Back Care

8th December, 2008 - Posted by Andy - No Comments

Introduction
Back pain is common and the largest single cause of sickness absence in the UK. Although it can be very painful, it is normally not serious.
Lower back pain, also known as lumbago, affects 7 out of 10 people at some time in their lives. Low back pain means a pain, or ache, anywhere on your back, in between the bottom of the ribs and the top of the legs.

The pain can come on suddenly, slowly or be the direct result of a fall or injury.
In most cases, the pain lasts from a few days to a few weeks and usually clears up after about six weeks.
There are two categories of back pain
• acute - this is where your back pain lasts for less than 3 months, and
• chronic - this is where your back pain develops gradually over time, lasts more than 3 weeks, and causes long-term problems.

Back pain can affect anyone, of any age, but it is more common in people between the ages of 35-55 years.
In the majority of cases, the cause of pain can be linked to the way the bones, muscles and ligaments in the back, work together.

The back is a complex structure consisting of:
• 24 small bones (vertebrae),
• shock absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend,
• ligaments to hold vertebrae and discs together,
• tendons to connect muscles to vertebrae,
• spinal cord (carries nerves from the brain to the rest of the body),
• nerves, and
• muscles.

The structure of the lower back - the lumbar region
• the lumbar region is made up of 5 vertebrae, known as L1 to L5,
• this region bares the entire weight of your upper body (plus any extra weight you are carrying), and
• the region is under continue pressure, especially when your are bending, twisting and lifting.

Back Pain
The complex structure of your 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 of stress or damage to your ligaments, muscles, tendons or discs. In some cases the back pain can spread to the buttocks and thighs.
In most cases the back will heal itself and staying active and continuing with your usual activities will normally promote healing.
In severe and persistent cases it is important to seek medical advice so that a correct diagnosis can be reached and appropriate treatment given, as treatment may depend on the underlying cause in some cases. For example, pain caused by some types of arthritis may be treated by specific medicines.

Symptoms
The symptom of low back pain is a pain or ache anywhere on your back, in between the bottom of the ribs and the top of the legs.
The majority of cases of back pain usually clear up quite quickly. However if you are worried or concerned about your back pain, seek medical advice.
Visit your GP as soon as possible if begin to experience back pain together with any of the following symptoms:
• a fever,
• weight loss,
• inflammation or swelling on the back,
• constant back pain that does not ease after lying down or resting,
• pain that travels to the chest or pain high up in your back,
• pain down the legs and below the knees,
• you have had a recent trauma or injury to your back,
• loss of bladder control,
• unable to pass urine,
• loss of bowel control,
• numbness around the genitals, buttocks or anus, or
• It is advised you seek medical advice if you are experiencing back pain and:
• you are under 20 years old or over 55 years
• you have taken steroids for a few months,
• you are a drug abuser,
• you have or have had cancer, or
• you have a low immune system due to chemotherapy or another medical condition e.g. HIV/AIDS

Also, if the pain developed slowly but has got increasingly worse over days or weeks, ask your GP for advice.

Causes
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.
Back pain can also be triggered by everyday activities at home or work, and poor posture including:
• bending awkwardly,
• lifting, carrying, pushing or pulling incorrectly,
• slouching in chairs,
• standing or bending down for long periods,
• twisting,
• coughing,
• sneezing,
• muscle tension,
• over-stretching,
• driving in hunched positions, or
• driving for long periods without a break.

Sometimes, you can just wake up with back pain and have no idea what has caused it.
Some other causes of back pain are:
• pregnancy,
• gynaecological problems in women, e.g. pelvic inflammatory disease,
• different types of arthritis, e.g. osteoarthritis,
• stress related tension,
• viral infections,
• bone disorders,
• bladder and kidney infections,
• osteoporosis,
• a trip or fall,
• trauma or injury e.g. fracture,
• lack of exercise,
• obesity, or
• sleep disorders.

Serious back pain can be 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 pain will usually be in the lower back but you may experience pain in the buttocks, thigh, calves, feet and toes due to irritation of the sciatic nerve, which runs down both legs. Occasionally, the pain is also accompanied by pins and needles, numbness and weakness.
Discs may tend to dry out and weaken with age, or following an injury. This results in the discs becoming less flexible, which means they do not cushion the vertebrae as well as before. This is a common cause of stiffness and pain, especially early in the morning and/or in the elderly.
Persistent lower back pain may also be caused by a number of other rare conditions such as congenital spinal defects, bone diseases, shingles, fibromyalgia, prostatitis, or cancer that has spread to the spine.

Diagnosis
A diagnosis is made from discussing the symptoms with your GP and a physical examination.
In most cases, no tests are needed as X-rays or scans of the back are not always helpful because they do not show anything unusual if you have simple back pain.
You will only be sent for tests if the pain lasts for longer than six weeks, you have had an injury or blow to your back or if your doctor suspects there may be an underlying cause for the pain.

For suspected disc problems, X-rays, a computed tomography scan (CT or CAT scan) may be required. A magnetic resonance imaging (MRI) may be suggested to provide more accurate information about the soft tissues in your back, rather than the bones.
In some cases, blood tests or a myelogram (a special kind of X-ray using an injected dye) may be needed.

