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Back pain
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Lower back pain, also referred to as lumbago, affects 4 out of 5 people at some time in their lives. In most cases the pain lasts from a few days to a few weeks, but in some cases can last longer and reoccur. Back pain may come on quickly and be severe (acute) or develop gradually over time and cause longer-term problems (chronic).

The back is a complex structure consisting of: 24 bones (vertebrae) cushioned by shock absorbing discs (intervertebral discs), ligaments to hold vertebrae and discs together, tendons to connect muscles to vertebrae, spinal cord and nerves, and muscles.

The lower part of the back, the lumbar region, is composed of 5 vertebrae known as L1 to L5. This region bears the entire weight of the upper body (plus any extra weight carried) and is also under continual stress especially when bending, twisting, and lifting.

The complex structure of the lower back means that quite small amounts of damage to any of the structures of the back can cause a lot of pain and discomfort. Pain in the lower back is a symptom that there has been stress or damage to the ligaments, muscles, tendons or discs.

In most cases the back will heal itself but in severe and persistent cases it is essential to seek medical advice so that a correct diagnosis can be reached and appropriate treatment given.

Most lower back pain is referred to as non-specific because it is caused, not by serious damage or disease, but by sprains, muscle strains, minor injuries, or a pinched or irritated nerve. It can also occur during pregnancy, or because of stress, viral infection, kidney infection, or sleep disorder.

Back pain can also be triggered by everyday activities: awkward bending, lifting, twisting, coughing, sneezing, muscle tension, over-stretching or driving for long periods without a break. Accidents in the home, at work, or when driving (including whiplash) are also common causes.

The most common form of serious back pain is caused by the bulging or rupture of one or more of the intervertebral discs causing the inner jelly-like material (nucleus pulposus) to press on the spinal cord or nerve roots which run next to the disc. This is commonly known as a slipped disc but is more accurately described as a prolapsed (bulging) or herniated (ruptured) disc; the core of the disc leaks rather than slips resulting not only in back pain but also pain in the buttocks, thigh and leg due to irritation of the sciatic nerve.

Discs usually dehydrate and degenerate with age, or following an injury. This results in the discs becoming less flexible, less useful in cushioning the vertebrae, and therefore a common cause of stiffness and pain, especially early in the morning and in the elderly (through osteoporosis).

Persistent lower back pain may also be caused by a number of other rare conditions such as congenital spinal defects, bone diseases, tumour, pelvic inflammatory disease, congenital defects, and prostatitis.

Diagnosis is made from symptoms and physical examination.For suspected disc problems x-rays, a computed tomography scan (CT or CAT scan), or a magnetic resonance imaging scan (MRI) may be suggested to provide more accurate information.

Currently recommended treatment for lower back pain is:

use of over-the-counter painkillers;
use of anti-inflammatory drugs and stronger painkillers (consult your pharmacist or GP first);
continue with normal activities wherever possible;
treatment by a qualified osteopath, chiropractor, physiotherapist, or acupuncturist may help, although studies have shown that advice to keep active may be just as helpful as a course of physiotherapy for mild pain;
continue to work, or returning as soon as possible;
bed rest for no longer than two days, any more will be counter productive;
exercises to strengthen the muscles and improve posture;
apply cold (bag of frozen peas wrapped in a tea towel) to reduce the initial inflammation;
apply heat (heating pad or hot shower) after a few days to ease muscular pain;
ultrasound may help reduce inflammation.
you may find that the Alexander technique helps. The Alexander Technique is a method that works to change movement habits in your everyday activities. It helps to make you aware of balance, posture and co-ordination and aims to help you to relearn the correct way to hold and to move your body and release unnecessary muscular tension. You should always see you GP first as there are many possible causes of your back pain. Alexander teachers do not make medical diagnoses.
In rare serious cases surgery such as microdiscectomy, which involves the repair of a protruding or ruptured disc, may be suggested.

To avoid back pain you must minimise excess stresses and strains on your back, and ensure your back is strong and supple. The following advice also applies to those with persistent, recurring episodes of back pain:

lose excess weight,
do strengthening exercises to improve your back and stomach muscles,
adopt a good body posture,
practise the Alexander technique
ensure an appropriate bed and mattress,
correct lifting and handling,
avoidance of sudden exertion or muscle strain,
try and reduce stress, anxiety and tension, and
take regular exercise (walking, swimming and stretching are good for those with a bad back).

© Queen's Printer and Controller of HMSO, 2005

Crown copyright material is reproduced with the permission of the controller of HMSO and the Queens Printer for Scotland.



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