Back Pain

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Back pain is a very common symptom which plagues most people at some point in their lives. Fortunately, most episodes are acute and self-limiting. Occasionally however, it can become chronic and debilitating.

Back pain may arise from different structures in the back. Most commonly, they are muscular strains and sprains, from poor posture and lifting of heavy loads. Typically, these muscular pains occur at the most mobile sections of the spine – the neck and lower back.

Causes of Back Pain

There are a whole host of reasons why you may be experiencing back pain. It may be a consequence of daily activity (such as prolonged sitting at the office), an acute injury (such as carrying a heavy object), or a more sinister underlying condition.

Possible causes of back pain would include:

• Muscle and ligament strains

• Degenerative disease eg. osteoarthritis of the spine

• Bone fractures eg. from acute injury, osteoporotic fractures

• Slipped, herniated vertebral discs

• Infections of the spine eg. Tuberculosis

• Tumours

SYMPTOMS

Pain is our body's way of telling us that something's wrong. It is like a built in alarm system, to tell us to stop doing something which may be harmful to the body.

The feeling of pain is also very subjective. What may be perceived as being very painful to someone, may be felt more as a discomfort to another. This difference in perception is highly influenced by personality, cultural differences, circumstances under which it occurs etc.

The affected part of the back, most commonly the lower back and neck, may feel anything from a dull, tight ache, to an acute stabbing pain. This pain may be triggered by a number of factors including:

• Lifting, pushing or pulling heavy loads
• Sitting for extended periods of time
• Standing or bending down for extended periods of time
• Poor posture
• Being overweight
• Being pregnant
• Sleeping on an unsuitable mattress

"Red Flag" Symptoms

Symptoms associated with back pain that would warrant seeing your doctor urgently include:

• Fever, chills, cold sweats
• Weakness, numbness, pain or tingling sensation down a limb (indicating nerve compression)
• Numbness around the anal region or difficulty getting an erection
• Loss of bladder or bowel control

DIAGNOSIS & INVESTIGATIONS

Your doctor should, in most cases, be able to determine what is wrong with you by asking you about your symptoms and conducting a thorough physical examination.

Should your doctor feel that there may be an underlying cause for your pain, other than being purely muscular in nature, you may be asked to go for further tests, or be referred to a specialist.

Some of the tests commonly done include:
• X-rays: These show bony abnormalities such as arthritis of the spine and fractures.
• Blood tests: These may help to identify specific causes of your pain, such as infections, inflammatory diseases, tumours etc.
• CT and MRI scans: These provide more detailed images of the bone and surrounding soft tissue, required in the work-up of conditions such as a slipped disc.

MANAGEMENT

Most back pains improve with rest during the acute stage, followed by incremental strengthening exercises. Staying in bed for too long is not advisable since the supporting muscles of the spine will become weaker with disuse. Weak supporting muscles make the back more susceptible to recurrent injury.

A recent study showed that maintaining regular activities helps patients recover more quickly than bed rest. As such, activity should be resumed as soon as possible whilst avoiding lifting heavy loads.

Analgesics (Pain-killers):

Pain-killers such as paracetamol, muscle relaxants and NSAIDS (non-steroidal anti-inflammatory drugs) and commonly used in treatment in the acute stages of back pain. Occasionally, stronger medication may be used, if deemed necessary, by your doctor.

Surgery:

Certain conditions may require surgery. These would include conditions such as a severe slipped disc with significant compression to the surrounding spinal cord or spinal nerves, tumours and certain fractures. Minimally invasive surgical techniques employed in recent years have many advantages compared to traditional open techniques. Damaged intervetebral discs can nowadays be replaced by artificial discs.

Non-Surgical Treatments:

• Physiotherapy
• Chiropractic
• Acupuncture

TIPS FOR TAKING CARE OF YOUR BACK

Do not sit too much:
Most of us sit at our desks for far too long, resulting in a stiff back, neck and shoulders. Take 1 minute breaks to stand, walk and stretch for every 30 mins of work.

Poor posture:
Slouching, crossing legs, wearing high-heels etc all add up to cause that back pain. Be mindful of your posture at all times.

Ensure an ergonomic work station (chair, desk, computer etc)
Correct posture: back straight, shoulders back, both feet flat on the ground with knees even or slightly higher than the hips.

Lose weight if you are overweight:
The excess weight you carry puts more strain on your back muscles

Do regular stretching: (see our 7 step programme)
For improved flexibility

Strengthening exercises:
Strengthen your back muscles for more support

Ensure safe lifting technique:
(1) Stand close to the load with your feet shoulder width apart

(2) Tighten your abdominal muscles

(3) Keep your back straight as you squat down to grasp the object

(4) Keep the load close to your body and use your legs to stand up, lifting the load off the floor

(5) Your back should remain straight throughout the lifting process

(6) Employ the same technique in reverse when putting down the object.

JOBS MOST OFTEN ASSOCIATED WITH BACK PAIN

Back pain can occur under different work conditions and environments. Certain occupations, however, carry a greater risk than others. These occupations would include:

• Heavy manual labour and equipment operating

• Occupations requiring carrying of heavy loads, such as nursing, delivery, home removal etc.

• Office work which involves prolonged periods of sitting at a work station.

TIPS TO MAKE YOUR WORK STATION MORE ERGONOMICALLY FRIENDLY

• Make sure that your chair is comfortable and can be adjusted. Both feet should be able to be put flat on the ground with knees even or slightly higher than your hips.

• Choose a desk of the correct height for you.

• Keep your mouse pad next to and at the same level as the keyboard.

• Position your keyboard in front of your monitor, not to one side, so that you do not have to turn to look at your monitor.

• Use foot and wrist rests if you need to.

• Get your eyes checked to ensure that you do not have to bend forward to look at the monitor.

• Use a telephone headset if you are constantly on the phone.

• Avoid sitting in the same position for prolonged stretches.