Treatment
Most cases of back pain will improve on their own within a few days or weeks. Staying as active as possible will help relieve symptoms even if you are in a lot of pain.
Current recommended treatment for lower back pain includes:
• continuing with your normal activities wherever possible,
• the use of over-the-counter painkillers,
• the use of anti-inflammatory medicines and stronger painkillers (consult your pharmacist or GP first),
• the use of a muscle relaxant may be prescribed but only for a few days,
• if you are in severe pain, keep any bed rest as short as possible, as complete rest does not help recovery,
• doing exercises to strengthen your muscles and improve your posture,
• applying a cold compress (bag of frozen peas wrapped in a tea towel) to reduce the initial inflammation, applying heat (heating pad, hot water bottle or hot shower) after a few days to ease muscular pain,
• the use of anti-arthritis medication for back pain caused by arthritis.

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 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.
You can also consider seeing a qualified physiotherapist, osteopath or chiropractor as some of the treatments they provide, like physiotherapy or back or spinal manipulation, may provide short term comfort in some people with acute back pain or nerve root pain.

In rare, serious cases, surgery may be required to repair a protruding or ruptured disc.
It is advised that you continue to work, or return to work as soon as possible.

Transcutaneous Electrical Nerve Stimulation (TENS)
An increasing popular treatment for people with long-term back pain is the use of Transcutaneous Electrical Nerve Stimulation (TENS) machines. The machine delivers small electric pulses to your body through electrodes that are placed on your skin.
It is thought that these pulses work in two ways. A low electric pulse can encourage your body to produce more endorphins - the body’s own pain-killing chemical. A high electric pulse can block pain signals going from your back to your brain.
Many medical studies have been carried out on the use of TENS but the results have been conflicting. Some studies suggest the machines are of little use, while other studies suggest that they may be able to help certain people.

You should only use a TENS machine under the direction of a doctor or health care professional.
The following people must not use a TENS machine:
• pregnant women - unless specifically advised by their doctor,
• people with epilepsy,
• people who have a pacemaker fitted, and
• people with a history of heart disease.

Prevention
To avoid back pain, you must reduce excess stresses and strains on your back, and ensure that your back is strong and supple.
If you have persistent, recurring bouts of back pain, the advice outlined below may be useful.
• lose any excess weight -( You can use the Body Mass Index (BMI) to find out if you are a healthy weight for your height. A BMI calculator is available in the ‘Mind & body magazine’ section of this site),
• practise the Alexander technique,
• wear flat shoes with cushioned soles as these can reduce the stress on your back,
• avoid sudden movements or muscle strain, and
• try and reduce your stress, anxiety and tension.

Posture
How you sit, stand, and lie down is important and can have an important effect on your back. The following tips should help you maintain a good posture
• Standing - you should stand upright, with your head facing forward and your back straight. Balance your weight evenly on both feet and keep your legs straight.
• Sitting - when sitting, you should be able 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.
• Driving - as with sitting, make sure 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 you can stretch your legs.
• Sleeping - in the past people with back pain were told to sleep on a firm mattress, but studies have shown that a medium-firm mattress is better. 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 (three-quarters of an inch) thick - on top of the base of your bed and under the mattress. Support your head with a pillow, but make sure your neck isn’t forced up at a steep angle.

Exercise
Exercise is both an excellent way of preventing back pain and reducing any back pain you might have. (If you have chronic back pain - back pain that has lasted more than 3 months - you should consult your GP before starting any exercise programme.)
Exercises like walking or swimming strengthen the muscles that support your back without putting any strain on it, or subjecting it to a sudden jolt.
Activities like 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 to help prevent or relieve back pain:
• Wall Slides - stand with your back against a wall with your feet at shoulder-width apart. Slide down into a crouch so your knees are bent to about 90 degrees. Count to five and then slide back up the wall. Repeat 5 times.
• Leg Raises - lie flat on your back on the floor. Lift each heel in turn just off the floor while keeping your legs straight. Repeat 5 times.
• Bottom Lifts - lie flat on your back on the floor. Bend your knees so your feet are flat on the floor. Then lift your bottom in the air by tightening your stomach muscles while keeping your back straight. Repeat 5 times.

At first you should do these exercises once or twice a day, and then gradually increase to doing them six times a day, as your back allows.
These exercises are also useful for ‘warming up’ your back. Many people injure their back when doing everyday chores at home or work, such as lifting, gardening or using a vacuum cleaner. ‘Warming up’ your back before you start these chores can help prevent injury.
Lifting and handling
One of the biggest causes of back injury, especially at work, is lifting or handling objects incorrectly. Learning and following the correct method for lifting and handling objects can help prevent back pain.
• 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 don’t stoop or squat. Tighten your stomach muscles to pull your pelvis in. Don’t 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 - especially 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 your 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, don’t 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
Preventing back pain in children

Back pain in secondary school age children has been linked to heavy schoolbags and backpacks as well as ill-fitting classroom seating. Nearly half of all teenagers in the UK have experienced occasional backache from carrying overloaded bags, poor posture and an unhealthy lifestyle.
The best schoolbag for your child is a well designed backpack. This should be worn over both shoulders to balance out the weight. A heavy satchel or shoulder bag can put stress on your child’s spine.

Encourage your child to exercise regularly, or plan joint activities, such as a walk in the countryside or a trip to a swimming pool.

[sources: nhs direct]

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