Prevention and treatment of Back Pain

The body also produces its own natural painkillers called endorphins. Exercise and treatments such as physiotherapy, manipulation and acupuncture help to increase the endorphins in your body.
Chronic pain is more difficult than acute pain to help and sometimes doesn't respond to treatments such as over-the-counter painkillers and physiotherapy.
People with chronic pain often need specialist advice and support. Sometimes, they are referred by doctors and physiotherapists to pain clinics.
Although most cases of back pain are caused by the stress and strain we put our bodies under, some conditions can make the problem worse or trigger it in the first place.

Back pain: when to see your doctor

Many people with back pain never need to see their doctor. But you should feel able to call or visit your GP if you're worried about your back or feel unable to cope with the pain. As a general rule, people with back pain are advised to contact their doctor if the pain is no better after about a week.
You should certainly see your GP as soon as possible if you have any of these symptoms:

• Difficulty passing urine, or if you are passing blood
• Numbness around the back passage or genitals
• Numbness, pins and needles or weakness in the legs or arms
• Pain running down one or both legs
• Unsteadiness when standing

These are associated with uncommon conditions, but ones that need treatment immediately.

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What doctors can do for back pain

There's no quick fix for most back pain and your doctor is unlikely to be able to 'cure' you. However, they will be able to:

• Check you don't have a serious condition
• Discuss your posture and activity level
• If needed, help with a weight-loss programme
• Prescribe another type of painkiller
• Refer you to other health practitioners who can help

Your doctor will probably give you a physical examination and ask you about your back pain.
Here are some probable questions your GP will ask. Think them through to make the most of your medical examination:

• When did your back pain start?
• What were you doing when it started?
• Have you had any back problems in the past?
• Where is your pain?
• What sort of pain is it - dull, piercing or shooting?
• Does it stay in the same place?
• What makes the pain better, or worse?
• Do you have any other symptoms, in your back or elsewhere?
• What does your back pain stop you doing?
• What have you been doing which might have contributed to giving yourself a bad back?
• What can you do in the future to try and keep your back healthy in the long term?

If you're not happy with your doctor's diagnosis or if your symptoms keep coming back, go back to your GP or ask another health expert for their opinion.

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Other people who can help back pain

If your back problem doesn't clear up quickly, your family doctor may refer you to another health practitioner. This is most likely to be a physiotherapist or another doctor, and may involve a visit to the hospital for examinations, tests and treatment.
Even if your doctor doesn't refer you to anyone else, you can visit another health practitioner privately. Some people go straight to a physiotherapist, osteopath or chiropractor as soon as back pain starts, but this can be expensive.
Private sessions can cost about £30, and the practitioner may recommend a course of treatment over several weeks. It's a good idea to check with your doctor whether you can see someone on the NHS before making decisions about who to see privately. Some doctors can refer you to an osteopath or acupuncturist.
If you do decide to see a practitioner privately, personal recommendation is a good starting point. But remember your back problem is unique - just because a specialist helped a friend it doesn't mean they'll be able to do the same for you.

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First aid for backs

The following self-help treatments may help to relieve back pain.

Apply heat and ice

Apply an ice pack to the affected area. If you haven't got an ice pack, use a bag of frozen vegetables instead. Don't put the ice directly on your skin, as it might cause a cold burn. Put a wet cloth between the ice and your skin.
If ice doesn't work, try applying gentle warmth with a hot water bottle. Don't apply the hot water bottle directly to the skin - cover it so it isn't too hot. A hot bath or shower might also help.
Some people find alternating heat and cold produces most relief. Try to get professional advice on applying heat and ice if you can.

Medication

Take painkillers following the instructions on the packet - never take more than the recommended dose. Many people find that paracetamol or ibuprofen helps - your pharmacist can advise you.
Painkillers shouldn't be used as a long-term solution. If you find you still need them after a week or so, consult your doctor.

Relaxation

Muscle tension is bad for back pain, so try to relax as much as possible. Take a long bath or listen to soothing music. Use a relaxation tape if you have one.
A gentle massage from a partner or friend may help, but make sure they don't do anything that causes pain.
Topical anti-inflammatory gels such as ibuprofen can also be massaged gently onto the skin over the back.

