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Encyclopaedia


Back pain

Introduction

Back pain is a common problem that affects most people at some point during their life.

The pain can be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. Back pain is not generally caused by a serious condition. Find out more about what can cause back pain.

In most cases, back pain will improve in a few weeks or months, although some people experience long-term pain or pain that keeps coming back.

Types of back pain

Backache is most common in the lower back ('lumbago'), although it can be felt anywhere along your spine, from your neck down to your hips. Read information on neck pain and shoulder pain, which are covered separately.

Sometimes, back pain can be caused by an injury or disease, such as:

  • whiplash - neck injury caused by a sudden impact
  • frozen shoulder - inflammation around the shoulder that causes pain and stiffness
  • ankylosing spondylitis - a long-term condition that causes pain and stiffness where the spine meets the pelvis
  • slipped disc - when one of the discs in the spine is damaged and presses on the nerves
  • sciatica – irritation or compression of the sciatic nerve, which causes pain, numbness and tingling that travels down one leg

The rest of the information will focus on back pain that doesn't have an obvious cause. Doctors call this "non-specific back pain".

What to do

Most cases of back pain get better on their own and you may not need to see a doctor.

If you've only had back pain for a few days or weeks, the following advice may help relieve your symptoms and speed up your recovery:

  • remain as active as possible and try to continue with your daily activities
  • take over-the-counter painkillers, such as paracetamol or ibuprofen if you feel you need to
  • use hot or cold compression packs - you can buy these from your local pharmacy, or a bag of frozen vegetables and a hot water bottle will work just as well

Although it can be difficult to be cheerful or optimistic if you are in pain, it's important to stay positive because this can help you recover faster.

Treatments for long-term back pain

If you're worried about your back or your pain hasn't improved by around six weeks, it's a good idea to visit your GP, who can advise you about the treatments available.

These include:

Some people choose to see a therapist for manual therapy or acupuncture without seeing their GP first. If you want to do this you will usually need to pay for private treatment, which is likely to cost around £30-50 for each appointment.

Spinal surgery is usually only recommended when all else has failed.

Preventing back pain

How you sit, stand, lie and lift can all affect the health of your back.

Try to avoid placing too much pressure on your back and ensure your back is strong and supple. Regular exercise, such as walking and swimming, is an excellent way of preventing back pain. Activities such as yoga or pilates can improve your flexibility and strengthen your back muscles.

Signs of a serious problem

You should seek urgent medical help if you have back pain and:

  • a high temperature
  • unexplained weight loss
  • a swelling or deformity in your back
  • it's constant and doesn't ease after lying down
  • pain in your chest
  • a loss of bladder or bowel control
  • an inability to pass urine
  • numbness around your genitals, buttocks or back passage
  • it's worse at night
  • it started after an accident, such as after a car accident

These problems could be a sign of something more serious and need to be assessed as soon as possible.

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Causes

Your back is a complex structure made up of bones, muscles, nerves and joints, so pinpointing the exact cause of the pain can often be difficult.

Most cases of back pain are not caused by serious damage or disease but by minor sprains, strains, injuries or a pinched or irritated nerve.

These types of back pain can be triggered by everyday activities at home and at work, or it can develop gradually over time. Possible causes of back pain include:

  • bending awkwardly or for long periods
  • lifting, carrying, pushing or pulling heavy objects
  • slouching in chairs
  • twisting awkwardly
  • over-stretching
  • driving or sitting in a hunched position or for long periods without taking a break
  • overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury)

Sometimes the pain develops suddenly for no apparent reason. Some people can wake up one morning with back pain and have no idea what has caused it.

Who's most at risk?

Some risk factors increase the risk of developing back pain, these include:

  • being overweight – extra body weight puts pressure  on the spine.  Use the healthy weight BMI calculator to find out if you need to lose weight.
  • smoking – this could be due to tissue damage of the back or due to the fact that smokers tend to have unhealthier lifestyles than non-smokers. Get help quitting.
  • being pregnant –  the excess weight of carrying your baby can place additional strain on your back
  • long-term use of medication that are known to weaken bones, such as corticosteroids.
  • being stressed or depressed

Medical conditions

In a few cases, your symptoms may suggest a specific medical condition is causing your back pain. These conditions include:

  • neck pain and stiffness, headaches and back pain following an accident can be symptoms of whiplash
  • shoulder pain and stiffness, which makes it difficult to dress, drive or sleep, may be a sign of frozen shoulder
  • pain in your lower back associated with pain, numbness and a tingling sensation that travels down one leg may be a symptom of sciatica or a slipped or prolapsed disc
  • joint pain (including in the back) when walking and stiffness first thing in the morning are symptoms of arthritis - if the pain and stiffness take more than 30 minutes to resolve on waking up, or seem to start when you stop to rest after exercise, make sure you mention this to your GP

Rarely, back pain can be a sign of a serious condition such as a spinal fracture, an infection of the spine, or cancer.

If you see your GP with back pain, they will look for signs of these conditions.

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Diagnosis

Most cases of back pain don’t require medical attention and can be treated with over-the-counter painkillers and self-care.

However, you should contact your GP if you’re worried about your condition or struggling to cope with the pain.

Seeing your GP

Your GP will ask you about your and examine your back.

The examination will usually assess your ability to sit, stand, walk and lift your legs as well as testing the range of movement in your back.

Your doctor may also ask you about any illnesses or injuries you may have had, your lifestyle and the type of work you do.

Below are some of the questions a doctor may ask and it may be helpful to consider these ahead of your appointment.

  • When did the back pain start?
  • Where are you feeling pain?
  • Have you had any back problems before?
  • Can you describe the pain?
  • What makes the pain better or worse?

What happend next?

If your GP thinks there may be a more serious cause you will be referred for further tests, such as an X-ray or MRI scan.

Otherwise, your GP can advise you about things you can do and treatments that may help reduce your pain and speed up your recovery.

Find out about treating back pain.

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Treatment

Treatments for back pain will vary depending on how long you have had the pain, how severe it is and your individual needs and preferences.

Short-term back pain

Initially, back pain is usually treated with over-the-counter painkillers and home treatments. Most people will experience a significant improvement in their symptoms within six weeks.

Keep moving

It used to be thought that bed rest would help you recover from a bad back, but it's now recognised that people who remain active are likely to recover more quickly.

This may be difficult at first if the pain is severe, but try to move around as soon as you can and aim to do a little more each day.

Activity can range from walking around the house to walking to the shops. You will have to accept some discomfort but avoid anything that causes a lot of pain.

There is no need to wait until you are completely pain-free before returning to work. Going back to work will help you return to a normal pattern of activity, and it can distract you from the pain.

Painkillers

The painkiller paracetamol is often one of the first medications recommended for back pain, although some people find non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, more effective. A stronger painkiller, such as codeine, is also an option and is sometimes taken in addition to paracetamol.

Painkillers can have side effects, some can be addictive and others may not be suitable, depending on your health and medical history. For example, the long-term use of NSAIDs can affect how well your kidneys work.

Your GP or a pharmacist will be able to give you advice about the most appropriate type of medication for you.

If over-the-counter medications are not controlling your pain, your GP may be able to prescribe something stronger. They may also recommend a short course of a musle relaxant, such as diazepam, if you experience muscle spasms in your back.

Hot and cold treatments

Some people find that heat - for example, a hot bath or a hot water bottle placed on the affected area helps ease the pain.

Cold, such as an ice pack or a bag of frozen vegetables, placed on the painful area is also effective. Do not put the ice directly on to your skin though because it might cause a cold burn. Wrap an ice pack or bag of frozen vegetables in a cloth before applying it to the affected area.

Another option is to alternate between hot and cold using ice packs and a hot water bottle. Hot and cold compression packs can be bought at most pharmacies.

Relax and stay positive

Trying to relax is a crucial part of easing the pain because muscle tension caused by worrying about your condition may make things worse.

Although it can be difficult, it's also important to stay optimistic and recognise that your pain should get better because people who manage to stay positive despite their pain tend to recover quicker.

Change your sleeping position

Changing your sleeping position can take some of the strain off your back and ease the pain.

If you sleep on your side, draw your legs up slightly towards your chest and put a pillow between your legs. If you sleep on your back, placing pillows under your knees will help maintain the normal curve of your lower back.

