Back problems can be caused by injury, inflammation, tension or spasm, and may affect muscles, ligaments, cartilage or bone. Arthritis, muscle strain, osteoporosis, sciatica and stress are other common causes. Treatment can include exercise, manual therapy (including massage) and medication. Staying active is an important part of managing back pain.
Back pain is a very common problem. It is usually not due to any serious disease. Most episodes of back pain get better quickly. Simple analgesics (pain-relieving medication) and a change of activity are generally all that is needed.
About half of all people who get back pain will have further episodes. The first step to managing back pain is to rule out the possibility of any medical problem, such as infection or fracture (although these are rarely the cause).
Structure of the back
Your back is a complex structure that provides support for your pelvis, legs, ribcage, arms and skull. The spine is made up of bones called vertebrae that are stacked together to form a loose ‘S’-shaped column.
Each vertebra is cushioned by spongy tissue or cartilage called intervertebral discs. These discs act as shock absorbers and give the spine its flexibility. They have a flat structure with a jelly-like centre. Vertebrae are joined by pairs of small joints known as ‘facet’ joints. A mesh of connective tissue called ligaments holds the spine together.
Complex layers of muscle provide structural support and allow movement. The spinal cord runs through the centre of the vertebral stack and connects the brain to the rest of the body.
Types of back problems
There are many different back problems, all of which can cause back pain, such as:
- soft tissue injuries – like sprains and strains
- disc problems
- postural stress
- sciatica (nerve irritation)
- structural problems
Causes of back pain
There are many possible causes of back pain and it is often difficult to work out which structure is the cause. Any structure in the back has the potential to cause pain if it is affected by injury or disease. Most people with back pain do not have any significant damage to their spine. The pain comes from the muscles, ligaments and joints.
Some common causes of back pain include:
- Arthritis – osteoarthritis and ankylosing spondylitis are two forms of arthritis linked to back pain.
- Muscle and ligament strains – if your back is out of condition or if you have pre-existing problems, you are more vulnerable to soft tissue injuries such as sprains (stretching or tearing ligaments) and strains (injuring muscles or tendons). Stretching a ligament or muscle too far or too quickly can result in a tear of the tissue. Excessive force and repetitive use may also damage muscles.
- Osteoporosis – is a disease characterised by loss of bone density and strength. The vertebrae can become so porous and brittle that they break easily. Pain is due to a fracture of the vertebrae.
- Sciatica – develops when the nerve that runs from the lower back into the leg is compressed by a bulging intervertebral disc, causing pain.
- Stress – one of the side effects of stress is increased muscle tension. This can lead to fatigue, stiffness and localised pain. Constantly tight muscles can create imbalances in a person’s posture that may cause misalignment of the spine.
- Structural problems – lifelong bad posture, osteoporosis and genetic conditions (such as kyphosis, a curving of the upper back (sometimes called hunchback), and scoliosis, which produces a sideways curve) can cause pain by putting added stress on the structures of the spinal column.
Lifestyle factors contribute to back pain
Most cases of back pain are exacerbated by lifestyle factors including:
- lack of exercise
- being overweight or obese
- sitting for long periods
- poor posture
- bad work practices.
Prevention of back pain
In most cases, back pain can be prevented by making a few lifestyle changes. Some suggestions include:
- Exercise regularly – this is important to improve posture and increase muscle support of the spine. Aim for 30 minutes of moderate physical activity every day. This can be broken into shorter blocks of exercise if you prefer.
- Lift and carry safely – if you are picking up a heavy load, squat down, hold the object as close to your body as practical and lift by using your legs (keeping your back straight). Get some help from another person or use equipment (such as a trolley) if the load is too heavy to manage comfortably on your own.
- Maintain a healthy body weight – being overweight or obese puts extra strain on your back.
- Be aware of your posture – consider your posture, particularly in seated positions such as when driving or sitting at a desk for long periods of time. Don’t slump, keep your back upright and use support where necessary (such as a lumbar support cushion or footstool).
- Take regular breaks – when driving, standing or sitting for long periods of time, take a break at least every hour. This will help change the position of your joints and loosen your muscles. Include a short walk and a few stretches as part of your break.
- Relax – learn some relaxation techniques to reduce stress levels and related muscle tension. Try massage, heat or cold packs and gentle exercise. Seek advice from a physiotherapist.
- Change your mattress – surfaces that are too soft or too hard can aggravate a sore back. Avoid sleeping on your stomach.
Seeking help for back pain
In many cases of back pain, the first and most important treatment is to keep active and resume normal activities – work, sport and recreation – as soon as possible. The majority of back injuries will improve by themselves. However, there are times when it is important to see your doctor to check there are no medical problems that may be contributing to the pain.
See your doctor if you have back pain and any warning signs such as:
- severe pain that gets worse instead of better over time
- you are unwell with back pain or have a fever
- difficulty passing or controlling urine
- numbness around your anus or genitals
- numbness, pain, pins-and-needles or weakness in your legs
- unsteadiness on your feet.
Treatment of back pain
In the first couple of weeks after the onset of an episode of back pain, treatment will focus on reducing pain and maintaining movement. Treatment options include:
- Relative rest – this may mean temporarily reducing activity such as sport and heavy lifting.
- Exercise – seek advice from a health professional, such as a physiotherapist or exercise physiologist, who can prescribe an individual exercise program for you. Exercise may include stretching, mobility and strengthening exercises that target the muscles stabilising and supporting the back.
- Medication – pain-relieving and muscle-relaxant medication may be prescribed temporarily by your doctor.
- Heat and cold therapy – hot and cold packs applied to the area of pain may be helpful in relieving pain temporarily.
- Manual therapy – a qualified professional may use massage, manipulation or acupuncture.
- Education and counselling – can be helpful to encourage you to resume normal activities, emphasising that most people with back pain get better, and teaching active pain-coping strategies.
- Surgery – in severe cases, when the condition does not respond to other treatments and where doctors can tell which structure is causing pain, surgery may be an option. The techniques used depend on the condition. For example, surgery for a ruptured disc involves removing the fragments that may be pressing on nerves.
Managing long-term back pain
Back pain can be an ongoing problem for many people. About half of the people who get back pain will experience it again. It is important to strengthen and condition your back, and be aware of your posture, even after the pain has subsided.
Talk to your physiotherapist, osteopath, exercise physiologist or other health professional about what exercises you can do on an ongoing basis to maintain the health of your back and for your general wellbeing. Recommended activities may include walking, swimming and cycling. It is important that you learn about back pain and play an active role in your own treatment.
Where to get help
- Your doctor
- Australian Physiotherapy Association Tel. 1 300 306 622
- Australian Osteopathic Association Tel. 1800 467 836
- Exercise physiologist
Things to remember
- Back pain is a common problem.
- Back pain most often comes from muscles, ligaments and joints. It can be caused by injury, inflammation, tension, spasm or muscle imbalance.
- Staying active plays an important role in management and prevention of back problems. Remember, your back is designed to move.
- Seek advice from a doctor if any warning signs exist.
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Last reviewed: March 2014
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