasn't begun to ease and is preventing you doing everyday tasks after more than three or four days.
You're still in severe pain or pain has worsened after six weeks.
Seek urgent medical help if back pain is accompanied by any of these:
- Recent serious trauma, ie car accident
- Numbness or tingling in groin or legs
- Loss of bladder/bowel control or inability of pass urine
- Medical history of osteoporosis or cancer, or recent unexplained weight loss
- Night Pain
- Leg weakness that comes on suddenly or gets progressively worse, or more pain in the leg than the back
- Inability of get comfortable sitting or sleeping at times when you feel back pain
6 Steps To Fast Relief
- Ice it: if pain starts after an obvious injury such as a fall, kock, sprain or strain, apply an ice pack for 10 minutes several times a day. Alternate with a (covered) hot-water bottle to encourage blood flow, but start and finish with ice to ease inflammation.
- Keep moving: stay active and carry on as normal - as much as you can. Start slowly, with a gentle activity like walking, and increase gradually.
- Don't take to your bed: extended bed res causes muscles to seize up and weaken. if you must life down, restrict yourself to one to two hours over the first couple of days. Place a pillow under your knees to ease strain or between your knees if you're lying on your side.
- Treat pain: take ibuprofen or aspirin every four to six hours. For more severe pain, take codeine. Paracetamol can be added for greater relief. Stick within the maximum recommended daily dose. If that doesn't work, your GP can prescribe a stronger painkiller or muscle relaxant.
- Manipulate it: if pain hasn't eased after a week or so, consider physiotherapy (sometimes available on the NHS via your GP), osteopathy or chiropractic to mobilise your spine. Techniques may include massage to ease tight, tense muscles, ultrasound and a variety of manipulative techniques to realign the spine. You're also likely to be taught home exercises to strengthen your back.
- Consider acupuncture: The National Institute for Health and Clinical Excellence (NICE) recommends acupuncture for back pain - up to ten sessions over no more than 12 weeks. Ask your GP if it's available on the NHS in your area or a find a private practitioner at acupuncture.org.uk
Is It A Slipped Disc?
Back pain accompanied by shooting pain in your leg and/or numbness or weakness in your buttocks or legs could be a slipped disc. Discs are doughnut-shaped structures found between vetebrae that act as shock absorbers. Each disc has a fibrous outer ring made of cartilage with a soft, jelly-like core made up of water and collagen. If the outer ring tears or ruptures, the centre bulges out, pressing nerby nerves, with causes inflammation and pain. Ice and/or heat, physiotherapy or, if these don't help, a steroid injection are common treatments. Surgery is occasionally needed.
3 (New) Ways To A Strong Back
Strengthening the core muscles, which support your spine, is the key. Walking, swmming, (especially backstroke) and other low-impact actvities are good (visit backcare.org.uk and click on Library to download a leaflet, back in the Gym). Take a painkiller before activity if necessary. Posture also matters, and Alexander Technique, Pilates and yogo and t'ai chi can all help!
1. BACK4GOOD: Endorsed by the charity BackCare, this eight-week programme, the brainchild of Body Control Pilates guru Lynne Robinson, is individually tailored. You'll learn how to keep your pelvis in 'neutral' alignment to reduce muscle strain, plus classic pilates moves such as roll downs to mobilise and strengthen core muscles in your back and abdomen, and improve posture, From £10-£20 a session, see back4good.eu
2. YOGAFOR BACKS: With 300 teachers across the UK, this 12-week yoga based course devised by lyengar yoga teacher Alison Trewhela, helps strengthen muscles and improve range of movement. You'll learn yoga positions and sequences, plus breathing techniques to focus your mind. According to an Arthritis Research UK-funded trial, it provides safe, effective and lasting benefits for people with lower back pain. From £10-20 a session, see yogaforbacks.co.uk
3. SIPPA: Stands for Stress Illness Recovery Pracitioners' Association, and is a pioneering mind-body programme developed by physiotherapist Georgie Oldfield for people with back and other ongoing pain problems. It included therapeutic journaling (writing down your feelings), CBT, mindfulness, visualisation and other self-care techniques designed to reduce stress and break the pain cycle. Research has shown that nerve messages in the spinal cord and brain become scrambled in chronic pain, so pain is experienced even when theres no longer an obvious physical causes. As a first step, read Georgie's book Chronic Pain: Your Key To Recovery, £9.95 (avaiable on the website). If you need more help, there's an online programme (£187), or you can book an appointment with a trained practitioner. From £60, see sirpauk.com
Can You Help?
This autumn, a team led by Nick Birch and a group from Southampton University are embarking on the largest ever randomised control trial, looking at how Pilates can help LBP. Find out more at thebackdoor.org.uk
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