WHAT IS IT? BACK PAIN

Back pain is very common and usually improves within a few weeks or months.

Pain in the lower back (lumbago) is particularly common, although it can be felt anywhere along the spine, from the neck down to the hips.

In most cases the pain is not caused by anything serious and will usually get better over time.

There are things you can do to help relieve it. But sometimes the pain can last a long time or keep coming back.

Consult your Doctor

If you experience any of the following symptoms in conjunction with back pain then please contact your doctor or GP immediately:


Cauda equina syndrome

  • Bilateral sciatica (pins and needles/ burning pain/ weakness/ numbness) in both legs

  • Severe or progressive weakness in both legs with knee extension, ankle eversion, or foot dorsiflexion/plantarflexion.

  • Difficulty/ loss of sensation with urinating either with retention or incontinence

  • Loss of sensation when emptying bowels/ faecal incontinence

  • Perineal or genital sensory loss or numbness.

Spinal fracture

  • Sudden onset of severe central spinal pain which is relieved by lying down.

  • There may be a history of major trauma (road traffic accident or fall from a height)

  • Minor trauma or strenuous lifting in people with osteoporosis or those who use corticosteroids.

  • Structural deformity of the spine

Cancer

  • The person usually being more than 55 years of age.

  • Gradual onset of symptoms.

  • Severe constant pain that doesn’t go away, aggravated by coughing/ sneezing

  • Localised spinal tenderness.

  • Unexplained weight loss.

  • History of cancer

Infection

  • Fever

  • Tuberculosis, or recent urinary tract infection.

  • Diabetes.

  • History of intravenous drug use.

  • HIV infection, or if the person is immunocompromised.

Signs & Symptoms

  • All age groups can be affected, but the impact on quality of life is more severe in adults

  • Severe acute pain in the back

  • Tenderness either side of the spine

  • Muscle spasms

  • Reduction or inability to move through the lower back

  • Stiffness in the morning which lasts <30 minutes-1 hour

  • Single sided intermittent sciatic type symptoms, potentially worse at night- down the leg (tingling, burning, pins and needles, numbness)

What Causes It?

  • Repetitive overhead activities leading to excessive back extension

  • Postural Strain

  • Lumbar sprain or strain

  • Traumatic injury- leading to pressure on discs or joints

  • Poor heavy lifting mechanics- poor moving and handling techniques

  • Weak lower back muscles

  • Other muscular pain- in feet/ hips/ knees/ mid-back

  • Obesity, poor health, and smoking can aggravate joints and discs

  • Depression, anxiety and mental stress

  • Sitting, standing, walking for more than 2 hours per day either suddenly or overtime

How to Self Manage

  • Sciatica symptoms usually settle within 4–6 weeks, but may persist for longer in some people.

  • Taking anti-inflammatories or painkiller as long as these are safe for you to take.

  • Heat packs or hot water bottles may relieve pain and muscle spasm.

  • A small firm cushion between the knees when sleeping on the side, or firm pillows under the knees when lying on the back, may ease symptoms.

  • Simple exercises may help relieve symptoms- www.backcare.org.uk.

  • Prolonged bed rest is not recommended as this can lead to stiffness and weakness of the lower back.

  • Normal movements may produce some pain which should not be harmful if activities are resumed gradually and as tolerated.

  • The person does not need to be pain-free before returning to normal activities or work. Work adjustments (chair/ workstations) should be arranged by Occupational Health.

  • Keeping as active as possible and exercising regularly is important to reduce the risk of recurrence.

  • Meditation and mindfulness practice

Prognosis

  • Sciatica symptoms usually settle within 4–6 weeks, but may persist for longer in some people.

  • 90% of people with Low Back Pain will recover in 3-4 months with no treatment.

  • 70% of people with Low Back Pain will recover in 6 weeks with no treatment.

  • Physiotherapy speeds up the rate of recovery and helps assist the patient with the self-management of their symptoms

How Physio Helps

  • Usually consists 6 weeks of a personal management plan discussed with your physiotherapist.

  • Exercise programmes: aerobic activity, stability and movement advice, muscle strengthening, and postural control

  • Assessments and screening to determine which structures have been affected and what symptoms can be addressed.

  • Biomechanical review/ Postural correction/ Motor control retraining of lower back muscles

  • Soft tissue massage and trigger point release.

  • Acupuncture and dry needling.

  • Mindfulness and Cognitive behavioural therapy

  • Mobilisations and manipulation (manual therapy)

  • Referral to an orthopaedic specialist for advice on management with persistent low back pain.

  • Review of workplace/sporting ergonomics.

References

  • Campbell, J. and Colvin, L.A. (2013) Management of low back pain. BMJ. 347, f3148.

  • Keele University (2017) The STarT Back Screening Tool. Keele University.. www.keele.ac.uk

  • National Collaborating Centre for Primary Care (2009) Low back pain: early management of persistent non-specific low back pain. National Institute for Health and Clinical Excellence.. www.nice.org.uk 

  • NICE (2015) Suspected cancer: recognition and referral (NG12). National Institute for Health and Care Excellence. www.nice.org.uk

  • Toward Optimized Practice (2015) Evidence-informed primary care management of low back pain. Alberta Medical Association. www.topalbertadoctors.org

  • Williams, C.M., Henschke, N., Maher, C.G., et al. (2013) Red flags to screen for vertebral fracture in patients presenting with low-back pain (Cochrane review). The Cochrane Library. John Wiley & Sons, Ltd. www.thecochranelibrary.com

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