How to fight back pain

We answer you and bust a few myths about a problem suffered by many

EVEN if you haven’t experienced back pain, chances are you know someone who has.

A recent British Chiropractic Association study found 83% of women and 76% of men were sufferers.

Catherine Quinn, a chiropractor and president of the BCA, says it’s all too easy to fall victim to it.

“Often with back pain, you’ve tried to do something that your body is not prepared to do – stretched a little too far or tried to carry something too heavy for your muscles and joints to deal with,” she says. “Your body’s only way of telling you is to give you this pain response.”

The study also found women are more likely to develop back pain at a younger age than men – 10% never seek help, and only 11% of both sexes make simple lifestyle changes that could keep it at bay.

The findings come after a report in medical journal The Lancet earlier this year stated disability due to back pain has risen by more than 50% since 1990.

Ashley James, a Chartered Society of Physiotherapy spokesman, says: “It causes a lot of work absence, which costs businesses a lot of money, and it’s getting worse because we’re mismanaging it.”

He says there are many misconceptions regarding the reasons and remedies for back pain that prolong the problem too.

“It’s so deeply ingrained in society that people just take these beliefs as facts,” says Ashley. So here’s a guide to the real facts about back pain that blows apart the myths.

What’s the biggest cause of back pain?

The trigger for lower back pain is usually to do with lifting. Ashley says: “Contrary to popular belief, there is no one best way to lift anything, just positions you’re physically prepared for or not.

“What we should avoid is large changes in position quickly.”

Getting used to moving in lots of different ways over time is beneficial, as well as finding what’s called your ‘Goldilocks load’.

“A bit of a load for our back is actually good, and lifting relatively heavy things acts as a great prevention exercise for lower back pains,” explains Ashley.

“It’s quite common in people with a history of back pain to underload their back structures and that can lead to pain, but obviously we can go too heavy too.

“We’re looking for the ‘Goldilocks load’ of not too much or too little, and that will differ for everyone depending on capabilities and current strength.”

Does sitting for hours at work increase the risk?

Despite what we’ve always been told, sitting down at work all day doesn’t increase the risk of back pain.

“As long as you’re relatively active outside of work then it cancels out what you’ve done during the day,” says Ashley. “But sitting at work and then sitting all evening at home does increase the risk of lower back pain. We’ve become hung up on trends – the most recent one being core stability.

“Everyone thinks they need to have a strong core to have no lower back pain, which isn’t true.

“Even the strongest people have back pain at some point.”

Likewise, there’s no inherently bad posture that causes back pain – and whether your computer screen’s six or eight inches above your desk “isn’t going to make a blind bit of difference”.

“If you don’t do much exercise, and you’re overweight, it’s very unlikely it’s the chair or the position you’re in that’s driving that painful experience for you,” explains Ashley. “It’s trying to think a bit

Your body’s only way of telling you that you’ve overdone it is to give you this pain response... so listen to it

broader about the causes of pain. It’s very often not one single cause.”

Can I do anything to Prevent back pain?

Although we’re bombarded with adverts for special pillows, cushions, massage aides , desks and chairs, there is no magic product you can buy. The only two things advocated are exercise and education – and there’s no single exercise that’s been demonstrated to be superior to another. Catherine says: “If you're strong and active nice keep those joints and mobile, you’re going to be able to cope with more. Think what your goals are. I want my patients to be doing exercise and movement they take pleasure in. It doesn’t have to be running on a treadmill, there are lots of ways you can be active – so go for a walk, do yoga, swim.

“It’s about finding what you enjoy doing and making it quality time and an investment in keeping your body functioning as well as it can – and building confidence in that body too.”

Is resting best to alleviate the pain?

It’s wrong to believe moving a painful back will cause more damage. Ashley says: “Movement is a good thing in the 90% of cases where the cause of the pain can’t be attributed to a specific structure in the back.

“If you’re in high levels of pain, but it’s localised to the back, then the best rehabilitation is to get back to your daily tasks and work, and engage in some form of physical activity as soon as you feel able.

“One of the worst things you can do is stay still, because that reinforces negative movement patterns and doesn’t help the body get going again. The earlier you start moving, the better.”

Should over-the-counter painkillers be avoided?

The BCA study revealed more than a third of women go to the chemists as first port of call for a back pain fix – that’s 12% more than men.

“In some cases, it’s helpful because you’re managing your level of pain,” says Catherine. “But we’re seeing this epidemic across the world with people over-medicating for issues like back pain, which could easily be managed with exercise and lifestyle adaptation.”

Medication such as morphine, Tramadol or codeine shouldn’t be used for lower back pain. “They’re addictive and fairly ineffective,” says Ashley.

“But anti-inflammatories are good if you’re okay taking them.”

When should I seek help for back pain?

While the BCA found women were likely to wait six weeks before seeking help, The Lancet reported men take longer. But Ashley says it doesn’t really matter. “We know most back pain resolves within six weeks so it may be largely incidental that men or women wait to seek care,” says Ashley.

But he added their willingness to wait would certainly be helpful to the struggling NHS.

His advice is don’t worry too much: “Just get moving and it should resolve on its own, as long as you stay relatively active and carry on with daily tasks.

“However, if you have any pain radiating into one or both legs then it’s worth getting checked.

“Sometimes you can get nerve involvement from the lower back specifically and that might need different management.”

Does pain equate to physical damage?

“Pain is a complex beast,” says Ashley. “People’s common perception of it is that it’s directly related to physical damage, whether that’s muscle strain, ligaments or discs.

“But actually pain’s a really poor indicator of tissue health, particularly for lower back pain.”

For example, a study of people across different age brackets who weren’t experiencing any back pain found that among the 50-year-olds, 80% of them had disc degeneration, 60% of them had a disc bulge and 36% of them had a disc protrusion.

“These are things that people would be really worried about if you told them, but are actually perfectly normal findings on MRI scans in people with no pain,” says Ashley.

“This is why getting an MRI scan can be really unhelpful in the majority of lower back pain cases.”

Catherine adds: “You can MRI lots of people with back pain and not see anything at all.

“With a lot of back pain, there isn’t anything that’s structurally wrong. People like to think there’s a tear or an actual physical injury, and quite often that’s not the case.”

What contributes to the feeling of pain?

Stress, lack of sleep, and negative beliefs relating to back pain – such as thinking it will never go away or will cause permanent damage – are just some of the psychological factors that can contribute to feelings of pain and part of a ‘bio-psycho-social’ model professionals refer to.

“Bio is the biological, so the bones, discs, muscles that can play a part,” explains Ashley. “Psycho refers to the psychological, so that’s the negative beliefs, fear and stress. And then there’s social aspect, which is relationships with family, friends and colleagues.

“These can all play a part in how someone presents with lower back pain.

“Rather than focus on people’s fears, we need to reassure people and get them moving.”

One of the worst things you can do is stay still. It doesn’t help the body. The earlier you start moving, the better