Bed rest versus exercise

Doctors used to recommend long periods of rest for people with backache, but research has shown this is actually bad for backs. Even crawling around on your hands and knees is better than no movement at all.
Some kinds of exercise, such as walking, don't put too much stress on your back. It's a good idea to make a start on them even if your back is a bit sore, just to get your joints moving and your heart and lungs working.
Use a firm chair when sitting down, or sit on the floor rather than a sofa that’s too soft. Similarly, make sure your bed is firm enough.

Getting back to normal

In most cases, the back recovers naturally if allowed to do so and the pain should settle in a couple of days. Once this has happened, continue getting back to normal activities and try not to stay in one position or do any one activity for more than 30 minutes.
Avoid lifting, bending or twisting until the pain has gone for a few days. Refrain from returning to the activity that caused the pain for a week or so, even if you feel better, and gradually build up your exercise and activities day by day.
Don't just listen to your friends and relatives - ask an expert. Talk to your doctor or a properly physiotherapist, osteopath or chiropractor. You can also contact a voluntary organisation such as BackCare.

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Back pain: making adjustments

Making small changes to your lifestyle can reduce your risk of back pain.
Back pain can be caused by many factors. Run through your daily routine and examine the amount of strain you place on your spine.
Stress can also create muscle tension, causing a loss in flexibility that can lead to back pain. To reduce stress, try exercise, yoga, meditation, getting more sleep or listening to music.
If you smoke, stop. It puts you at increased risk for back problems since your blood has trouble delivering oxygen to working tissues, making your back weaker.

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Dealing with back pain at home

The best way to sit down is to do it without bending your back. Stand in front of the chair with one foot behind the other, almost under the chair. Bend your knees, and at the same time place your hands on the arms or seat of the chair. Lower yourself gently into the seat. A chair with arms makes this much easier.
The following can also help back health in the home:

• Make sure work surfaces are a comfortable height so you don't have to bend your back
• Use a ladder or stable chair when painting or cleaning - don't stretch too far
• Squat or kneel when cleaning the bath or reaching low shelves
• Use an upright vacuum cleaner and keep it close to your body
• Ensure easy access to each side of the bed so you don't have to stretch when making it, and kneel or squat to tuck in sheets and blankets.
• Take regular breaks from time-consuming tasks

If you have children, make sure you:

• Bend your knees to pick up a baby - don't twist
• Kneel down to talk to toddlers rather than picking them up
• Adjust the height of the cot so you don't need to bend, or choose one with drop sides
• When unloading a pram's shopping tray, always bend from the knees

When getting into bed, sit on the edge, lower your body on to one elbow and shoulder and draw up your knees and then feet. Reverse the procedure to get out.
The wrong sleeping arrangements can put additional strain on your back. If you're experiencing back problems, you might want to try the following:

• Replace a sagging mattress
• Lie on your back with a pillow under your knees or on your side with a pillow between your bent knees
• Don't have too many pillows - they support your neck, not strain it

When buying a bed, try any you are considering for as long as you can. Your bed should allow ease of movement but mould to the contours of your body. Don't assume a bed marked 'orthopaedic' is what you need - the word can sometimes be used as a marketing tool.
To test if a bed is giving you the correct level of support, lie on your back and slide your hand, palm down, between the small of your back and the mattress. If you can:

• Work your hand through with some resistance, the bed support is probably about right
• Slide your hand easily through a large gap, the bed is probably too hard (or saggy)
• Hardly force your hand through at all, the bed is probably too soft

If you're in pain, the easiest way to turn in bed is to bend your knees, bringing your heels up towards your buttocks. Let your knees fall to one side and as the weight of your legs takes you over, bring through your hip and shoulder - don't twist.

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Dealing with back pain out and about

When you're shopping:

• Don't shop until you drop - take regular rests or make several short trips
• Don't overload your trolley and use a high 'tray' trolley rather than a large deep one
• Distribute your shopping evenly between both hands or hold a bag in front of you, or use a small backpack (not large or over-filled)
• Wear comfortable shoes

In the car:

• Adjust your seat properly so your arms have a slight bent at the elbow when your hands are on the steering wheel
• Support your lower back with a small cushion or rolled up towel
• Take regular breaks on long journeys and get out of the car for a stroll and a stretch

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Dealing with back pain at work

Employers have a responsibility to ensure their employees don't get back problems as a result of working practices. They can face prosecution if they fail to identify and assess risks to staff and take preventative measures to overcome those that are found.
Employees also have a responsibility to look after their own backs but they should be properly trained in back care by their employer. The Government is keen workers get as much information and advice about back care as possible.

