Back Pain
Video Credit: Cheshire & Merseyside Back Pain Campaign
Back pain is common with 80% of people having an episode of back pain in their lifetime. In most cases, this will improve within a few days / weeks. Very few cases are due to serious disease.
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Back pain can be very painful and disabling leading to a big impact on your everyday activities at work and home. Most back pain will recover without any medical intervention.
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Understanding your back pain and the right things to do helps reduce the fear and concern about the condition. This along with keeping moving helps you to recover more quickly.
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Episodes of back pain are usually short-lived and most people will see an improvement by doing the following:
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Continue with your day-to-day life as much as possible - Gentle movement / activity helps speed recovery. Remember pain does not mean you are damaging your back and you should improve more quickly if you continue to move, even if this causes some discomfort.
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Take regular pain relief - Seek advice from a pharmacist if you are unsure what to take.
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The body needs time to recover. You should start to feel gradual improvement after 7-10 days but if after 2 weeks there is little change, or if your pain is severe contact your GP surgery.
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When should I seek urgent help?
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Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed.
Symptoms include:
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sciatica on both sides
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weakness or numbness in both legs that is severe or getting worse
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numbness around or under your genitals, or around your anus
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finding it hard to start peeing, can't pee or can't control when you pee – and this isn't normal for you
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you don't notice when you need to poo or can't control when you poo – and this isn't normal for you
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new onset erectile dysfunction
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Cauda equina syndrome requires emergency hospital admission and emergency surgery, because the longer it goes untreated, the greater the chance it will lead to permanent paralysis and incontinence.
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New / Sudden onset weakness
Sometimes, if the nerves in your back have have been pinched enough, this can cause weakness in certain movements. You should seek more urgent help if:
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You have developed new onset or worsening weakness into your arms or legs e.g unable to pull your foot up towards you or reducing grip strength
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If you are unsure if you need more urgent help, ring your GP or 111 as soon as possible or if you have been referred to Physiotherapy, contact the Physiotherapy Department.
Click the links to find out more.
Acute Back Pain
Acute back pain can come on suddenly, or over time and can range from a mild pain or ache to quite severe pain, which can be extremely distressing and can sometimes stop you carrying out your everyday activities.
It is often difficult to identify why your back is painful as the pain can come from joints, muscles or nerves being inflammed, stretched or compressed. It can often be caused by lifting or moving awkwardly. However, more often than not, acute back pain comes on without any specific injury to your back.
You may experience:
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Back pain
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Muscle spasm
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Stiffness
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Leg pain (sciatica)
Watch the video above to find out how to help with this.
For most cases of back pain, X-ray and scans are of little benefit.
Chronic Back Pain
Chronic back pain refers to pain that has not gone away after three months. Like acute back pain, it is usually caused by a strain or a sprain in the back - but the pain and distress can last for much longer and it can have a big impact on your day-to-day life.
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Chronic back pain can range from a mild pain or ache, to a more severe pain. This can depend on a variety of things, such as how happy you are at home or at work, if you are prone to depression or if you have had back pain before. Chronic back pain usually requires treatment such as medication or physiotherapy.
In most cases though, your back will heal itself. It is important that you keep active and continue as normal, but if your pain is severe and persistent then you should seek medical advice for diagnosis and the appropriate treatment.
Do I need an MRI Scan?
Neck and back pain is very common and most of the time it will settle down and recover without any intervention.
We know that it can be very painful and limit our daily lives and it is natural to want to find out the cause of this pain.
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So, do you need a scan? Usually not.
An MRI of your neck or back can give a very detailed picture of the bones, discs and other soft tissue in that area. But that’s all it is, a picture. It does not tell you which part is causing the pain or why you feel the amount of pain you do.
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As we get older, we have an aging process that happens to the body – our hair starts to grey, our skin starts to wrinkle. We have an aging process on the outside of our body, but we also have an aging process that happens on the inside of the body. MRI is very good at giving us a picture of this process.
