Back pain Q & As
What is back pain?
Back pain is very common, with most people experiencing at least one episode during their lifetime. Your back is a complex structure composed of bones, muscles, nerves and joints. Back pain is caused by a problem of one of these elements.
It’s a musculoskeletal disorder that can present in a range of ways:
- a slight twinge to being severely painful
- a dull and constant ache to a sudden and sharp pain that makes movement difficult
- it can gradually become worse or start quickly if you fall or lift something too heavy.
What are the symptoms of a back pain?
Back pain is most common in the lumbar (lower back) region, although it can be felt anywhere along your spine, from your neck down to your hips.
Back pain symptoms include:
- muscle ache and spasms
- tension, soreness and stiffness
- pain that runs down your legs
- limited flexibility or range of motion of your back.
What risk factors contribute to back pain?
There are some risk factors that can increase your chances of developing back pain. These include:
- ageing – wear and tear or degenerative disease can lead to a reduction in bone strength, a decrease in muscle elasticity and tone and, a loss of fluid and flexibility of your intervertebral discs.
- being overweight –carrying extra weight puts pressure on your spine.
- smoking – can cause tissue damage in your back. Also, often smokers have an unhealthier lifestyle than non-smokers.
- fitness - back pain is less common in people who are physically fit. Fitness helps maintain back and abdomen muscle strength and the integrity of intervertebral discs.
- pregnancy – the extra weight you carry when you’re expecting a baby can put strain on your back.
- occupation - a job that involves heavy lifting can lead to back pain as well as an inactive job where you sit all day with inadequate back support or poor posture.
- suffering from mental illness – such as anxiety, stress or depression.
What causes back pain?
Most often back pain develops for no apparent reason and is known as non-specific back pain.
Sometimes it’s due to a disruption to the normal functioning of muscles, ligaments, cartilage or an irritated or pinched nerve. This can be caused by minor strains and sprains, injuries or muscle overuse.
In a few cases, back pain is caused by more serious damage or disease to your spine.
Conditions that are often linked to back pain include:
- a slipped disc – the soft material inside an intervertebral disc can bulge or rupture and press on a nerve when compressed. This is known as sciatica if the sciatic nerve is compressed.
- degenerative disc disease – ageing can cause the intervertebral discs to lose integrity and their cushioning ability.
- spondylolisthesis – when a vertebra slips out of place and pinches a nerve.
- spinal stenosis - narrowing of the spinal column that puts pressure on the spinal cord and nerves.
What should I do when my back hurts?
Back pain most often gets better on its own without seeing a doctor. There are some self-help remedies you can try to relieve a back that hurts and speed up your recovery. These include:
- keep active – try to carry on with your daily activities. Exercise strengthens and increases flexibility of your back as well as releasing natural painkillers, called endorphins.
- over-the-counter painkillers such as paracetamol or ibuprofen.
- heat or ice – may loosen tight muscles and lessen pain.
- rest comfortably - changing your sleeping position may take some of the strain off your back.
- relax and remain optimistic – to relieve muscle tension and recover faster.
When should I worry about my back pain?
Most cases of back pain don’t require urgent care, but you should see a doctor immediately if your pain is the result of trauma, or if your pain is accompanied by any of the following symptoms:
- a fever
- unexplained recent weight loss
- pain in your chest
- a swelling or a deformity in your back
- loss of bladder or bowel control
- an inability to pass urine
- constant pain that won’t ease
- worse pain at night
- numbness around your genitals, buttocks or back passage
- you have tingling or numbness in your legs or arms
When should I see a doctor?
It’s advisable to make an appointment with your doctor for an evaluation if your back pain has lasted for more than six weeks and it isn’t getting any better with self-help measures or, if it’s actually getting worse. You should also see your doctor of this is the first time you’ve had backache after reaching 50 years of age, or if you’ve a history of cancer or osteoporosis.
What questions should I ask my doctor?
It’s worth being prepared for your appointment with a doctor. Here are some questions you might find useful to ask:
- What’s the most likely cause of my back pain?
- Are there symptoms I should be aware of that could indicate a more serious condition?
- What can I do to relieve the pain without making it worse?
- Should I stop some activities to ease my back pain?
- Do I need diagnostic tests?
- What treatment options do you recommend?
- If you're recommending medications, what are the possible side effects?
- I have other medical conditions. How can I best manage them together?
- How long will I need treatment?
- How long will it take before I notice a reduction in back pain?
- What can I do to prevent back pain recurring?
What is the outlook for back pain?
The outlook for most people with back pain is good and they will recover within a few weeks. However, it depends on the cause of the back pain and how it’s managed. An acute strain injury will normally heal with minimal treatment but a slipped disc that’s irritating the sciatic nerve may be best treated by surgery.
It’s better to seek treatment early for back pain to allow you to manage it properly, as symptoms of long term back problems are more likely to persist. For example, if you see a physiotherapist quickly, this can speed up your recovery and also prevent the problem happening again.
Your outlook is also improved by a positive attitude.
How is the back structured?
Your back has many connected parts including: vertebrae (bones), joints, flexible ligaments and tendons, large muscles and highly sensitive nerves.
Your spine is a flexible column that supports your back. It’s composed of 24 vertebrae with discs between each that act as shock absorbers. On either side of your spine, running from top to bottom, are facet joints that link the vertebrae together and allow flexibility. Muscles, tendons and ligaments offer support and mobility.
