How to prevent and cope with back pain

Back pain is one of the most cited reasons for missing work. Indeed, many of us have suffered some form of back pain, either episodically or for an extended period. In fact, back pain is so commonplace that we often do not take the ailment seriously, until of course, it becomes sharp or debilitating.


What are the various causes of back pain?

From an evolutionary perspective, it is easy to understand why we experience back pain. The homo sapien is the only animal to stand upright, and it is our back that helps us maintain this stance against the relentless and powerful force of gravity.

That said, there are many specific reasons why our back may cause us trouble. From the neck downwards the human body has myriad muscles, nerves, tendons, bones, ligaments, and discs, and any damage to any one of these components can lead to pain.

People of all age groups, and not just the elderly or those with a past injury, face the risk of back pain due to one or more of the following reasons.

  • Strain: Your back could suffer a painful strain if you lift something in an awkward position or abruptly, or pick up a heavy object without bracing your core or bending your knees as is advised.
  • Posture: Slouching while sitting, which many of us tend to do, standing for long hours, driving for a long time without any breaks or continuously peering at a computer screen may trigger back problems.
  • Structural problems: Back pain may occur if any of the several discs that protect the spine are affected in any way or a bulging disc exerts pressure on a nerve or nerves.
  • Arthritis: Arthritis is a condition in which joints get inflamed and cause pain. There is also osteoarthritis, a degenerative disease which affects the joint cartilage and creates problems in the hip joints and the back.
  • Sciatica: At times, we may experience a sharp and shooting pain that travels down from the hips to the legs. This is caused by excessive pressure on the body’s largest nerve, the sciatic nerve, which branches from the lower back through the hips and buttocks and down each leg.
  • Osteoporosis: This is a condition that makes the bones brittle and porous. Fractures due to compression are not uncommon if one is affected by osteoporosis.
  • Spinal curve or an abnormal curvature of the spine
  • Kidney stones or infection


What are the various types of back pain?

Based on intensity and duration, back pain can be short-term, acute or chronic.

Back pain which lasts a few days to a few weeks is labeled ‘short-term’ by doctors. Some of the common triggers for short-term back pain are obesity, poor posture, inactivity or a sedentary lifestyle.

Acute back pain is usually severe and may last up to 12 weeks. Its intensity may vary from a mild muscle ache to stabbing pain — you may be unable to walk or stand for long or feel that your range of motion has become limited. Acute pain may occur due to various reasons such as trauma to the lower back, a sports-related injury, a sudden jolt that affects the tissues or bones in the lower back region or something as simple as bending while gardening.

Persistent or chronic back pain lasts longer than 12 weeks, and, in some cases, it may refuse to go away despite treatment or medication. Sometimes, the injury may heal but the pain may continue. Left untreated, acute back pain may turn into chronic back pain. Years of bad posture, carrying very heavy bags for long periods of time (especially on one shoulder), and wearing high heels are some of the leading causes of persistent or chronic back pain.

According to the NHS, people are most likely to develop chronic back pain after a period of stress or prolonged unhappiness. Interestingly, people can experience persistent back pain even when their medical test reports show nothing unusual.

On another note, it is important to understand how pain may vary in the neck, upper back, and lower back regions.

Among the three regions, the upper back is the least vulnerable to pain simply because the bones and the muscles here don’t move as much as those in our neck or lower back. Usually, upper-back pain occurs due to years of poor posture or an injury. Although uncommon, it may also happen due to a progressing illness, infection or instability in the spine.

The lumbar spine or the lower back is more prone to pain and injury than the upper back. This isn’t surprising because the lower back supports the upper body and helps us move, twist, bend, etc. In essence, the lower back supports the spinal column. So, when we experience lower-back pain, the reason is usually an impact or injury to the discs, muscles, ligaments or the joints of that area. In most cases, lower back pain is a result of inflammation following an impact or injury, but, given that a network of nerves overlies the discs, muscles and other parts, the pain may also be related to the nerves.

That said, it is quite difficult to distinguish one kind of pain from another. So, a few more specific details are necessary to understand and treat the common types of backaches.

The next time you read or hear the words ‘thoracic spine’, remember that it refers to the upper and middle back region. Thoracic pain could be an annoying niggle, a pins-and-needles kind of sensation or a sharp, intense ache. You may feel soreness or stiffness in the muscles. Note that you should see a doctor if at any point you experience numbness or tingling in the arms or legs, chest or even the stomach area. Mild upper back pain can be alleviated with self-care.

Lower-back pain may occur anywhere below the ribs and above the legs. Common types of lower back pain include mechanical and radicular pain. The former is caused by excessive stress on the muscles due to poor seating, awkward lifting of objects, and other factors. When a nerve root in the spine gets inflamed, compressed or injured, doctors call it radicular pain, which may be sharp. Radicular pain is often experienced only on one side of the body. As we have mentioned before, sometimes, lower-back pain may occur for no definitive cause.

 

back pain

Men and women of all age groups face the risk of back pain.


What are the various ways of treating back pain?

Here are some ways to ease back pain with self-care.

  • Rest — If your pain gets worse with movement or while doing daily chores, you can rest for a day or two. Do remember that a long period of rest is not advised because inactivity can weaken the back muscles.
  • Correct posture — Consciously adjust and maintain proper seating and standing postures. Slouching or straining your neck for long hours can be painful and may take a while to get better.
  • MassageA gentle massage loosens tight muscles and improves blood flow to the painful region.
  • Over-the-counter painkillers — Usually, non-steroidal anti-inflammatory medicines such as ibuprofen or aspirin alleviate short-term back pain. Using medically recommended pain-relieving gels also helps.
  • Exercise — Exercise is one of the best ways to prevent and manage back pain. Regular swimming, core-and-back-strengthening yoga, and Pilates are great for the back. However, refrain from exercising if the pain is really bad. Instead, go for slow and gentle walks until the pain subsides.
  • Quit smoking because it delays the healing process and prolongs pain.
  • A good mattress — Sometimes, sleeping on the wrong mattress causes back pain. Changing your mattress and pillows can help relieve pain. Choose a mattress that allows you to sleep comfortably and wake up without stiffness in the back. Typically, medium-firm mattresses provide more comfort than firm ones.