Preventing work-related back problems

If you spend much of your time at work sitting at a desk, there are steps you can take to reduce your risk of back problems.

Seating

A properly adjusted chair reduces the strain on your back.

• Sit up straight
• Make sure your knees are level with your hips
• If your chair doesn't provide enough back support, use a rolled up towel or cushion
• Are your feet flat on the floor? If not, use a footrest to relieve pressure on your joints and muscles
• Avoid crossing your legs or sitting with one (or both) twisted beneath you

Monitor

• Your computer monitor should be about 30cm to 75cm (12in to 30in) from your eyes - a good guide is to place it at arm's length
• The top of the screen should be roughly at eye level
• Position the monitor so it reflects as little overhead lighting and sunlight as possible

Keyboard

• Keep your wrists straight, not bent up or down - a wrist rest may help
• Your elbows should be vertically under your shoulders - position the mouse as close to you as possible to allow this
• A mouse mat with wrist pad can help keep your wrist straight
• Learning keyboard short cuts may also help

Other objects

• Position frequently used objects, such as a telephone or stapler, within easy reach - it's important to avoid repeatedly stretching or twisting
• If you spend a lot of time on the phone, consider using a headset - cradling the phone between your ear and shoulder can strain the muscles in your neck

Take a break

• If your job is computer-based, make sure you take regular breaks - for every hour at your keyboard, have at least five to ten minutes' rest
• Get up and move around
• Rest your eyes regularly - look away from the screen and focus on something in the distance for a few seconds
• Gentle exercise can help to relax your muscles and clear your mind

If you experience regular aches and pains at work, speak to your occupational health department or GP.

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Back pain: posture checklist

A good posture can greatly improve and prevent back problems. Follow these simple rules.

How to stand

• Don't round your back - imagine you are being lifted by a string fixed to the top of your head
• Avoid hunching your shoulders and tensing your neck when stressed
• Wear comfortable, low-heeled shoes - high heels put pressure on the lower back

How to sit

• Use an upright chair that supports your lower back
• Support the small of your back with a small cushion or rolled up towel
• Stand up and stretch every 20 to 30 minutes

How to lift

• Always look at alternatives to lifting - can you push or pull?
• Lift only what you can handle and get help if you need it
• Bend your knees and keep your back straight and your feet apart when lifting
• Avoid lifting and twisting at the same time
• Always lift and carry close to your body
• Bend your knees rather than your back when putting a load down

Illustrations courtesy of David Winter.

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Can exercise help back pain?

Make sure you're doing the right kind of activity to help protect your spine.

Keeping fit

Gentle exercise can build strong back and stomach muscles to support your spine and maintain flexibility.
Walking and cycling are easy to incorporate into your daily lifestyle. Swimming is particularly good for backs, because it strengthens the muscles while supporting the body with water. However, some strokes may not be suitable, so get professional advice.

Getting started

Following a regular exercise routine is a good idea, but if you have a bad back you should consult your doctor or physiotherapist about what exercise is safe.
Try to get a personal assessment - a qualified physiotherapist, osteopath or chiropractor can give you an exercise routine tailored to your own needs.
If you go to an exercise class, check it's run by a qualified teacher and that the teacher knows you have a bad back. A lot of commonly performed exercises may not be suitable for you.

Exercise dos and don'ts

When exercising, make sure you do:

• Choose exercises suitable to your level and work up gradually
• Take things at your own pace
• Drink water before, during and after exercise
• Do gentle warm-up stretches before and after exercising
• Wear good footwear and appropriate clothing
• Enjoy yourself

Don't:

• Continue with an activity if it hurts your back
• Eat a large meal before exercising
• Perform exercises on a stone or concrete floor
• Exercise if you feel ill
• Do exercises that put weight or excessive strain on an acutely painful joint or spine

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Back pain and keeping trim

Excess weight can pull the spine out of alignment and cause a back injury, so it's important to keep your weight down. Aerobic exercises such as cycling, walking and running can help you lose the excess pounds. However, keep in mind that some popular sports, such as golf and tennis, can actually injure your back if not done properly.
It's also important to maintain a healthy diet that's high in fruits, grains and vegetables. In addition to causing weight gain, a poor diet can also make your back weaker and more susceptible to injury.