Your spinal cord passes through the protective spinal column. It carries nerves from your brain to the rest of your body and these pass between the discs, muscles and ligaments.
What tests are available for back pain?
Your doctor may request investigative tests to help determine the cause of your back pain. The most common diagnostic tests include:
- X-ray – provides images that show the alignment of your bones and whether you have arthritis, broken or displaced bones or a tumour.
- CT scan – generates detailed and cross section images of the bones in your spine and can reveal herniated discs or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.
- MRI scan - provides detailed images of your vertebrae, intervertebral discs and nerve roots. MRIs are often used to accurately diagnose spinal disorders and to rule out spinal infections or tumours.
What are the possible diagnoses of back pain?
Back pain is commonly diagnosed as due to:
- spinal muscle or ligament strain – often caused by repeated heavy lifting or sudden awkward movements.
- bulging/ruptured disks – the inner core of the disc may leak out and irritate a nearby nerve root, known as sciatica if the sciatic nerve is aggravated.
- vertebrae slippage – causes nerve compressions and is known as spondylolisthesis.
- arthritis – degeneration such as osteoarthritis can lead to a narrowing of the space around the spinal cord, known as spinal stenosis.
- abnormal spine curves – such as scoliosis where your spine curves to the side.
- osteoporosis – your vertebrae become porous and brittle and can more easily develop compression fractures.
What is …?
- lumbago – lower back pain.
- slipped disc – also known as a prolapsed or herniated disc. It’s when an intervertebral disc in your spine is bulging or damaged and presses on a nerve.
- trapped nerve – an irritation or compression of a nerve in your spine that’s often due to: a slipped disc, slippage of a vertebrae where the nerve exits the spine or an overgrowth of the facet joint.
- sciatica – irritation of your sciatic nerve that runs from the back of your pelvis, through your buttocks, and down both legs to your feet.
- spinal stenosis – narrowing of your spinal column that puts pressure on your spinal cord and nerves.
- scoliosis – an abnormal twisting and curvature of your spine.
- spondylolisthesis – a vertebra slips out of position and presses on a nerve.
- osteoporosis - a weakening of your bones that makes them fragile and more likely to break.
- osteoarthritis – breaking down of the protective cartilage on the ends of your bones that causing pain, swelling and problems moving the joint. Bony growths can also develop.
Why does back pain become chronic?
Acute pain is an unpleasant sensation triggered in the nervous system to alert you that something’s wrong with your body, and that you need take care of yourself. Sometimes, acute pain becomes chronic and persists for months or even years. In many instances, this happens because your physiological condition is ongoing and unresolved, for example if you have arthritis. However, often the pain doesn’t appear to be caused by any disease, injury or detectable damage to the nervous system.
What types of surgery are available for back pain?
There are a number of back surgeries available to treat back pain. Sometimes they are used in combination to have the best outcome for you. Back surgery is performed to relieve pressure on a compressed nerve, to stabilise adjacent vertebrae or to improve a deformity such as scoliosis.
- spinal fusion – joining of two or more vertebrae using a section of bone to stabilise and strengthen your spine.
- discectomy – removal of herniated/prolapsed disc material that is pressing on your nerve in the spine. Traditionally performed by open surgery but these day a minimally invasive technique called microdiscectomy is commonly used.
- laminectomy – removal of a section of bone from one of your vertebrae that’s compressing a nerve in your spine.
- lumbar spinal decompression– surgery to give the nerve root more space. It can be performed by at least one of these procedures: spinal fusion, discectomy and laminectomy.
- artificial disks – an alternative to spinal fusion for painful movement between two vertebrae.
What non-surgical options are available?
Non-surgical treatments for chronic back pain include:
- Physical therapies - provided by a physiotherapist/another doctor with specialist training and comprises:
- exercise programmes to strengthen your muscles and improve your posture, as well as physical activity and stretching exercises.
- acupuncture - fine needles are inserted at different points in your body to help reduce lower back pain.
- manual therapy - massage or spine mobilisation and manipulation.
- Pain relieving injections - delivery of steroids and anaesthetic into your joints, ligaments, muscles or around your nerves.
- facet joint injections – local anaesthetic and steroid medication is injected in to your facet joint to relieve the pain and inflammation.
- nerve root blocks - injecting local anaesthetic and an anti-inflammatory steroid medicine into the area around your nerve root to reduce pain of a trapped or inflamed nerve and reduce inflammation.
What treatments are available for back pain?
There are many treatments available for back pain. Your best treatment option will depend on how long you’ve had the pain, it’s cause if it can be diagnosed, how severe it is and, your individual needs and preferences.
For acute episodes of back pain, self-help treatments such as painkillers and remaining as active as possible will help alleviate your pain.
If the pain becomes chronic, then non-surgical options may include physiotherapy (exercise programmes, acupuncture, massage and manipulation) and pain injections (facet joint or nerve root blocks). If these aren’t successful or your doctor diagnoses your condition as one that needs a surgical procedure, then surgery will be recommended. There are a number of back surgery options that your consultant will talk to you about.
Will the pain come back?
Acute back pain may come back every now and then, depending upon its cause.
If you’re managing chronic pain using non-surgical treatments, you may still experience pain as these options are not a cure but used to reduce the level of your pain and inflammation. Pain relieving injections may last around three months.
If you’ve had surgery, then the pain resulting specifically to your back pain surgery should not return.