When should I be worried about back pain?

What should I know about back pain?

Back pain is a very common problem and will affect many of us at some point during our lives.

The good news is that in most cases it isn’t a serious problem, and it might just be caused by a simple strain to a muscle or ligament.

As far as possible, it’s best to continue with your normal everyday activities as soon as you can and to keep moving.

Being active and exercising won’t make your back pain worse, even if you have a bit of pain and discomfort at first. Staying active will help you get better. Taking painkillers can help you do this.

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How your back works

The spine, which is also called the backbone or spinal column, is one of the strongest parts of the body and gives us a great deal of flexibility and strength.

It’s made up of 24 bones, known as vertebrae, one sitting on top of the other. These bones have discs in between and lots of strong ligaments and muscles around them for support. There are also the bones in the tailbone at the bottom of the back, which are fused together and have no discs in between.

On either side of the spine, running from top to bottom, are many small joints called the facet joints.

The spinal cord passes inside the vertebrae, which protect it.

The spinal cord connects to the brain through the base of the skull and to the rest of the body by nerves that pass through spaces between the bones of the spine. These nerves are also known as nerve roots.

As you grow older, the structures of your spine, such as the joints, discs and ligaments, age as well. The structures remain strong but it’s usual for your back to get stiffer as you get older.

Causes

Often back pain doesn’t have one simple cause but may be due to one or more of the following:

• poor posture

• lack of exercise resulting in stiffening of the spine and weak muscles

• muscle strains or sprains.

As well as the things listed above, there are also specific conditions which are linked with pain felt in the back. It’s important to remember that severe pain doesn’t necessarily mean there’s a serious problem. Some common conditions are listed below.

Spondylosis

As we grow older, the bones, discs and ligaments in the spine can naturally weaken as they age. This happens to all of us to some degree as part of the ageing process, but it doesn’t have to be a problem and not everyone will have pain from this.

As we grow older the discs in the spine become thinner and the spaces between the vertebrae become narrower. Little pieces of bone, known as osteophytes, may form at the edges of the vertebrae and facet joints.

The medical term for this is spondylosis and is very similar to the changes caused by osteoarthritis in other joints.

Keeping the spine supple and the muscles around the spine and pelvis strong, will reduce the impact of spondylosis.

Sciatica

Back pain is sometimes linked with pain in the legs, and there may be numbness or a tingling feeling. This is called sciatica.

This is due to a nerve in the spine being pressed on or squeezed. For most people with sciatica, the leg pain can be the worst part and occasionally they may have little or no back pain at all.

In most cases sciatica is caused by a bulging disc pressing on the nerve. Discs are designed to bulge so we can move our spines about easily, but sometimes a bulge can ‘catch’ a nerve root and cause pain that travels all the way down the leg and foot.

Most people recover fairly quickly, although in some cases it might take a number of months.

Starting gentle exercise as soon as you can will greatly help with sciatica. It is also a very good idea to see a physiotherapist.

Spinal stenosis

Sometimes back pain is linked with pain in the legs which starts after you start walking for a few minutes, and then tends to get better very quickly when you sit down. This is known as spinal stenosis.

This can happen from birth or can develop as we get older.

Problems are caused when something presses on the small space in the middle of the spine, where the nerves are. This space, which is called the spinal canal or nerve root canal, can be squeezed by bone or ligament.

Symptoms often affect both legs, but one may be worse than the other. The pain usually gets better when you sit down and rest, and some people find they have less pain if they walk a little stooped. Like sciatica, the main problem tends to be leg pain more than the back pain.

In most cases, neither sciatica nor spinal stenosis are serious problems. However, if the symptoms cause you a lot of trouble and greatly affect your quality of life then you should see your doctor for further advice and to discuss what else can be done.

Other causes

Other rarer causes of back pain include:

• bone problems such as a fracture – often linked to thinning of the bones, which is known as osteoporosis

• an infection

• a tumour

• inflammation, for example in the condition ankylosing spondylitis.

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When to see a doctor

Even though it's common, most cases of back pain tend to clear up without the need to see a doctor.

You should see your doctor if your pain:

• is really bad

• lasts for a long time

• stops you from working or doing the things you enjoy

• affects your everyday activities

• gets worse.

You should also see your doctor if you have any changes in sexual function, for example, being unable to get an erection.

If the pain is causing you significant problems and stops you from getting on with normal life and work activities, your doctor will examine you and ask you questions.

These questions will help predict how likely it is that you need further help with your back pain. If you do need further support, your doctor will make a referral to physiotherapy so that you can have treatment early, to help with the pain and return to normal activities.

It’s natural to want to know what has caused your back pain. However, specialists may not be able to tell you for certain what has caused your back pain, even after carefully assessing you.

If you’re concerned about the cause of your back pain, it can help to talk openly about any worries with a healthcare professional, as reducing any fear may help speed up your recovery.

What are the warning signs of a serious problem?

Very rarely back pain or pain that travels down the leg is a sign of a serious problem.

If you have any of the following symptoms, you should seek urgent medical attention:

• difficulty controlling or passing urine

• loss of control of your bowels

• numbness around your back passage or your genitals

• serious weakness in your legs so you find standing really difficult

• severe and ongoing back pain that gets worse over several weeks.

The above symptoms could potentially be linked to a rare but serious condition that needs urgent medical attention.

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Diagnosis

National guidelines suggest that doctors should use a common-sense ‘wait and see’ approach when diagnosing back pain before deciding if you need further treatment, especially as most cases of back pain improve by themselves. As a patient this approach can sometimes be frustrating, but you may find that if you keep up your self-help measures, you won’t need further treatment anyway.

Should you need further treatment, your GP will be able to assess your back pain by discussing your symptoms with you. Most problems can be diagnosed after a simple examination, and it’s unlikely that any special tests will be needed.

Tests

You may be sent for tests if:

• you’ve had an injury to your back, for example a bad fall

• your doctor suspects that there may be an underlying cause for your pain

• the pain has lasted for an unusually long time.

In this case a magnetic resonance imaging (MRI) scan or computerised tomography (CT) scan may be needed.

X-rays are much less commonly used because back pain is often caused by problems with soft tissues, such as ligaments and muscles, which can’t be seen on x-rays.

Changes to the spine as a result of spondylosis can show up on x-rays. These common changes that happen to us all can appear on x-rays without people having any pain or problems. Because of this, x-rays aren’t particularly helpful.

Remember that sometimes even after a thorough investigation it might not be possible to say for certain what is causing back pain.

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Managing your symptoms

The most important things to do to treat back pain is to keep moving, continue with everyday activities and have a healthy lifestyle.

Some people worry that if they have back pain, doing certain activities such as lifting things, twisting and turning might make their back pain worse. It’s important to remember that our backs and our spines are very strong and are designed to move.

In fact, too much rest can make back pain worse.

Being active and continuing with your everyday activities as soon as possible, and as much as possible, will speed up your recovery.

There’s also evidence to suggest that how you respond emotionally to having back pain has an important impact on how quickly you get better. The more positive you are, the more active you are, the quicker your back will get better.

Remember, if you’re ever struggling don’t suffer in silence, talk to a healthcare professional.

Keep moving

Staying active is the most important way you can help yourself if you have back pain.

Keeping the muscles around the spine strong, will provide more support to the bones and joints and take pressure off them. The more you move, the more the back will keep its natural range of movement.

If you stop being active for a long time, the muscles in your back become weak and you become less fit, and this can make your back pain worse. Not moving can make your back more stiff and painful.

Regular exercise leads to shorter and less frequent episodes of back pain. It also releases chemicals called endorphins, which are the body’s natural painkillers. These improve pain and make you feel happier.

Exercise might make your back feel a bit sore at first but it doesn’t cause any harm – so don’t let it put you off. If you're getting back to exercise, start off gently and gradually increase the amount of exercise you do. Regular and small episodes of exercise is a good way to start and then each day try to do a little bit more.

Try taking some painkillers beforehand too. Over time, your back will get stronger and more flexible, and this should reduce pain.

Types of exercise for back pain

It’s better to choose a form of exercise that you enjoy as you’re more likely to stick to it. There are many forms of exercise that have helped people with back pain. Examples include:

• swimming

• walking

• yoga

• Pilates

• going to the gym.

Research has found that a specially developed 12-week yoga programme can help people with low back pain lead more active lives and manage their condition more effectively. Many of the people who took part in the study also found that they had the knowledge to prevent further attacks if they felt an episode of back pain coming on.

You can find more information about the 12-week programme at www.yogaforbacks.co.uk

Many community and sports centres also run yoga classes if you’re interested in trying it. Make sure you speak to the yoga instructor before you start so they’re aware that you have back pain.

You can find some examples of exercises you might like to try to reduce your pain on our exercises for the back page.

Pain during exercise

You may feel some discomfort and sometimes pain when you exercise. This feeling is normal and should calm down a few minutes after you finish. It’s not a sign that you're hurting yourself. Exercise will help reduce pain and can help you manage your back pain better.

While you can push yourself and do strenuous exercise, it’s important not to overdo it. If you are in pain that you can’t cope with during or after your activity, you will need to see a doctor. The key is to start off gently and to gradually increase the amount you do.

Often people stop exercising once their back pain has cleared up. But if you stop exercising all the improvements you’ve made will disappear within a few weeks. So, it’s important that you continue to exercise regularly and don’t stop when the pain is gone and you’re feeling better.

If you’re ever having any trouble exercising, it can be a good idea to see a GP or ask for a referral to a physiotherapist for tailored exercise advice. If you're a member of a gym, there may well be personal trainers there who can give you expert advice. Make sure you tell them about your condition.