Lower back pain, also known as lumbago, affects 7 out of 10 people at some time in their lives. Low back pain means a pain or ache anywhere on your back, in between the bottom of the ribs and the top of the legs.
The pain can come on suddenly, slowly or be the direct result of a fall or injury.
Back pain is common and one of the main reasons for sickness absence in the UK, and although painful, it is normally not serious. In most cases the pain lasts from a few days to a few weeks and usually clears up after about six weeks.
If back pain lasts for less than 3 months it is called acute. If it develops gradually over time, lasts more than 12 weeks and causes long-term problems, it is known as chronic back pain.
Back pain can affect anyone of any age but is more common between the ages of 35 55 years.
In the majority of cases, the cause of pain can be linked to the way the bones, muscles and ligaments in the back, work together.
The back is a complex structure consisting of:
24 small bones (vertebrae),shock absorbing discs (intervertebral discs) that cushion the bones and allow the spine to bend, ligaments to hold vertebrae and discs together,tendons to connect muscles to vertebrae,spinal cord (carries nerves from the brain to the rest of the body),nerves, andmusclesThe lower part of the back, the lumbar region, is composed of 5 vertebrae known as L1 to L5. This region bears the entire weight of the upper body (plus any extra weight carried) and is also under continual pressure especially when bending, twisting, and lifting.
The complex structure of the lower back means that quite small amounts of damage to any of the structures of the back can cause a lot of pain and discomfort. Pain in the lower back is a symptom of stress or damage to the ligaments, muscles, tendons or discs. In some cases the back pain can spread to the buttocks and thighs.
In most cases the back will heal itself and staying active and continuing with your usual activities will normally promote healing. However in severe and persistent cases it is important to seek medical advice so that a correct diagnosis can be reached and appropriate treatment given, as treatment may depend on the underlying cause in some cases. For example, pain caused by some types of arthritis may be treated by specific medicines.
The symptom of low back pain is a pain or ache anywhere on your back, in between the bottom of the ribs and the top of the legs.
The majority of cases of back pain usually clear up quite quickly. However if you are worried or concerned about your back pain, seek medical advice.
Visit your GP as soon as possible if you have back pain together with any of the following symptoms:
a fever, weight loss, inflammation or swelling on the back, constant back pain that does not ease after lying down or resting, pain that travels to the chest or pain high up in your back, pain down the legs and below the knees, you have had a recent trauma or injury to your back, loss of bladder control,unable to pass urine, loss of bowel control, numbness around the genitals, buttocks or anus.
It is advised you seek medical advice if you are experiencing back pain and:
you are under 20 years old or over 55 yearsyou have taken steroids for a few months you are a drug abuser, you have or have had cancer, or you have a low immune system due to chemotherapy or another medical condition e.g. HIV/AIDS.
Also, If the pain developed slowly but has got increasingly worse over days or weeks, ask your GP for advice.
Most, lower back pain is referred to as non-specific because it is caused, not by serious damage or disease, but by sprains, muscle strains, minor injuries, or a pinched or irritated nerve.
Back pain can also be triggered by everyday activities at home or work, and poor posture including:
bending awkwardly,lifting, carrying, pushing or pulling incorrectly,slouching in chairs,standing or bending down for long periods,twisting,coughing,sneezing,muscle tension,over-stretching,driving in hunched positions, ordriving for long periods without a break. Sometimes, you can just wake up with back pain and have no idea what has caused it.
Some other causes of back pain are:
pregnancy, gynaecological problems in women, e.g. pelvic inflammatory disease, different types of arthritis, e.g. osteoarthritis, stress related tension, viral infections, bone disorders, bladder and kidney infections, osteoporosis, a trip or fall, trauma or injury e.g. fracture lack of exercise,obesity, or sleep disorders.
Serious back pain can be caused by the bulging or rupture of one or more of the intervertebral discs causing the inner jelly-like material (nucleus pulposus) to press on the spinal cord or nerve roots which run next to the disc. This is commonly known as a slipped disc but is more accurately described as a prolapsed (bulging) or herniated (ruptured) disc.
