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Back pain usually gets better by itself, but chronic pain can be disabling. Regular exercise, losing weight and careful lifting and carrying can help prevent back injuries.
Homo erectus came down out of the trees and stared walking on two legs sometime between one and two million years ago. It was good news for the human race just think how hard it would be to take a phone call, place a bet on the horses, or open a jar of gherkins if we still got around on all fours.
But this gaint step for mankind came at a price. Standing erect suddenly meant a lot more weight to carry. Without two arms to bear the weight of the top part of the body, that extra weight now had to be carried by the the spine, hips, knees and ankles. No surprise that, ever since, these weight-bearing joints have tended to give us trouble.
But of all them, it's the spine, especially the lower part, that bears the greatest stress and is most prone to injury. Add extra body weight from our high-fat, high-calorie diet and our tendency to lift heavy objects and sit in awkward positions and we shouldn't be suprised that back pain is such a problem in our society.
Around eight in 10 people in western countries suffer from back pain at least occasionally. It's the second most common reason people go and see their GP (the first is respiratory infections). And it's the third most common reason for taking time off work (after headaches and colds).
Back pain isn't disease in itself it's a symptom of injury to the back. And like most musculoskeletal injuries, providing the back itself is structurally sound and healthy, in most cases, people with back pain recover well. But in a smaller percentage of people usually with severe injuries or with an underlying condition of the spine it can become chronic and disabling.
What we think of as the back is actually the spinal column a series of 24 to 25 bony discs called the vertebrae stacked on top of each other to form an S-shaped column. It's supported by ligaments that run up and down it, and by muscles than run either side of it. Its main job is to support the weight of the body.
But it also needs to be flexible. Between each bony disc is a thinner disc of cartilage with a soft jelly-like inner core surrounded by rings of tough fibre. The cartilage disc acts as a shock absorber, and the vertebrae and discs together act as a series of joints allowing the spine to move forwards, back and sideways, and to partially rotate. It's these joints that give the back its flexibility, allowing us to arch, twist and bend (and make those of us of a certain age looks like fools on the dance floor).
The other job of the spine is to protect the spinal cord a tube of nervous tissue which travels from the base of the brain down through the spinal column, ending in a series of nerves which leave the spinal column to supply the limbs and internal organs of the body.
Like any supporting structure, the back is subject to stresses. It can cope with the normal stresses of everyday life running, pushing, lifting, and twisting but if subjected to abnormally high stresses, muscles and ligaments can become overstretched and tear, and joints can become damaged.
Abnormal stress can be:
These stresses cause more damage if the back is in poor condition if ligaments and muscles are weak or wasted, they're more susceptible to injury. So back pain is more common in people who:
If the person has some underlying degenerative condition of the spine, they are also more susceptible to injury.
Someone who has osteoporosis (age-related demineralisation of the bones) may be more prone to a fractured vertebra. Someone who has arthritis in the vertebrae may have bony spurs that can grow out from the edges of the vertebra and press against the nerves that leave the spinal column. They irritate and damage the nerves and cause pain, numbness or other symptoms.
In old age, the cartilage discs between the vertebrae can shrink, weaken, and lose their elasticity. They may rupture, allowing the inner soft gel-like part to herniate out (i.e. escape through the fibrous outer part). This material too can press against the nerves and cause pain and other symptoms. This is known as a slipped (or herniated) disc.
Sometimes, a vertebra can slip forward relative to the rest of the spine and as it does, pinch a nerve, causing the same symptoms (this is called spondylolisthesis).
And there may be other diseases that can affect the bony spine secondary cancers that have travelled to the spine from other organs, or infections in the spine (though neither of these are common).
In a normal healthy person, it's usually pretty clear what's happened the pain follows stress to the back, therefore it's a back injury. It's often not necessary to see a doctor, especially if the pain is mild.
However you should see a doctor if:
In this case a GP may want to order further tests to see if there is any serious injury like a slipped disc or a vertebral facture, for instance or whether there's any underlying condition like arthritis, osteoporosis, or a tumour or infection of the spine.
Tests the doctor may order include:
In most cases, back pain gets better by itself in a few days or at most a few weeks. It used to be thought that back pain needed three days or more of bed rest on a firm mattress. We now know that prolonged periods of rest may actually worsen the condition, and a firm mattress has no effect. In fact, the sooner you become active and go back to work, the better for your back (though strenuous activity like heavy lifting, bending or twisting should be avoided).
Mild painkillers like paracetamol or aspirin will help relieve the pain. In more severe cases, or if it doesn't improve, your GP may refer you to a physiotherapist. There's evidence that treatment techniques such as massage, exercises to stretch and strengthen back muscles, and spinal manipulation (by a physiotherapist or a chiropractor) may be helpful.
There is no scientific evidence supporting the use of muscle relaxant drugs, acupuncture, transcutaneous electrical nerve stimulation, magnet therapy, traction, or physical treatments like ice, heat, short wave diathermy, massage, ultrasound and hydrotherapy.
The back wasn't designed to spend long periods of time sitting at a desk. Nor was it designed to lift, pull or push heavy weights. Both are features of many workplaces. No surprise then that back injury accounts for one-third of all workplace injuries.
It's the responsibility of both employers and employees to make sure the workplace is safe. It's best to be proactive rather than wait for injuries to accumulate before doing something. There needs to be an emphasis on ergonomic seating, procedures for safe lifting and moving of goods, and workspaces designed to prevent repetitive movements that place stress on the back. Poorly designed buildings, furniture and equipment may need to be replaced, and work processes changed. Your workplace may have an occupational health and safety (OH&S) policy and /or OH&S officers that can advise you.
Ninety per cent of people make a full recovery within four weeks. In about 30 per cent of cases though, there's a recurrence of back pain. But again, the pain usually settles with painkillers, a short period of rest and activity. To reduce the chance of a recurrence, you should take care not to injure the back again (see Prevention, below).
However in a smaller percentage of people, the pain just never goes away.Usually, if it lasts longer than three months, it's considered to be chronic back pain.
Chronic back pain usually arises because there's an underlying condition such as arthritis or osteoporosis, or because the injury was severe a fractured vertebra or spondylolisthesis, for instance.
Unfortunately, chronic back pain is much harder to cure, because the injury is so severe or because the underlying condition is degenerative one that can't be reversed. So the treatment is aimed at reducing pain and disability and keeping the person as pain free, comfortable and mobile as possible. In a few cases surgery may be possible for instance to remove disc material from a slipped disc that is causing sciatica or other nerve symptoms. (The operation is called a discectomy.) Or, if it's caused by the bony spurs of arthritis, the protruding bit(s) of bone can be removed, or and the nerve 'decompressed' (this is called a laminectomy). A forward slippage of a vertebra spondylolisthesis can be treated with surgical fusion of the affected vertebra to other nearby vertebra.
On the whole, though, the success rate for spinal surgery is very variable, and so surgery is usually only performed in carefully chosen cases. Conservative treatment consisting of resting for short periods, activity, pain relief, and physiotherapy usually produces as good or better results. People with a positive attitude towards their condition tend to do best.
To avoid recurrence and lessen the chance of chronic back pain, it's very important to prevent back injury from occurring in the first place. The ways to do this is are:
Back pain is uncommon in kids and when it does occur, it's usually because of schoolbags worn on the back. About 70 per cent of school kids have bags that are too heavy and/or not worn correctly. To prevent back pain, schoolbags: