Back pain is a very common complaint. According to the Mayo Clinic, approximately 80% of all Americans will have low back pain at least once in their lives.
Back pain is a common reason for absence from work and doctor visits. Although back pain may be painful and uncomfortable, it is not usually serious.
Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years. Experts say that back pain is associated with the way our bones, muscles and ligaments in our backs work together.
Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen and pelvic internal organs, and the skin around the lumbar area. Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.
Risk factors for back pain
A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.
The following factors are linked to a higher risk of developing low back pain:
- A mentally stressful job
- Pregnancy - pregnant women are much more likely to get back pain
- A sedentary lifestyle
- Age - older adults are more susceptible than young adults or children
- Gender - back pain is more common among females than males
- Strenuous physical exercise (especially if not done properly)
- Strenuous physical work.
Signs and symptoms of back pain
A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.
The main symptom of back pain is, as the name suggests, an ache or pain anywhere on the back, and sometimes all the way down to the buttocks and legs. In most cases signs and symptoms clear up on their own within a short period.
If any of the following signs or symptoms accompanies a back pain your should see your doctor:
- Weight loss
- Elevated body temperature (fever)
- Inflammation (swelling) on the back
- Persistent back pain - lying down or resting does not help
- Pain down the legs
- Pain reaches below the knees
- A recent injury, blow or trauma to your back
- Urinary incontinence - you pee unintentionally (even small amounts)
- Difficulty urinating - passing urine is hard
- Fecal incontinence - you lose your bowel control (you poo unintentionally)
- Numbness around the genitals
- Numbness around the anus
- Numbness around the buttocks.
According to the National Health Service (NHS), UK, the following groups of people should seek medical advice if they experience back pain:
- People aged less than 20 and more than 55 years
- Patients who have been taking steroids for a few months
- Drug abusers
- Patients with cancer
- Patients who have had cancer
- Patients with low immune systems.
Causes of back pain
The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones - the segments of our spine are cushioned with cartilage-like pads. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found.
Strain - the most common causes of back pain are:
- Strained muscles
- Strained ligaments
- Lifting something improperly
- Lifting something that is too heavy
- The result of an abrupt and awkward movement
- A muscle spasm.
Structural problems - the following structural problems may also result in back pain:
- Ruptured disks - each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
- Bulging disks - in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Sciatica - a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disk pressing on a nerve.
- Arthritis - patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases spinal stenosis can develop - the space around the spinal cord narrows.
- Abnormal curvature of the spine - if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis, when the spine curves to the side.
- Osteoporosis - bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
Below are some other causes of back pain:
- Cauda equina syndrome - the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia and thigh. There are sometimes bowel and bladder function disturbances.
- Cancer of the spine - a tumor located on the spine may press against a nerve, resulting in back pain.
- Infection of the spine - if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.
- Other infections - pelvic inflammatory disease (females), bladder or kidney infections.
- Sleep disorders - individuals with sleep disorders are more likely to experience back pain, compared to others.
- Shingles - an infection that can affect the nerves.
- Bad mattress - if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing back pain.
Everyday activities or poor posture.
Back pain can also be the result of some everyday activity or poor posture. Examples include:
Back pain can also be the result of some everyday activity or poor posture. Examples include:
- Bending awkwardly
- Pushing something
- Pulling something
- Carrying something
- Lifting something
- Standing for long periods
- Bending down for long periods
- Muscle tension
- Sitting in a hunched position for long periods (e.g. when driving)
- Long driving sessions without a break (even when not hunched).
Preventing back pain
Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.
Exercise - regular exercise helps build strength as well as keeping your body weight down. Experts say that low-impact aerobic activities are best; activities that do not strain or jerk the back. Before starting any exercise program, talk to a health care professional.
- Core-strengthening exercises; exercises that work the abdominal and back muscles, help strengthen muscles which protect your back.
- Flexibility - exercises aimed at improving flexibility in your hips and upper legs may help too.
Smoking - a significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height and weight.
Body weight - the fatter you are the greater your risk of developing back pain. The difference in back pain risk between obese and normal-weight individuals is considerable.
Posture when standing - make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet - keep your legs straight.
Posture when sitting - a good seat should have good back support, arm rests and a swivel base (for working). When sitting try to keep your knees and hips level and keep your feet flat on the floor - if you can't, use a footstool. You should ideally be able to sit upright with support in the small of your back. If you are using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.
Lifting things - the secret for protecting your back when lifting things is to think "legs not back". In other words, use your legs to do the lifting, more than your back. Keep your back as straight as you can, keep your feet apart with one leg slightly forward so you can maintain balance, bend only at the knees, hold the weight close to your body, and straighten the legs while changing the position of your back as little as possible. Bending your back initially is unavoidable, when you bend your back try not to stoop or squat, tighten your stomach muscles so that your pelvis is pulled in. Most important, do not straighten your legs before lifting; otherwise you will be using your back for most of the work.
Do not lift and twist at the same time. If something is particularly heavy, see if you can lift it with someone else. While you are lifting keep looking straight ahead, not up nor down, so that the back of your neck is like a continuous straight line from your spine.
Moving things - remember that it is better for your back to push things across the floor, rather than pulling them.
Shoes - flat shoes place less of a strain on the back.
Driving - it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. The pedals should be squarely in front of your feet. If you are on a long journey, have plenty of breaks - get out of the car and walk around.
Your bed - you should have a mattress that keeps you spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle.