Back pain is very common. Women’s College Hospital physiotherapist Chandra Farrer noted that 90 per cent of people will experience back pain at some time in their life. The good news is that most people also recover: 90 per cent of cases of back pain will resolve or improve whether the patient gets treatment or not.
'But for 10 per cent of those people, the pain will persist and will affect their day-to-day life and they’ll end up seeing a health-care professional,' Farrer said during a talk on Oct. 14, 2009 at the Marion Powell Women’s Health Information Centre at Women’s College Hospital. She and athletic therapist Heather Robinson discussed back care in a session called Healthy Solutions for a Healthy Back.
Back pain also has a high risk of recurrence, with 70 per cent of people having more than one episode. It can also become chronic.
Although lots of people get back pain, and most of the time they recover without treatment, there are some symptoms that require a doctor’s attention.
Farrer said that when symptoms such as pain, numbness or pins and needles in the legs begin to affect day-to-day activities, it’s time to see a doctor. In cases of trauma – if you’ve fallen or been in a car accident, for example – be sure to see a doctor to make sure there are no broken bones or other injuries causing the pain. People with a history of osteoporosis should also see a doctor about back pain, because it may be from a broken bone in the spine.
Other symptoms that require a physician visit include back pain accompanied by a fever or weight loss, nighttime pain that interferes with sleep, back pain accompanied by bowel or bladder incontinence, or the inability to empty your bladder. Bowel and bladder symptoms require immediate medical attention.
Common causes of a common problem
One of the biggest causes of back pain is poor posture, athletic therapist Heather Robinson said.
'Our goal for posture is to have ears over shoulders over hips when sitting and when standing,' she said. Avoid crossing the legs, and sit with feet flat on the floor, knees bent at about 90 degrees and hips bent at about 90 degrees, with the back well supported by a chair.
The slumped forward position so many people adopt while working at a desk puts a lot of pressure on the spine and the discs. Ideally, the back should be straight when standing, sitting or lying down. The best positions to adopt when lying down are on your back, or on your side with a pillow between your knees.
Improper lifting and carrying is another common cause of back pain. Robinson reminded the audience that when lifting something, lift with the legs. Bend the knees, get down on one or both knees and lift from there. Avoid bending from the waist to lift things – even children! Sit down and let the child come close to you, then lift them from a sitting position.
Proper lifting is easier if there is some strength in the legs: doing small squats at home can help strengthen the muscles that should be doing the heavy lifting.
Heavy carrying – such as the heavy bags that many women carry – can also cause back trouble. Instead of a shoulder bag that keeps all the weight on one side, Robinson recommends carrying a backpack, using both straps and preferably a waist strap.
'Using the waist strap is surprisingly effective in reducing the amount of weight that ends up on your shoulders,' she said. But she noted that children, in particular, should not carry more than 10 to 15 per cent of their body weight in a backpack.
Carrying too much weight on the body – being overweight or obese – can also cause back pain. Excess body weight is often associated with weak abdominal muscles, which make it more difficult to maintain good posture.
Inactivity is also a bad habit for backs.
'Not getting regular exercise increases your chance of getting back pain,' Robinson said. 'So try to get physical on a regular basis. It doesn’t really matter what you do as long as you do it regularly, on a daily basis if possible: walking, swimming, aquafit. Something like that.'
Different sources, different pain
Back pain can come from different sources. The most common cause of back pain in young people ages 20 to 50 is disc herniation.
'The bones of the spine sit like building blocks, and there are discs in between them,' Farrer explained. 'You can think of (disc herniation) like a balloon or a tire that gets a little bit of a blowout: the disc is intact, but there’s this little herniation out the side.'
The protruding herniation can pinch a nerve, which can cause pain or numbness in the leg.
As people get older, another common disc problem is degenerative discs. As we age, discs suffer the same wear and tear as the rest of the body: they dry out and become less cushiony. This shrinkage brings the bones of the spine closer together, which can pinch nerves and trigger back pain.
Inflammatory back pain is more common in people who have certain types of arthritis, such as rheumatoid arthritis, or conditions such as spondylitis (inflamed vertebrae).
Joint problems, muscle strains and 'referred' pain – back pain that actually originates in another part of the body – are other causes of back pain. Problems such as kidney stones or some gynecological conditions can manifest themselves as referred back pain, even though they are not caused by a back problem.
Just as some back pain may not come from the back, there are also back problems that only cause pain in other parts of the body.
'Some people have only leg pain and no back pain, but the cause of the pain is the low back,' Farrer said. 'Some people have numbness or a tingling sensation in the leg. It’s actually coming from the back, but they have no symptoms locally. You don’t necessarily have to have back pain to have back problems.'
Managing back pain
If you don’t know what’s causing your back pain, Farrer recommends seeing your physician just to make sure there’s nothing seriously wrong with your back. When talking about back pain, let your doctor know where it hurts, what alleviates it and what makes it worse.
Managing back pain can include various types of therapy, such as chiropractic, physiotherapy, athletic therapy and massage, as well as medical treatments such as medications, injections and even surgery. Treatment guidelines are divided into recommendations for people who have had pain for less than four weeks, and those who have had pain for more than four weeks.
For patients whose pain has lasted less than four weeks, recommendations include:
• stay active
• educate yourself about how to protect your back through proper lifting and finding resting positions that are comfortable
• applying heat at home
• acetaminophen
• NSAIDS
• muscle relaxants
• spinal manipulation (except for those with osteoporosis)
For people with long-term back pain, the recommendations include all of the same remedies for acute back pain, and sometimes adding treatments such as opioid pain relievers, low-dose antidepressants to help with pain, and mind-body therapies such as mindfulness meditation or other stress management techniques.
Very few back pain patients require surgery. In fact, 99 per cent of back patients evaluated in a surgical clinic are not offered surgery. Surgery is almost exclusively reserved for cases with neurological symptoms such as numbness and burning in the legs, and cases involving bladder or bowel dysfunction. It is most effective for patients with only one level of the spine affected, such as a single disc herniation.
Stay active to stay pain-free
Regular exercise is key to a healthy back. Robinson noted that nowhere on the list of recommendations for back pain will you see 'bed rest' – it only makes the muscles weaker and hinders recovery.
While core strength programs have been a cornerstone of back health advice for years, Robinson said recent research suggests that doing any regular exercise can achieve good results.
'It doesn’t seem to matter what you do as long as you do it on a regular basis. But we still work on the core because we know that makes people better,' Robinson said. Core strength means strengthening the area between the chest and the hips. These are the muscles that help to stabilize the body and help the limbs work more efficiently. Pilates, yoga and specially focused core workouts can help build strength in these important muscles, but other forms of exercise may also be helpful for back health.
'There’s a lot of research that regular walking is as effective as a core program for managing back pain, which is surprising and encouraging,' Robinson said, adding that as long as they are doing some sort of consistent exercise – particularly core or aerobic – on a regular basis, people tend to do very well with resolving their own back pain. But the key is to continue the program even after recovery.
'They often ask, do I have to do it for the rest of my life? Well, you’re going to have that body for the rest of your life. So yes,' Robinson said. 'You’ve got to think of it as a long-term lifelong plan. So you do it for a few months, your back pain goes away, that’s when people stop doing it. And often times that’s when back pain starts up again.'
Whether you choose walking, swimming, cycling, yoga, a core workout, or your favourite low-impact sport, stick with your program for a healthy back.
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