Exercise and lifestyle

Try to address the causes of your back pain to prevent further episodes. Common causes include being overweight, poor posture and stress.

Regular exercise and being active on a daily basis will help keep your back strong and healthy. Activities such as walking, swimming and yoga are popular choices.

The important thing is to choose an enjoyable activity that you can benefit from without feeling pain.

Read more about preventing back pain.

Long-term back pain

If you have had back pain for more than six weeks (known as chronic back pain), your GP will advise you about which painkillers to take and recommend:

  • Exercise classes - group classes supervised by a qualified instructor, where you are taught exercises to strengthen your muscles and improve your posture, as well as aerobic and stretching exercises.
  • manual therapy – therapies including manipulation, mobilisation and massage, usually carried out by chiropractors, osteopaths or physiotherapists (although chiropractic and osteopathy aren't widely available on the NHS).
  • Acupuncturetreatment where fine needles are inserted at different points in the body. It's been shown to help reduce lower back pain, although it's not always available on the NHS.

These treatments are often effective for people whose back pain is seriously affecting their ability to carry out daily activities and who feel distressed and need help coping.

Some of the other treatments that may be recommended are described below.

Antidepressants

If painkillers do not work, you may be prescribed tricyclic antidepressants (TCAs) such as amitriptyline. TCAs were originally intended to treat depression, but they are also effective at treating some cases of persistent pain.

If you are prescribed a TCA to treat persistent back pain, the dose is likely to be very small. See medicines for back pain for more information.

Counselling

If the treatments listed above are not effective, you may be offered psychological therapy to help you deal with your condition.

While back pain is very real, how you think and feel about your condition can make it worse. Therapies such as Cognitive behavioural therapy (CBT) can help you manage your back pain better by changing how you think about your condition.

Pain clinics

If you have long-term (chronic) pain, you may be able to attend a specialist pain clinic.

Pain clinics can help you to learn how to manage your pain and provide advice about things like increasing your activity level and how to have a better quality of life despite being in pain.

This is done with a combination of group therapy, exercises, relaxation and education about pain and the psychology of pain.

Surgery

Surgery for back pain is usually only recommended when all other treatment options have failed or if your back pain is so severe you are unable to sleep or carry out your daily activities.

The type of surgery suitable for you will depend on the type of back pain you have and its cause.

Two procedures sometimes carried out include:

  • a discectomy - where part of one of the discs between the bones of the spine (the vertebrae) is removed to stop it pressing on nearby nerves (known as a slipped or prolapsed disc)
  • spinal fusion - where two or more vertebrae are joined together with a section of bone to stabilise the spine and reduce pain

These procedures can help reduce pain caused by compressed nerves in your spine, but they are not always successful and you may still have some pain afterwards.

As with all types of surgical procedures, these operations also carry a risk of potentially serious complications. In some cases, nerves near the spine can be damaged, resulting in problems such as numbness or weakness in a part of one or both legs or, in rare cases, some degree of paralysis.

Before you agree to have surgery, you should fully discuss the risks and benefits with your surgeon.

Treatments not recommended

A number of other treatments are have sometimes been used to treat long-term back pain but are not recommended by the National Institute for Health and Clinical Excellence (NICE) due to a lack of evidence about their effectiveness in treating non-specific back pain (back pain with no identified cause). They include:

  • low level laser therapy – low energy lasers are focused on your back to try to reduce inflammation and encourage tissue repair
  • interferential therapy (IFT) – a device is used to pass an electrical current through your back to try to accelerate healing while stimulating the production of endorphins (the body’s natural painkillers)
  • therapeutic ultrasound – where sound waves are directed at your back to accelerate healing and encourage tissue repair
  • transcutaneous Electrical Nerve Stimulation (TENS) - a machine delivers small electric pulses to your back through electrodes (small sticky patches) that are placed on your skin; the pulses stimulate endorphin production and prevent pain signals travelling from your spine to your brain
  • lumbar supports – cushions, pillows and braces are used to support your spine
  • traction – a pulling force is applied to your spine
  • injections - painkilling medication is injected directly into your back

 

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Prevention

Keeping your back strong and supple is the best way to avoid back pain. Regular exercise, maintaining good posture and lifting properly will all help.