An aggravated back problem may require consultation with a healthcare professional. Here are some remedies GPs typically recommend.

  • Ice and Heat Treatment — A hot or cold compress, as recommended by a doctor, works well to mitigate pain.
  • Muscle Relaxants — You may be prescribed muscle relaxants if you experience spasms in the back. As their name suggests, such medications help relax the muscles and reduce tension in the affected area. They ease the pain and help improve mobility of the spine.
  • Physiotherapy — If your pain is in the acute/chronic stage or your mobility has been hampered, then it is best to seek help from a physiotherapist.
  • Spinal Traction Treatment — Spinal traction is a treatment in which manual or mechanical pressure is applied on the back to relieve pressure. In manual traction, a physical therapist uses his/her hands to apply force manually and widen the space between the vertebrae, which provides relief. In mechanical traction, the therapist may use ropes, pulleys or strings.

Visit your doctor if your pain becomes intense. Surgery may be required in rare and chronic cases where an MRI/CT scan reveals an anatomy-related problem.


When should you consult a GP?

You must visit a doctor if you have back pain accompanied by one or more of the following conditions:

  1. You have fever and you are passing urine frequently, or you are experiencing a burning sensation while urinating.
  2. You have a tingling sensation or numbness in your legs or arms.
  3. You have bowel incontinence.
  4. You have pain in the back as well as behind the legs — it may be sciatica.
  5. Any therapy for a back-related problem has not made any difference beyond a few weeks.


What are the risk factors for back pain?

Some of us are more prone to back pain compared to others. The reasons are logical and self-explanatory. Just ask yourself these questions:

  1. Do I get enough exercise?
  2. Am I in a job that involves a lot of physical labour?
  3. Am I obese or overweight?
  4. Am I an expectant mother?
  5. Do I fall in the over-50 age group, and am I leading a sedentary lifestyle?
  6. Do I smoke?

If your answer to any of these questions is ‘yes’, it is time for you to take charge and bring about some positive changes in your life. To begin with, start exercising regularly. Doctors recommend around 150 minutes of exercise a week. If you do a desk job, take regular water/coffee/tea breaks. They needn’t be long — but getting up from your desk to walk to the coffee machine/water cooler will give your back a much-needed breather.

If your job involves peering at a computer screen continuously for a long time, keep reminders on your phone to turn away from the screen periodically. Take a few seconds to simply look up and down and give a few left and right twists to your neck. This will help you avoid straining your neck and you will not have to face a stiff back or neck at the end of the day.

 

What are the common exercises to prevent back pain?

Here are some basic, simple exercises you can do at home to keep your back pain-free. Some of these take only a few minutes, and many don’t need any physical equipment.

Simple knee roll — Lie flat on your back. Keep your knees bent and perpendicular to the floor. Ensure that your knees touch each other and your heels are in contact with the floor. Place your arms out wide, and without moving your upper body, roll both your knees together, over to one side and then to the other. Your lower body alone moves from left to right while your upper body remains at rest. Repeat this 8-10 times. Ensure that you do not turn or lift your neck at any point.

Stretching — Move into a stretch slowly and avoid overstretching.

  • Back stretch: Lie flat on your stomach. Place your forearms on either side of your head and keep your neck straight. Make sure your elbows are not pushing in or out. Then, with the help of your forearms, push your shoulders up and back till you find yourself lifted a few inches off the floor. A gentle stretch in the stomach is all you should feel. At this point, breathe in for 5 seconds and release. Repeat this 8-10 times. Remember not to bend your neck backward or lift your hips up.
  • Knee-to-chest stretch: Lie on your back with your feet flat on the floor and your knees bent. Pull one knee to your chest and hold it for 5 seconds. At all times, ensure that your spine does not rise off the floor. Follow the same sequence of steps with the other leg. Repeat this cycle 2-3 times.

Bridge exercise — Lie on your back with your knees bent and heels touching the floor. Push your heels hard into the floor, squeeze your hips, and lift them off the floor until your shoulders, hips, and knees are in a straight line. Hold for 5-6 seconds, and then slowly — without any jerks — lower your hips back to the floor and rest for 10 seconds. Make sure that you don’t arch your lower back as your hips move upward. You can avoid overarching by tightening your abdominal muscles prior to —and throughout — the lift. Repeat this exercise in cycles of 5 on the first day and work your way up, over time.

Cat stretch — This is an effective yoga stretch. Place your palms and knees on the floor while ensuring that your hands and shoulders as well as your knees and hips are in the same line.  You should resemble the shape of a table at this point. As you inhale, raise your chin and tilt your head back, push your navel downwards and raise your tailbone. Hold this cat pose and take long, deep breaths. Then follow it up with a countermovement. As you exhale, drop your chin to your chest and arch your back up as much as you can. Hold this pose for a few seconds before returning to your initial table-like position. Repeat this exercise in cycles of 3–5.

Shoulder blade squeeze — Sit upright on a chair that does not have any arms. Now pull your shoulder blades together and hold the position for five seconds before releasing. Do this exercise in cycles of 3-5 twice a day.

Originally written 6th December 2018