14 Feb

Back pain can impact on many things we want to do on a daily basis. Fortunately there are a number of things you can do to lower the chances of developing disabling back pain and reduce the impact back pain may have on your life.

Back pain

The first part of my career in my surgery consultations I saw many patients with lower back pain but this was as a result of heavy manual work by miners, steelworkers, labourers and farmers. Working conditions were hard and there was little attention paid to prevent chronic back problems. We only had limited ways of investigating and simply relied on our clinical skills to diagnose a problem and tended to air on the side of caution as we were unaware of what was occurring in the body . After years of carrying out sophisticated CT scans and MRI scans and following up patients we now realise we were being over cautious and pain did not necessarily mean serious damage and most cases of back pain could be treated by encouraging movement and over the counter painkillers. Physiotherapy and other treatments were not widely available and at that time the advise was bed-rest in every case! Many patients took to their beds for many weeks and as a consequence became long term invalids often never to work again. We now know that this bad advise and that 60% of acute back pain will have resolve after 2 weeks and most will resolve in 12 weeks. Also, by having regular exercise a recurrence can be prevented as well as advising manual workers at their place of employment how to lift and to encourage the use of equipment to assist lifting to avoid unnecessary trauma.

During the second half of my career the patients who I see with back pain are sedentary workers who develop it as a result of prolonged sitting.
Back pain
It is actually more about how the body has to adapt to all the sitting, standing, and lifting than the activity itself.
Musculoskeletal problems today affect more women than in men for all age groups. For both genders, prevalence is noted higher in the 75 years and above age group. Nationally evidence suggests that MSK pain prevalence is higher in ethnic groups 63%-89% than White subjects (53%) at 45-64 age groups. 11.2 million working days per year are lost through MSK problems. Patients with MSK conditions account for the second largest group of patients in receipt of incapacity benefits after mental health. Back pain occurs in 4 out of 5 people at some time in their life.

In Ealing this accounts for 16% of incapacity claims, which is higher than the London average (15%). Increasing longevity, obesity and lack of weight bearing exercise will increase the number of patients with MSK conditions. The Chartered Society of Physiotherapy found that nationally 36 per cent of employees worked through their lunch break and 31 per cent experienced pain at work at least once a week. The economic and personal costs could be greatly reduced by encouraging better working habits and recommending appropriate exercises and providing early access to services, such as physiotherapy, for people who develop ongoing musculoskeletal conditions.

Because of the amount of time spent sitting, the body must gradually adapt itself to that position. This happens in a number of ways. The first thing it must adapt to is how the weight goes through the hips and pelvis. Then, there is the sitting position – upright, slouching, or something in-between.
This position could be termed the Office Worker’s Slump. In the Office Worker’s Slump, the back curves forward, which means the abdominals are not engaged, while the lower back muscles (erector spinae) are constantly shortened. The result is stress on the lumber vertebrae and subsequent intervertebral discs.
Back -sitting
The Office Worker’s Slump puts the spine under unnecessary daily stress, and throws its surrounding supportive muscles into a state of imbalance. These muscles help prevent injury to the back; harm their effectiveness, and there is an increase risk of suffering back problems.
Then people with already susceptible backs attend training sessions at the gym and put their backs under undue strain. Simply moving heavy equipment around can cause damage – and that’s before making a start on those heavy weight bearing moves.
The results vary from mild to crippling back pain – but both can be easily avoided. It is therefore important to follow gym work in the correct fashion and far from amplifying back issues, it can help to lower the risk of spinal injury.

Back pain is not generally caused by a serious condition but if not treated promptly by exercise and painkillers a pain cycle can easily evolve.
Pain cycle

The back is a complex structure made up of bones, muscles, nerves and joints. This can often make it difficult to pinpoint the exact cause of the pain.

Back- anatomy
Causes of lower back pain
Most cases of back pain are not caused by serious damage or disease but by sprains, minor strains, minor injuries or a pinched or irritated nerve. In most cases, the pain gets better within 2 weeks and completely recovers in 4-6 weeks. As stated earlier it can usually be successfully treated by taking over the counter painkillers, keeping mobile and carrying out suggested back exercises for at least 6-8 weeks after recovery to prevent a relapse.
Back pain can be triggered by everyday activities at home or at work, or it can develop gradually over time as a result of prolonged sitting or standing or lifting badly. Other causes of back pain include:

  • bending awkwardly or for long periods
  • lifting, carrying, pushing or pulling incorrectly
  • slouching in chairs
  • twisting
  • over-stretching
  • driving in a hunched position or driving for long periods without taking a break
  • overuse of the muscles, usually due to sport or repetitive movements (repetitive strain injury)
  • Sometimes back pain develops suddenly for no apparent reason. Some people just wake up one morning with back pain and have no idea what has caused it.

Red flagYou should seek immediate medical help if your back pain is accompanied by:

  • fever of 38ºC (100.4ºF) or above
  • unexplained weight loss
  • swelling in the back
  • constant back pain that doesn’t ease after lying down
  • pain in your chest or high up in your back
  • pain down your legs and below the knees
  • loss of bladder or bowel control
  • inability to pass urine
  • numbness around your genitals, buttocks or back passage
  • pain that is worse at night

How to prevent back pain

Keeping your back strong and supple is the best way to avoid getting back pain. Regular exercise, maintaining good posture and lifting correctly will all help.
If you have recurring bouts of back pain, the following advice may be useful:

  • lose weight – too much upper body weight can strain the lower back; you can use the healthy weight calculator to find out whether you need to lose weight.
  • wear flat shoes with cushioned soles as they can help reduce the pressure on your back
  • avoid sudden movements which can cause muscle strain
  • try to reduce any stress, anxiety and tension, which can all cause or worsen back pain – consider Yoga, Pilates and/or meditation.
  • stay active – regular exercise, such as walking and swimming, is an excellent way of preventing back pain.

Read more on:-

        • examine your posture at the working desk

Back posture

  • using pillows when lying down to support the back
    Back pain
  • regular exercises whilst at the desk
    imageIn view of the fact that the majority of cases of back pain are not related to serious damage or disease your GP will encourage you to take the above advice and carry out the exercises illustrated below or as instructed on the video below showing a demonstration from our physiotherapists at Ealing Hospital.

Recommended back exercises

Edited by Dr Ian Bernstein

Edited by Dr Ian Bernstein

In Ealing we are fortunate enough to have an excellent community based facility for assessing and treating musculoskeletal problems started by an enthusiastic GP who has pioneered assessment and treatment of MSK problems in the community and by passing on his expert knowledge this has empowered other GP’s in Ealing to select the appropriate patients to be referred for more specialist care. This is not only beneficial economically but has reduced waiting lists for secondary care Orthopaedic opinions and investigations such MRI scans. The service is constantly being expanded and along with specialised physiotherapists and now Orthopaedic surgeons there is a comprehensive team of therapists who are able treat a wide range of musculoskeletal conditions including back problems in Clayponds Hospital. Hence, in Ealing patients are now initially treating themselves and then if they demonstrate no significant improvement after 6 weeks can be referred for specialist assessment, investigation and treatment by this service.
If a very serious cause is considered the case can be fast tracked and the patient can be seen immediately or within 2 weeks.
For further information for those living with back pain:-

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Posted by on February 14, 2014 in Training and Advice


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