Low Back Pain

Introduction

Back pain is a common problem that affects most people at some point in their life. It may be triggered by bad posture while sitting or standing, bending awkwardly, or lifting incorrectly. It’s not generally caused by a serious condition. 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

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

  • 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
  • Whiplash – neck injury caused by a sudden impact

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 doctor/pain physician who can advise you about the treatments available.

These include:

  • Stronger painkillers
  • Exercise classes – where you are taught specific exercises to strengthen your muscles and improve your posture
  • Manual therapy, such as physiotherapy, chiropractic or osteopathy
  • Counselling, such as cognitive behavioural therapy (CBT)
  • Epidural injections
  • Ozone nucleolysis
  • Facet injections
  • Caudal epidural injection
  • Median branch Radiofrequency ablation

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 it’s 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 (fever)
  • Unexplained weight loss
  • A swelling or a 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

Preventing back pain

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

If you have recurring back pain, the following advice may be useful:

  • Lose weight – too much upper body weight can strain the lower back; you can use the healthy weight calculator to find out whether you need to lose weight
  • Wear flat shoes with cushioned soles as they can help 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 – read more about recognising and managing stress
  • Atay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain (see below)

Sciatica

Introduction

Sciatica is the name given to any sort of pain that is caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

Signs and symptoms

When the sciatic nerve is compressed or irritated, it can cause pain, numbness and a tingling sensation that radiates from your lower back and travels down one of your legs to your foot and toes. The pain can range from being mild to very painful, and may be made worse by sneezing, coughing, or sitting for a long period of time.
Some people with sciatica may also experience muscle weakness in the affected leg. While people with sciatica can also have general back pain, the pain associated with sciatica usually affects the buttocks and legs much more than the back.

What causes sciatica?

In the vast majority of cases, sciatica is caused by a herniated or “slipped” disc. This is when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves. Less common causes include spinal stenosis (narrowing of the nerve passages in the spine), a spinal injury or infection, or a growth within the spine (such as a tumour).

You can minimise your risk of developing a slipped disc or back injury that could lead to sciatica by adopting a better posture and lifting techniques at work, as well as stretching before and after exercise, and exercising regularly.

How sciatica is treated

Many cases of sciatica will pass in around six weeks without the need for treatment. However, a combination of things you can do at home – such as taking over-the-counter painkillers, exercising and using hot or cold packs – may help reduce the symptoms until the condition improves.

In more persistent cases, you may be advised to follow a structured exercise programme under the supervision of a physiotherapist, have injections of anti-inflammatory and painkilling medication into your spine, and/or take stronger painkiller tablets.In rare cases, surgery may be needed to correct the problem in your spine.

TREATMENT

Treating sciatica

Treatment for sciatica is not always necessary, as the condition often improves naturally within around six weeks. However, if your symptoms are severe or persistent, a number of treatments are available. These usually include self-help and conservative treatments, such as medication and physiotherapy, although it’s not clear exactly how effective many of these treatments are in treating sciatica.In a small number of cases, surgery may be recommended to correct the problem in your spine that is thought to be causing your symptoms.

Self-help

There are a number of things you can do yourself to help reduce troublesome sciatica symptoms. These include remaining as active as possible, using hot or cold compresses, and taking simple painkillers, such as paracetamol or ibuprofen.

Exercise

If you have sciatica, it’s important for you to remain as physically active as possible. Simple exercises, such as walking and gentle stretching, can help reduce the severity of your symptoms and strengthen the muscles that support your back. While bed rest may provide some temporary pain relief, prolonged bed rest is often considered unnecessary and unhelpful. If you have had to take time off work due to sciatica, you should aim to return to work as soon as possible.

Compression packs

Some people find that using either hot or cold compression packs on painful areas can help to reduce the pain.
You can make your own cold compression pack by wrapping a pack of frozen peas in a towel. Hot compression packs are usually available from pharmacies. You may find it effective to use one type of pack followed by the other.

Painkillers

If you have persistent or troublesome sciatic pain, there are a number of painkilling medications that may help.

