Lower Back Pain
Dr Simon Gazeley, a GP at Springfield Surgery in the Canalside Healthcare Centre in Bingley, will be sharing with The Bingley Hub readers exclusive advice on topical health issues and giving his tips for a healthy life.
One of the commonest problems we see in General Practice is low back pain. Around 8 out of 10 people will get back problems at some point in their life. Pain can be quite severe and debilitating, and often causes a lot of anxiety about what is causing the pain and what the future holds.
In most cases however, back pain is not related to a serious back problem, and will resolve relatively quickly. The usual advice is to keep active and carry on with your normal activities as much as possible. However, if pain is “chronic” (in medical terms, this means persistant ie. lasting several weeks) or there are “red-flags” present then further assessment may be needed.
Structure of the back
The lower back, the lumbosacral spine, extends from the bottom of the ribs to the coccyx (tail bone). There are a series of bones called vertebrae, with shock-absorbing discs inbetween, called vertebral discs. These are all kept together with strong ligaments to support the back. Muscles attach to the spine to allow us to move. Inside the vertebrae is the spinal cord; nerves pass out of the cord to control our legs. These nerves run right next to the discs and vertebrae.
What causes low back pain?
Often it is impossible to tell the exact cause of back pain. Non-specific back pain is by far the commonest cause, accounting for around 19 out of 20 bad backs. It is impossible to tell from examination or XRaying or scanning what the cause is. It is probably related to sprain of muscles or ligaments. In these cases, further tests are usually unnecessary, as there is no test that can prove or confirm non-specific back pain. Guidelines in the UK are quite clear that routine tests such as scans and Xrays should not be done for a diagnosis of non-specific back pain.
However, there are some situations where it is very important for back pain to be assessed:
- Chronic pain – if your pain slowly gets worse over days and weeks
- Weakness or numbness in legs or feet, as this may be a sign of nerve irritation
- Signs that nerves are being squashed ie. Numbness around the anus, bladder symptoms, incontinence of poo
- An injury to the spine that may have caused a fracture, especially if you have osteoporosis
- Pain in older people associated with general symptoms such as weight loss or fever.
If you have any of these “red flags” you should see your GP.
What can I do if I have non-specific back pain?
The best thing you can do is to keep active, and continue normal activities as much as possible. The pain may be particularly bad for the first day or two and it may be difficult, but try not to rest if you can, and if you have to for no longer than 48 hours. Too much rest makes the back worse, and you’ll have to accept some discomfort when you are trying to get active.
Simple painkillers such as paracetamol or ibuprofen can be effective and help get you active again if you’re limited by the pain. Some people are concerned that they may be “masking the pain and causing more damage” but this is simply not the case. It is better to take pain killers if it allows you to get more mobile than it is not to take something and be less active.
If your pain seems slow to settle, you may choose to see a physio, osteopath or chiropractor. All can help. There may also be some benefit from doing specific exercises at home, there is an excellent page on the arthritis UK website…