Back pain guide

Types of back pain

Neck pain

Neck pain refers to any pain experienced in the area from the base of the skull to the shoulders and can spread to your upper back or arms.

This can include feelings of stiffness or tightness, as well as sharp pain and, in severe cases, can reduce the movement of the neck and head. Neck pain can also cause tension headaches.

Most muscles in the body will relax completely when they are not being used, but the muscles in the neck are permanently tensed in order to support the head. Although most common in people over 50, neck pain can develop at any age as the result of excess strain on the neck. This could include slouching, sleeping in an awkward position or working at a computer for long periods of time without a break.

Neck pain can also develop as the result of an accident. Perhaps the best known is whiplash; an injury sustained as a result of the head being thrown forward and back in a car accident.

Neck pain is rarely the result of a serious injury and will often lessen after a few days. If you are suffering from neck pain, try to keep moving and maintain your normal routine as best you can. Over-the-counter painkillers may also help.

Visit the Health A-Z section of NHS Choices for more detailed information about all aspects of neck pain and stiff neck.

Upper and middle back pain

The upper and middle back refers to the section of vertebrae, known as the thoracic vertebrae, which runs from the base of the neck to the bottom of your ribcage. This type of back pain is less common than neck or lower back pain as the bones in this area are not required to move and flex as much.

Like many other types of back pain, upper and middle back pain can range from aching and stiffness to a sharp or burning sensation. Pain in this area is often the result of pinched nerves in the spine by the ribs.

One cause of back pain in this area is poor posture. Try to keep your back as straight as possible and balance your weight evenly on both feet. When sitting, keep your shoulders rolled back and be sure to adopt suitable positions when driving, sitting or using computers.

For more advice on ways you can protect your back, see the 'preventing back pain' section of this guide.

Lower back pain

This is the commonest type of back pain with around 8 out of 10 people affected at some time in their lives. The lower back is defined as the area between the bottom of the ribcage and the top of the legs. Symptoms range from tension and stiffness to pain and soreness.

Most people's back pain is described as non-specific, meaning it is caused by structures in the back as opposed to rare conditions such as cancer or a fracture.

The back is a delicate area of muscles, nerves, bones and joints and is continuously working hard to support the weight of the upper body. Lower back pain is often triggered by everyday activities such as bending awkwardly, lifting incorrectly, standing for long periods of time, slouching when sitting and driving for long periods without taking breaks.

The 'preventing back pain' section of this guide has advice on guarding against these common causes of back pain and includes tips on lifting correctly, sitting properly, using computers and avoiding back pain caused by driving.

Buttocks and legs (sciatica)

Sciatica is pain caused by irritation or compression of the sciatic nerve. The sciatic nerve is the longest nerve in your body and runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet.

When something compresses or irritates the sciatic nerve, it can cause a pain that radiates out from your lower back and travels down your leg to your calf. This can be mild to very painful.

The most common cause of sciatica is a slipped disc. This occurs when one of the discs that sit between and cushion the vertebrae is ruptured. Most cases of sciatica will pass without the need for treatment. A combination of the self-help measures described in this guide such as over-the-counter painkillers, exercise and hot or cold packs can usually relieve the symptoms.

For persistent sciatica, you may be advised to try a structured exercise programme under the supervision of a physiotherapist. In rare cases, surgery may be needed to control the symptoms.

Visit the Health A-Z section of NHS Choices for further details about causes, symptoms and treatments for sciatica.

Urgent (red flag symptoms)

Most cases of back pain will usually get better without medical help. However, there are a number of warning signs, known as 'red flags', which may indicate that your back pain is serious.

These red flag signs include:

·         a high temperature (fever) of 38C (100F) or above

·         unexplained weight loss

·         constant back pain that does not ease after lying down or resting

·         pain that travels to your chest or that is high up in your back

·         pain down your legs and below the knees

·         a recent trauma or injury to your back

·         loss of bladder control

·         inability to pass urine

·         loss of bowel control

·         numbness around your genitals, buttocks or back passage

If you have any of the signs or symptoms listed above, contact your GP immediately. If this is not possible, you can telephone NHS Direct on 0845 4647.

You should also seek medical advice if you are having back pain and:

·         you are under 20 or over 55 years old

·         you have taken steroids for a few months

·         you misuse drugs

·         you have or have had cancer

·         you have a weakened immune system as a result of chemotherapy treatment or a medical condition such as HIV or AIDS

Also contact your GP if your symptoms fail to improve within three days or you have persistent pain that lasts longer than six weeks.