Spinal injections

If other methods of pain relief have not worked, your GP may refer you to a specialist for a spinal corticosteroid and/or local anaesthetic injection. This delivers strong anti-inflammatory and painkilling medication directly to the inflamed area around the nerves of your spine, which may help release the pressure on your sciatic nerve to reduce your pain.

Slipped Disc

A slipped disc – known as a prolapsed or herniated disc – occurs when one of the discs that sit between the bones of the spine (the vertebrae) is damaged and presses on the nerves.

This can cause back pain and neck pain, as well as symptoms such as numbness, a tingling sensation, or weakness in other areas of the body. The sciatic nerve is often affected in cases of slipped disc. It is the longest nerve in the body and runs from the back of the pelvis, through the buttocks and down both legs to the feet. If pressure is placed on the sciatic nerve (sciatica), it can cause mild to severe pain in the leg, hip or buttocks. Read more about the symptoms of a slipped disc.

The spine

The spine consists of 24 individual bones called vertebrae that are stacked on top of each other.
In between each vertebra there are protective circular pads of cartilage (connective tissue) called discs, which have a tough, fibrous case that contains a softer gel-like substance. The discs help maintain your back’s flexibility and wide range of movement. The spinal cord is highly sensitive and passes through the middle of the vertebral column. It contains nerve cells and bundles of nerve fibres that connect all parts of the body to the brain.

What causes a slipped disc?

A slipped disc occurs when the outer case of the disc splits, resulting in the gel inside bulging out of the disc. The damaged disc can put pressure on the whole spinal cord or on a single nerve root (where a nerve leaves the spinal cord). This means a slipped disc can cause pain both in the area of the protruding disc and in the area of the body controlled by the nerve that the disc is pressing on.

It is not always clear what causes a disc to break down, although age is a common factor in many cases. As you get older, your spinal discs start to lose their water content, making them less flexible and more likely to rupture.

Smoking also plays a role as it causes the discs to lose their natural flexibility.
It’s important to note not all slipped discs cause symptoms such as pain, weakness or tingling. Many people will go their whole life and not know they have a slipped disc, even though they have one.

Diagnosing a slipped disc

Your GP will usually be able to diagnose a slipped disc from your symptoms and medical history. They may also carry out a physical examination to test your:

  • Posture
  • Reflexes
  • Muscle strength
  • Walking ability
  • Sensation in your limbs

Treating a slipped disc

It can take about four to six weeks to recover from a slipped disc. Treatment usually involves a combination of physical therapy, such as massage and exercise, and medication to relieve the pain.

Surgery to release the compressed nerve and remove part of the disc may be considered in severe cases, or if the pain continues for longer than six weeks. In many cases, a slipped disc will eventually shrink back away from the nerve and the pain will ease as the disc stops pressing on the affected nerve.

Often the slipped disc will stay pressing on the nerve, but the pain goes away because the brain learns to “turn down the volume” on the pain messages coming from the nerve. If you have a slipped disc, it is very important to keep active. Initially moving may be difficult, but after resting for a couple of days you should start to move around. This will help keep your back mobile and stop the joints becoming stiff and the muscles that support the spine becoming weak. Keeping moving will speed up your recovery.

Any exercise you do should be gentle and not put too much strain on your back. Exercises that involve high impact, such as running, jumping or twisting, should be avoided at first as they may cause a flare-up of the pain.

Preventing a slipped disc

Taking a few sensible precautions, such as leading a healthy lifestyle, can help prevent back pain and lower your risk of getting a slipped disc. For example, you should:

  • Take regular exercise
  • Use a safe technique when lifting heavy objects
  • Always maintain a good posture when sitting and standing
  • Quit smoking if you smoke

Lumbar spine illustration

  1. Healthy disc
  2. Nerve
  3. Slipped disc
  4. Damaged disc
  5. Spinal cord

How common are slipped discs?

Slipped discs are most common in people aged between 30 and 50 years old. The condition affects twice as many men as women