Our backs are complex structures which are involved in
virtually every move we make, so it's hardly surprising that back pain is so
common. In fact, doctors see more patients for back pain than any other ailment
Eight out of ten of us will suffer from pain or aching in the back at some
time in our lives. Lower back pain is most frequent between the ages of 35 and
55 and it is responsible for more lost days at work than all the other causes
WHAT CAUSES PAIN ?
There are so many different causes of
back pain that it's often hard to pinpoint a single factor. In the first place,
walking on two legs instead of on all fours, as our ape ancestors did, means
that a lot of extra strain is put on the spine.
Other factors are involved too. If your job requires heavy work; being in the
same position for long periods of time; lots of bending, twisting and lifting;
or repetitive movements or having to stoop, you are likely to experience back
pain. Manual workers, office workers, nurses, drivers, mothers of small children
and the elderly are all at risk. Even something as simple as poor posture can
give you aches.
There are several physical causes of back pain. A nerve trapped between two
vertebrae can be very painful, as can arthritis in the spinal joints. Inflamed
or strained muscles or tendons, restricted joints and problems with the
ligaments can all cause discomfort.
Stress can contribute to back problems and, if your back muscles are tense,
you are more likely to injure your back. Illnesses can also be responsible, such
as shingles, gynaecological and kidney problems and, very rarely, cancer.
IS BACK PAIN SERIOUS?
Most causes of back pain are not serious. In fact, in nine out of ten cases, no
single cause of the pain can be found, and doctors refer to the pain as
Your back is made up of some 50 bones, 100 joints, 1,000 muscles and
1,000,000 nerves. The spine itself is rather like the central pole of a tent,
supported by ligaments and muscles which act as guy ropes. If these become tense
or distorted, they pull on the 'pole' and make the back ache.
The spine itself consists of 24 small bones, or vertebrae, stacked one on top
of the other. Because of the way our bodies are made, the vertebrae in the
lumbar, or lower, region take the most strain, which is why low back pain is so
THE SPINAL DISCS
The vertebrae are joined in front by an intervertebral disc - a tough fibrous
ring containing a jelly-like substance which acts as a shock absorber. Pressures
on the disc caused by moving incorrectly are among the biggest causes of back
pain. In fact, even simple things like reaching up to a high shelf can place
extra pressure on the discs in the lower back and cause pain.
The vertebrae are joined behind by a pair of small joints, called posterior
vertebral joints, which help the body in weight-bearing and also help us to
move. When we move, the surfaces of these joints are pushed together, pulled
apart, angled to each other or slid across each other - all of which can put
strains on different parts of the spine. Pain can occur if anything interferes
with these joints.
The joints in turn are held together by a network of ligaments -- tough bands
of fibre which hold the bones together -- and a series of 'facet' joints. Each
joint is surrounded by muscles and tendons -- the 'ropes' which attach the
muscles to the bones.
The spinal cord runs through a hole in each of the vertebrae. The body's
nerve roots are attached to the cord, which is an extension of the brain.
Pressure on the cord, for example from a damaged disc, can cause pins and
needles, acute pain, and, in extreme cases, paralysis.
MAKING A DIAGNOSIS
To determine the cause of the pain,
the doctor will examine your back thoroughly and will feel down your spine. He
may apply firm or gentle pressure to ascertain the source of the pain and any
tender areas. He may also recommend that you have an X-ray, which can detect any
abnormalities in the vertebrae. However, an X-ray won't show up the muscles or
ligaments, which may be the root of the problem.
Back pain is complicated to diagnose because problems in the spine can lead
to referred pain -- pain elsewhere in the body. Spinal problems, for example,
can produce symptoms such as chest pain, which can be mistaken for other
illnesses, such as heart disease. Other symptoms such as dizziness and ringing
in the ears can also originate in the spine, particularly after a whiplash
Pain from the neck and upper back may be referred down the arm and shoulder,
between the shoulder blades or to the chest, abdomen or lower back.
Pain from the lumbar spine may be
referred to the buttocks, coccyx and to either or both legs, causing sciatica --
pain that radiates along the sciatic nerve which runs from the buttock to the
Back pain can be acute, which means coming on suddenly, or chronic, which
means constant or recurring. By and large, acute back pain is linked to injury,
such as dislocated disc, torn ligament or pulled muscle. Chronic back pain is
often the result of poor posture.
TYPES OF TREATMENT
Most cases of back pain resolve themselves with no treatment at all. In cases of
acute severe back pain, the doctor may suggest pain-killing drugs plus a short
period of bed rest. However, most experts now agree that the sooner you can get
moving the better. In severe cases, the doctor may also suggest tranquillizers,
anti-inflammatory drugs or strong pain-killing drugs.
In selected cases, physiotherapy can help to relieve back pain.
Physiotherapists can give heat and cold treatments and usually offer a range of
electrical treatments such as shortwave diathermy, ultrasound and interferential
treatment. TENS (Transcutaneous Electronic Nerve Stimulation), which involves
applying a mild electrical current to certain points on the back to block pain
messages, can be very helpful in some cases.
Physiotherapists may also perform manipulation and massage and suggest
exercises to help strengthen your back. Wearing a collar or a corset can give
Surgery is much less often recommended nowadays, except in very severe cases, or
where there is a specific known cause that can be corrected by surgery.
Rhizolysis and rhizotomy, which involve killing some of the nerve endings, help
Another alternative is nerve root surgery, where the nerve supply to a
particular area of the back is cut altogether. Surgeons can also remove disc
material which may be pressing on nerves and causing pain. However, surgery
should only be considered as a last resort, since it can be risky and may worsen
Some of the most successful treatments for back pain are chiropractic and
osteopathy. The theory behind both of these therapies is that misalignments of
the spine can cause pain and problems elsewhere in the body. A chiropractor
specializes in the spine, while an osteopath deals with the whole skeleton.
The therapist diagnoses the source of pain and then twists, presses or pulls
to correct the alignment and restore normal function. Soft tissue work -
massaging the muscles around the spine - may also be performed.
Acupuncture has been used with notable success. The acupuncturist takes a full
history of your symptoms and inserts sterilized needles into points on your
body. The aim is to restore physical harmony and so treat the pain.
The Alexander technique is a method of postural realignment. Teachers believe
that almost all of us hold ourselves incorrectly. Learning how to move, stand
and sit as we go about our daily lives can relieve strain on the back and so