Treating back pain

Keep moving

In the past, it was thought the best cure for back pain was to rest. We now know that rest can be harmful as it allows your muscles to weaken, therefore delaying recovery. Staying mobile and keeping active is important for your recovery. Try not to let back pain interfere with your daily routine too much and return to work as soon as possible.

Could some part of your daily routine be causing or at least aggravating your back pain? Explore the 'preventing back pain' area of this guide for ideas and advice on the best ways of sitting, lifting and driving so that your back is protected. There is also advice on using computers.

Painkillers

If back pain is so severe that it begins interfering with your daily activities, medication could be the next step. It is recommended that you first try over-the-counter medication such as paracetamol. If that doesn't provide sufficient relief, try ibuprofen. In either case, make sure you are taking the painkillers as regularly as the dosage information recommends.

Don't wait until your back pain is very bad. If you want any further advice on this, speak to your GP or pharmacist.

Visit the Health A-Z section of NHS Choices for more information on treatment for back pain.

Manual therapy

Manual therapy is designed to provide physical relief for your symptoms and can be performed by a number of different types of practitioners. Perhaps the best-known example is a physiotherapist.

There are many people offering back pain treatment and if you choose to arrange manual therapy yourself, there are a number of questions you should ask. Here is what the charity BackCare recommends you consider:

·         Is there any scientific evidence that the treatment is effective and safe?

·         Who will perform the treatment? Are they qualified or registered with a regulatory body?

·         What are the possible benefits, risks and costs?

·         Is the treatment appropriate for your condition and circumstances?

·         Can you get information and advice on this type of treatment from multiple sources?

·         Can you speak to anyone who has tried this type of treatment?

Your GP may refer you for some manual therapy, which will begin with an examination to see if there are joints that can be freed up. This can be done with a gentle massage, mobilisation or manipulation. Your GP, or the practitioner they might refer you to, will be able to advise on stretching routines or exercises you should be doing to keep your back muscles strong.

Hot or cold packs

Some back pain sufferers find relief by applying hot or cold packs to the affected area. If you think your back pain is the result of a sprain or a tear, try a hot pack first. If you think the pain is the result of an inflammation, a cold pack may be better.

Hot and cold packs can be bought from pharmacies and can be left in the freezer until required. Many can also be heated in the microwave; depending on the type of relief you require. (Always follow manufacturer's instructions). Failing that, a bag of frozen peas or a hot water bottle will do the same job. It is not advisable to apply a hot or cold pack directly to the area, instead, make sure it is wrapped in a thin piece of towel.

Stretching

If you are in the middle of experiencing an episode of back pain, some gentle stretches can help ease any discomfort and will help strengthen the muscles in your back.

Strengthening the muscles in your back will help protect it from further problems. It is for this reason that stretching should become part of your daily routine if you suffer or have suffered from back pain in the past.

BackCare, the charity for healthier backs, has produced a leaflet on stretches for spinal mobility that should be performed daily. You can find this leaflet on the BackCare website.

As well as stretching, research shows that exercise can be effective in reducing back pain. If back pain has become a recurring problem, exercising regularly will improve the strength of your back muscles and will become an important part of your coping strategy.

 

Preventing back pain

Keeping your back strong

Strengthening your back through exercise is one of the best ways to keep back pain at bay. It can also be very helpful in treating back pain.

Choose a low-impact, gentle exercise that will help strengthen the muscles in your back, without the risk of strain or sudden jolts. Swimming, yoga and pilates are very good for improving flexibility and strength and once you feel your back is strong enough, you can graduate to something more energetic such as jogging, cycling or dancing.

Pick something you enjoy so that it is more likely to become a habit. You should aim to exercise three to five times a week for 30 minutes each time.

Stretching is another key way of strengthening your back. It can help to warm up the muscles in your back before starting to exercise and can even be helpful in preparing your back muscles prior to household chores or gardening. But the best way of maximising the benefits of stretching is to make them a part of your everyday routine. See the ‘stretching’ section of this guide for more information and a link to a printable back stretches handout.

Lifting

Lifting can strain your back and lifting badly can lead to injury. Follow these simple tips to avoid damaging your back:

·         Think before lifting. Plan the lift. Can handling aids be used? Where is the load going? Is the load too heavy for one person? Do you need help?

·         Adopt a stable position. Your feet should be apart with one leg slightly forward to maintain balance (alongside the load, if it's on the ground).

·         Be prepared to move your feet during the lift to maintain their stability.

·         Get a good hold. The load should be hugged as close as possible to the body at hip level.

·         At the start of the lift, slight bending of the back, hips and knees is preferable to fully bending the back or fully bending the hips and knees.

·         Don't bend the back any further while lifting. This can happen if the legs begin to straighten too early during the lift, putting pressure on the back.

·         Change directions with your feet, not your back. To avoid a twist, take a step or steps when necessary.

·         When lowering, face the place you have selected and lower the load slowly, bending your knees, never your back and let your legs do the work.

Read this article about more safe lifting tips.

Sitting

Sitting in the wrong position can cause or aggravate back pain. Try to follow these simple tips to combat poor sitting habits:

·         Sit up with your back straight and your shoulders down and back, elbows relaxed at your sides. Your buttocks should touch the back of your chair.

·         Avoid crossing your legs. This weakens your core muscles and can lead to stiffness in your low back and pelvic area.

·         Your feet should be firmly on the floor, but if it's more comfortable, use a footrest.

·         Your thighs should be at right angles to your body or sloping slightly down.

·         Rest your elbows and arms on your chair's armrests or desk, keeping your shoulders relaxed.

·         When sitting in a chair that rolls and pivots, don't twist at the waist while sitting. Instead, turn your whole body.

·         Don't sit in one position for long stretches of time. Get up and move around at least every 45 minutes, however, every 20 minutes is better. Don't forget to stretch.

·         When standing up, move to the front of the seat of your chair. Stand up by straightening your legs. Avoid bending forward at your waist.

Driving

Driving can prove a real challenge for backs, especially if you drive for extended periods of time. Here are some tips to help support and protect your back:

·         Sit with your buttocks touching the back of the seat. Adjust the seat so that your leg is slightly bent when you press a pedal to the floor.

·         For maximum back support, adjust seat depth so the distance between the edge of the seat and the back of your knees is about two or three fingers wide.

·         Your shoulders should be down and back against the backrest. They should remain in contact with the backrest when you turn the steering wheel.

·         Adjust the angle of the backrest so that you can easily reach the steering wheel with your arms bent.

·         If you feel your seat isn't giving good support, try a rolled-up towel or lumbar roll in the small of your back.

·         Adjust the tilt of the seat so that you can easily press the pedals down to the floor. Your thighs should rest lightly on the seat cushion without pressing on it.

·         The top of the headrest should be aligned with the top of your head. Adjust the angle to allow under an inch of space between your head and the headrest.

·         While driving, keep your chin in and don't grip the wheel too hard. Relax your shoulders and keep your head upright.

·         To reduce the risk of lower back pain, avoid sitting still for lengthy periods and stop regularly to walk and stretch.

·         Try to avoid twisting when getting out of the car. Turn your whole body towards the door; lower your feet to the ground and then stand up.

Computers

Computers are probably the biggest problem when it comes to back or neck strain. Ensuring your workspace is set up correctly will help in reducing the potential for harm:

·         Your keyboard should be directly in front of you. A keyboard that is off-centre can cause bad posture.

·         Turn your chair sideways to check that your elbow is level with the spacebar for the correct height.

·         If your keyboard is at the proper height, you should be able to keep your wrists straight while typing. This posture will reduce the risk of injury.

·         A palm or wrist support can help during rest periods from using the keyboard. Place the support under your palms, not your wrists.

·         Your mouse should be close to your keyboard. You should be able to keep your wrist straight, shoulders relaxed and elbows by your side while using it.

·         If you need to look back and forth between your monitor and documents, place your hard copy in such a way so as to avoid twisting your neck.

·         Consider a document holder, which should be placed close to and at the same height as the screen.

·         Place your phone close to you to avoid repetitive reaching.

·         Avoid cradling the phone between your ear and shoulder as this can cause neck pain and stiffness. Consider a headset or speaker phone.

Further reading on using computers:

If you use a laptop, this can cause a number of different issues. This article has specific advice for laptop users.

Read this article for further information about repetitive strain injury (RSI).

 

The structure of the back

The back is a complex structure that consists of:

·         24 small bones (vertebrae), that support the  weight of your upper body and form a protective canal for the spinal cord

·         Shock-absorbing intervertebral discs that cushion the bones and let the spine bend

·         Ligaments that hold the vertebrae and discs together

·         Tendons to connect muscles to vertebrae

·         A spinal cord, which carries nerve signals from the brain to the rest of the body

·         Nerves and muscles

The lumbar region is the lower part of the back and is made up of five vertebrae. This region supports the entire weight of your upper body which is why most cases of back pain develop in the lower back.

 

NHS Choices 2011