Low Backache

Back pain is a common condition that affects most people at some point during their life. Most cases of back pain are associated with pain and stiffness in the lower back.

The back is a complex structure that consists of:

• 24 small bones (vertebrae) that support the weight of your upper body and form a protective canal for the spinal cord
• shock-absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend
• ligaments that hold the vertebrae and discs together
• tendons that connect muscles to vertebrae
• the spinal cord, which carries nerve signals from the brain to the rest of the body
• nerves
• muscles

The lumbar region
The lumbar region is the lower part of the back. It is made up of five vertebrae: L1, L2, L3, L4 and L5.

The lumbar region supports the entire weight of your upper body (plus any extra weight that you are carrying). It is under constant pressure, particularly when you are bending, twisting and lifting. This is why most cases of back pain develop in the lower back.

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Back pain is classified in two main ways:

• specific back pain – pain that is associated with an underlying health condition or damage to the spine
• non-specific back pain – where the pain is not caused by serious damage or disease, but by sprains, muscle strains, minor injuries or a pinched or irritated nerve

Causes of specific back pain include:

• sciatica – a condition caused by a nerve in the back (the sciatic nerve) being irritated or compressed
• slipped disc – where one of the discs of the spine (see box, left) splits and the gel inside leaks out
• ankylosing spondylitis – a condition where the joints at the base of the spine become inflamed

The outlook for back pain can vary considerably between individuals. Some people have minor episodes of acute back pain before making a full recovery.

Other people have long periods of mild to moderate back pain that are interrupted by periods of severe pain, which makes them unable to do their normal daily activities.

While acute back pain can be frustrating to live with, try to remain as positive as possible. There is a lot of research to suggest that people with a positive mental attitude tend to have quicker recovery times and are much less likely to progress from acute to chronic back pain. If you have acute back pain, it is important to remain as active as possible. If you find it too painful to return to your normal daily activities immediately, pace yourself by carrying out your daily activities at a reduced level or a slower rate. Aim to do a little more each day. There is also no need to wait until you are completely pain-free before returning to work. Going back to work will help you to return to a normal pattern of activity, and it can often distract you from your symptoms of pain.

Many people with back pain find that using either hot or cold compression packs helps to reduce pain. You can make your own cold compression pack by wrapping a bag of frozen food in a towel. Hot compression packs are often available from larger pharmacies. You may find it useful to use one type of pack after the other.

Placing a small firm cushion beneath your knees when you are sleeping on your side, or using several firm pillows to prop up your knees when lying on your back, may help to ease your symptoms.

Psychological and social factors play an important role in the expected outlook for back pain, particularly for chronic back pain.

For example, people who have a positive frame of mind and report enjoying a good quality of life tend to make a faster recovery.

Firstline Medical Treatment options for back pain include painkillers (tablets, capsule0, spinal manipulation, acupuncture and exercise classes. Some cases of chronic back pain may also benefit from additional psychological treatment for the reasons discussed above.

National Institute for Health and Clinical Excellence (NICE)

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Recommended that chronic back pain should be treated using painkilling medication and one of the following treatment options:

• acupuncture – fine needles are inserted into your skin at certain points on the body
• exercise classes – aerobic exercise, muscle strengthening and stretching
• manual therapy – your back is massaged or manipulated

The exercises may include:

• aerobic activity – exercises designed to strengthen your heart and lower your blood pressure, such as jogging or swimming
• muscle strengthening
• stretching

(Source:  National Health Service, UK)

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Exercise for Rehabilitation of Back. Click here for further instruction, or see the exercise demo on Youtube above.