It would be normal to find a disc bulge or degeneration on an MRI scan. But these do not always cause us pain.
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So how do we know what is causing the pain?
The best way to diagnose your pain is to talk to a healthcare professional about your signs and symptoms. They will ask you questions like; "where exactly do you have the pain? What makes your pain worse? What makes it better? Do you have any pins and needles or numbness?"
A detailed assessment is much better at helping us understand why you have pain, and what you can do to help it.
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So when should I have an MRI?
MRIs are often used to rule out a serious problem, such as a broken bone or cancer. MRI can also be useful to help plan for further treatment e.g if surgery or an injection might be considered. A healthcare professional will take all of this into account when they asses you and might arrange an MRI if it would change your treatment. Back or neck pain on its own would not normally need a scan. However, should you develop any of the below signs alongside your neck or back pain, you should quickly seek further help:
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Sciatica in both arms or legs
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Weakness or numbness in your legs or arm that is severe or getting worse. Finding it difficult to use your hands for tasks like buttoning a shirt, picking up coins.
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Numbness around or under your genitals or around your anus. Problems getting an erection.
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Finding it hard to start peeing, or can’t control when you pee or you have accidents - and this is not normal for you.
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A loss of balance or control of your legs when walking.
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Unable to control what you do with your foot as you walk
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Dizziness, vomiting or blackouts, linked to moving your neck
Sciatica
Sciatica is a pain that travels down from your lower back or buttock, to your foot. It usually happens when the jelly within the discs that separate the bones of your spine (vertebrae) pushes out of the disc and irritates the sciatic nerve. Swollen muscles, joints or ligaments can also irritate the nerve causing sciatica.
The sciatic nerve runs down through the back, into the buttock, down the back of the leg and round to the outside of the lower leg and foot.
When the nerve gets compressed or irritated, the brain interprets the pain as coming from the buttock or leg instead of the back, where the problem actually is. The pain is often a severe shooting pain, sometimes accompanied with pins and needles or numbness.
You should seek urgent medical attention if you experience any of the signs mentions above (click to view)
Sciatica can usually be helped with exercise. If the pain is too severe to exercise, speak to your GP about medication you could take for a short time to allow you to exercise. When you're ready, try to exercise class on the back pain webpage.
Keeping Active
Regular exercise is a great way to manage back pain. People with higher fitness levels tend to experience less back pain. Try to go walking, swimming or cycling for 30 minuets or more a day.
Exercise classes such as yoga or pilates are also great for building strength in your back, and visiting the gym could also help.
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Keeping active is good for you, even if you're suffering back pain. Exercising can feel painful, but keeping active is one of the best ways to help manage your back.
Often people who have had back pain for long periods lose confidence their back. This means we often move the back less and are more cautious, which can mean we're less active and lose strength and our pain can get worse.
Exercise is a great way to build up confidence again, but it can be daunting. Start slow and steady. It takes time, but in most cases our back can recover.
Tips with Gardening
For many people, gardening is an active hobby that allows them to enjoy being outdoors. Having back pain doesn't mean you need to stop gardening. But it can help to adapt what we do.
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Plan out what you have to do that day. It can be a good idea to warm up and get your back moving. Think about what you have been doing recently to keep active. The body does not like big increases in exercise, so if you’ve not done much over the colder months, then its important to gradually build your fitness as you return to the garden.
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Supplementing gardening or physical work with an overall exercise program is a great way to keep the back and body healthy. If you’re not used to heavy lifting then it may be better to get some help or lighten the load. This may mean it takes a little longer to perform the task but lots of light trips are better for your back than one heavy task. Wheelbarrows can be really useful to make things easier. If you are tired, have a break to recover. Gardening is a great way to keep active, but be realistic with how fit you are. Consider the layout of your garden. It may be more suitable to have raised beds or pots which mean easier access and less demanding body positions. Again, it's better to start easy and gradually build up. Your health and your back are much more important than the condition of our garden.
The Myths about back pain.
from The Chartered Society of Physiotherapy
