Back pain – how to manage it

Most of us have experienced back pain – whether it’s stiff, aching muscles, or a burning, shooting or stabbing sensation. In fact, back pain is one of the leading reasons people seek medical help or miss work.

Different parts of your back can be affected, with lower back pain being the most common form.

Any sort of back pain can make it difficult to carry on with daily life, but the good news is that it usually gets better within a few weeks with self-care – and there are steps you can take to limit back pain in the future.

What are the symptoms?

Pain and/or discomfort can range from mild to severe, and can affect 1 area or may be more generalized. Back pain may be:

• acute – it comes on quickly and lasts a few days to a few weeks
• subacute – it can come on quickly or gradually and last 4 to 12 weeks
• chronic – it can start suddenly or gradually, lasts longer than 12 weeks and affects you every day.

Depending on the underlying cause and the part of your back that’s affected, you may experience symptoms such as:

• worsening pain when you bend or lift something
• increasing pain when resting, standing, or sitting
• stiffness in the morning, which eases as you go about your daily activities
• pain that comes and goes
• pain that travels into your buttock, leg, or hip
• numbness or a sense of weakness in your legs or feet.

Rarely, back pain can be a symptom of a serious condition, such as a broken bone or infection – seek emergency medical help if:

• you have pain or weakness in both legs
• you have new bowel or bladder problems (difficulty or loss of control)
• you developed the pain after a serious accident
• you have chest pain.

What causes it?

Back pain can be the result of problems affecting any of the structures in your back, which include:

• the spinal cord, a bundle of nerves that runs down your back
• the vertebrae – small bones that protect your spinal cord
• intervertebral disks, pads between the vertebrae
• ligaments – bands of tissue that hold the vertebrae in place
• tendons – tissue connecting muscle to bone
• muscles that support your spine and upper body, and allow movement.

Sometimes, pain is the result of a few different issues – and there may not be a clear cause. Generally, these are grouped into:

• problems with the back’s structure – such as a strained muscle, a common cause of back pain, which may come from a sudden awkward movement, or repeated heavy lifting. Or a herniated disk, where one of the pads between the vertebrae bulges out, or age-related wear and tear of the disks
• inflammatory conditions, including inflammatory arthritis that can affect the spine
• a range of other medical conditions, such as osteoporosis.

Who’s at risk?

Anyone can develop back pain, but certain factors raise your risk. These include:

• age – generally, the risk rises with age, starting from around 40
• not exercising enough – as weak or under-used muscles in the back or abdomen may not support your spine properly
• being overweight – carrying excess weight can strain your back
• work that involves heavy lifting, twisting, or pulling; or a desk job – especially if you have poor posture
• high stress levels – linked with more frequent and severe back pain, which may be connected to muscle tension
• having a medical condition such as arthritis
• smoking – can decrease blood flow to the spine plus leads to symptoms such as coughing, which puts pressure on the back.

Self-care for back pain

In most cases, back pain gets better on its own in a few weeks with self-care. Try these tips:

• keep active, and carry on with daily life as much as possible – stop tasks that make the pain worse, but don’t avoid movement due to fear of pain
• take over-the-counter pain relief – your pharmacist can advise
• an ice pack may help pain and swelling, and a heat pack can ease joint stiffness and muscle spasms.

When to see a doctor

Back pain doesn’t usually have a serious cause and should improve. But see your healthcare professional if:

• the pain doesn’t get better after a few weeks
• you have severe pain that stops you from doing anything, or it’s worrying you
• the pain is getting worse.

You need urgent medical care if:

• you have a fever
• you have unexplained weight loss
• you’ve noticed a lump/swelling or a shape change in your back
• the pain worsens with strain ie when coughing or pooing
• the pain is in between your shoulders, rather than in your lower back.

How is it diagnosed?

Your healthcare professional will ask you questions about your back pain, and may observe you as you sit, stand, walk, and lift your legs to help find the cause.

You may also have tests, including:

• X-rays, to check for broken bones and arthritis
• MRI or CT scans, which can show herniated disks and issues with muscles, tendons, tissues, nerves, blood vessels and ligaments
• blood tests to see if another condition may be the issue
• nerve studies (electromyography) to check whether nerve pressure is causing the problem.

What are the treatments?

Treatment depends on the cause of your back pain, but your healthcare professional may offer:

• physical therapy, to help strengthen your back and abdominal muscles, and improve your posture
• medication, including anti-inflammatories, pain relievers, muscle relaxants, and medicines that change how your nervous system processes pain
• procedures such as cortisone injections to reduce inflammation – usually given if other methods haven’t worked
• surgery, if other treatments haven’t helped – such as to remove a herniated disk.

Other treatments

Some people try complementary and alternative treatments for back pain, such as:

• acupuncture, where thin needles are inserted at specific points – research shows it may be helpful in back pain
• massage, which may be useful if the pain is muscular
• chiropractic care, where a practitioner manipulates the spine with the aim of easing pain.

Always talk to your healthcare professional before trying an alternative treatment.

Prevention

Looking after your back and overall wellbeing may help prevent pain in the future. These tips can all help to keep your back healthy:

• exercise – focus on low-impact activities such as swimming and walking, plus activities that strengthen the core muscles in your back and abdomen, like Pilates
• improve your posture when sitting and standing, making sure you have a comfortable chair for desk work
• lift carefully to prevent injuries – avoid lifting heavy items altogether if you can
• lose weight if you need to, and keep to a healthy weight
• don’t smoke.

Where to get support

Find information and other resources:

• The National Spine Health Foundation (US)
• Arthritis Foundation (US)
• Versus Arthritis (UK)
• Musculoskeletal Australia