If you have recurring back pain, the advice outlined below may be useful.

  • Lose weight  – too much upper body weight can strain the lower back. Use the body mass index (BMI) healthy weight calculator to find out whether you are a healthy weight for your height.
  • Wear flat shoes with cushioned soles, as these can reduce the pressure on your back.
  • Avoid sudden movements which can cause muscle strain.
  • Try to reduce any stress, anxiety and tension, which can all cause or worsen back pain.
  • Stay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain.

Exercise

Exercise is both an excellent way of preventing back pain and reducing back pain but you should seek medical advice before starting an exercise programme if you've had back pain for six weeks or more.

Exercises such as walking or swimming strengthen the muscles that support your back without putting any strain on it or subjecting it to a sudden jolt.

Activities such as yoga or pilates can help improve the flexibility and the strength of your back muscles. It is important that you carry out these activities under the guidance of a properly qualified instructor.

There are also a number of simple exercises you can do in your own home, several times a day, to help prevent or relieve back pain.

  • Bottom to heels stretch - kneel on all fours, with your knees under hips and hands under shoulders. Slowly take your bottom backwards, maintaining the natural curve in the spine. Hold the stretch for one deep breath and return to the starting position.
  • Knee rolls - Lie on your back and place a small flat cushion or book under your head. Keep your knees bent and together, then roll them to one side while keeping both shoulders on the floor. Hold the stretch for one deep breath and return to the starting position. Repeat eight to 10 times, alternating sides.
  • Back extensions - Lie on your stomach, and prop yourself on your elbows. Arch your back up by pushing down on your hands. Breathe and hold for five to 10 seconds. Return to the starting position. Repeat eight to 10 times.

Stop these exercises immediately if they make your pain worse.

Posture

How you sit, stand, and lie down can have an important effect on your back. The following tips should help you maintain a good posture.

Standing

Standing upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.

Sitting

Make sure you sit upright with support in the small of your back. Your knees and hips should be level and your feet should be flat on the floor (use a footstool if necessary). Some people find it useful to use a small cushion or rolled-up towel to support the small of the back.

If you use a keyboard, make sure that your forearms are horizontal and your elbows are at right angles.

Driving

Make sure that your lower back is properly supported. Correctly positioning your wing mirrors will prevent you from having to twist around. Foot controls should be squarely in front of your feet. If driving long distances, take regular breaks, so that you can stretch your legs.

Sleeping

Your mattress should be firm enough to support your body while supporting the weight of your shoulders and buttocks, keeping your spine straight.  If your mattress is too soft, place a firm board - ideally 2 cm thick - on top of the base of your bed and under the mattress. Support your head with a pillow, but make sure your neck is not at a steep angle.

Lifting and carrying

One of the biggest causes of back injury, particularly at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain. You should:

  • Think before you lift: can you manage the lift? Are there any handling aids you can use? Where is the load going?
  • Start in a good position: your feet should be apart, with one leg slightly forward to maintain balance. When lifting, let your legs take the strain - bend your back, knees and hips slightly but do not stoop or squat. Tighten your stomach muscles to pull your pelvis in. Do not straighten your legs before lifting as you may strain your back on the way up.
  • Keep the load close to your waist: keep the load as close to your body for as long as possible with the heaviest end nearest to you.
  • Avoid twisting your back or leaning sideways, particularly when your back is bent. Your shoulders should be level and facing in the same direction as your hips. Turning by moving your feet is better than lifting and twisting at the same time.
  • Keep your head up: once you have the load secure, look ahead, not down at the load.
  • Know your limits: there is a big difference between what you can lift and what you can safely lift. If in doubt, get help.
  • Push rather than pull: if you have to move a heavy object across the floor, it is better to push it rather than pull it.
  • Distribute the weight evenly: if you are carrying shopping bags or luggage, try to distribute the weight evenly on both sides of your body.

If your child needs to carry a bag to school, they should use a well-designed backpack that is worn over both shoulders. Avoids putting anything unnecessary in their bag to keep the weight to a minimum.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 05/05/2015 11:31:13

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