The pain will usually be in the lower back but you may experience pain in the buttocks, thigh, calves, feet and toes due to irritation of the sciatic nerve, which runs down both legs. Occasionally, the pain is also accompanied by pins and needles, numbness and weakness.
Discs may tend to dry out and weaken with age, or following an injury. This results in the discs becoming less flexible, which means they do not cushion the vertebrae as well as before. This is a common cause of stiffness and pain, especially early in the morning and/or in the elderly.
Persistent lower back pain may also be caused by a number of other rare conditions such as congenital spinal defects, bone diseases, shingles, fibromyalgia- link, prostatitis- link, or cancer that has spread to the spine.
A diagnosis is made from discussing the symptoms with your doctor and a physical examination. In most cases, no tests are needed as X-rays or scans of the back are not always helpful because they do not show anything unusual if you have simple back pain.
You will only be sent for tests if the pain lasts for longer than six weeks, you have had an injury or blow to your back or if your doctor suspects there may be an underlying cause for the pain.
For suspected disc problems, X-rays, a computed tomography scan (CT or CAT scan) may be required. A magnetic resonance imaging (MRI) may be suggested to provide more accurate information about the soft tissues in your back, rather than the bones.
In some cases, blood tests or a myelogram (a special kind of X-ray using an injected dye) may be needed.
Most cases of back pain will improve on their own within a few days or weeks. Staying as active as possible will help relieve symptoms even if you are in a lot of pain.
Current recommended treatment for lower back pain include:
continue with normal activities wherever possible, use of over-the-counter painkillers ,use of anti-inflammatory drugs and stronger painkillers (consult your pharmacist or GP first), a muscle relaxant may be prescribed but only for a few days if you are in severe pain, keep any bed rest as short as possible, as complete rest does not help recovery, exercises to strengthen the muscles and improve posture Apply a cold compress (bag of frozen peas wrapped in a tea towel) to reduce the initial inflammation, apply heat (heating pad, hot water bottle or hot shower) after a few days to ease muscular pain Anti-arthritis medication for pain caused by arthritis. You can also consider seeing a qualified physiotherapist, osteopath or chiropractor as some of the treatments they provide, like physiotherapy or back or spinal manipulation, may provide short term comfort in some people with acute back pain or nerve root pain.
You may find that the Alexander technique helps. The Alexander Technique is a method that works to change movement habits in your everyday activities. It helps to make you aware of balance, posture and co-ordination and aims to help you to relearn the correct way to hold and to move your body and release muscular tension. You should always see you GP first as there are many possible causes of your back pain. Alexander teachers do not make medical diagnoses.
In rare, serious cases, surgery may be required to repair a protruding or ruptured disc.
It is advised that you continue to work, or return to work as soon as possible.
To avoid back pain you must reduce excess stresses and strains on your back, and ensure your back is strong and supple.
The following advice also applies to those with persistent, recurring bouts of back pain:
lose any excess weight, do strengthening exercises to improve your back and stomach muscles ,improve your body posture practise the Alexander technique sleep on a bed with a firm, comfortable mattress sit in chairs that support the spine, with your feet flat on the floor or on a foot rest correct lifting and handling avoid sudden movements or muscle strain when driving, have a seat that supports the back and neck try and reduce your stress, anxiety and tension, and take regular exercise Exercises like walking, swimming, yoga and stretching movements are especially good for those with back pain.
Back pain in secondary school age children has been linked to heavy schoolbags and backpacks as well as ill-fitting classroom seating. Nearly half of all teenagers in the UK have experienced occasional backache from carrying overloaded bags, poor posture and an unhealthy lifestyle.
Take care when carrying shopping bags, luggage, backpacks or any heavy loads. Try to distribute the weight evenly on both sides of your body and carry any heavy items close to your waist with the heaviest end nearest to you and look straight ahead.
When lifting, let your legs take the strain - bend your back, knees and hips slightly but dont stoop or squat. Tighten your stomach muscles to pull your pelvis in. Dont straighten your legs before lifting as you may strain your back on the way up.
Stand firm your feet should be apart with one leg slightly in front to hold your balance. Try not to lean to the side or twist your body. If you need to change direction then let your feet do the work.
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