Low back pain

Low back pain is extremely common. Two out of three people can expect to have back pain bad enough to prompt them to seek help. Symptoms vary enormously ranging from localised back pain to referred symptoms in the hip, thigh, lower leg and foot. Thankfully most back problems are self limiting. There are however various activities that can either promote or delay recovery.

Man holding lower back

With back pain, immediately, everybody one meets has suffered too and are ready to give their advice and various remedies. Consequently there is a lot of mythology surrounding the subject of backs. Here are a few facts to dispel some of the commonest myths around!

  • Discs do not slip in or out, nor are they the only structure in the back to be a major cause of grief.
  • Bed rest for weeks on end will make you worse
  • We would not be better off on all fours (what a relief!)
  • We would be better off if we didn't sit as much
  • The spine is well designed for lifting, it's just that we don't always use it correctly.
  • Your tummy and bottom muscles are some of the most important muscles to support and stabilise your back.

Some useful anatomical points

  1. Discs behave slightly like sponges; they maintain their shape by absorbing water from the blood stream. When weight bearing, during the day, water is squeezed out of the disc, but happily is absorbed back again when  lying down at night.
  2. When we move the spine, movement occurs at several small joints in the back as well as at the disc. All these structures need movement to help maintain a healthy blood supply. If movement is denied them, they develop  arthritic changes more rapidly.
  3. Ligaments exist around joints. They are short tough elastic structures, designed to prevent excess movement. They can become overstretched or shortened by maintaining certain postures.
  4. The pressure in the back varies in different positions. It is lowest when lying on the back and  progressively increases as you move through standing to sitting. It is greatest when sitting bent forward. This is a position very similar to that adopted when driving or in the office.

The commonest contributory causes

Adults with back pain have restricted movement in one or more directions and often have some muscle weakness. Although symptoms may have come on extremely suddenly, the cause is generally more long standing. The commonest contributory causes are:-

  1. A sedentary occupation involving prolonged sitting or driving.
  2. Poor stomach muscle strength, women > men.
  3. Being inherently inflexible, men > women
  4. Having a sedentary job, being unfit and then attempting, for example, to lift paving slabs all weekend!

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Useful tips when/if you have back pain

Because no two back problems manifest themselves in exactly the same way it is difficult to produce a universal panacea, but the following will be helpful in the majority of people. Do not do anything that markedly increases pain.

  1. If sitting is comfortable, use a high chair with arms and a gently reclining back. Do not put your legs straight out in front of you on a stool, but do make sure your feet are supported either on a low foot stool or on the floor.
  2. If sitting is painful avoid it as much as possible. Kneel at a table to eat or perch on the very edge of a chair with your knees bent under you. Better still, lie on your tummy propped up on your elbows. If you have to drive try both sitting on a pillow to raise the height of your hips and use a lumbar roll in the small of your back. The latter can be bought from a physiotherapist or you can make a temporary one from a towel.
  3. If virtually all movements are agonising, rest on your back with a couple of pillows under your knees or lie on your painfree side (if you have one) with the top leg placed slightly forward and supported on a pillow. Do not put the mattress on the floor, because getting up and down will be agony and therefore counterproductive. Take some pain killers and use a heat pad or hot water bottle. Do not do this for longer than 2 days. If it is still as painful after this time you will be better trying to get up and move. A physiotherapist or your G.P will advise you on how much to do.  USE the tablets prescribed. By reducing the pain movement will be easier which will accelerate recovery. If feeling depressed about the whole thing remember nearly all back problems resolve completely.
  4. As soon as you can, without provoking pain, try lying on your tummy and keeping your hips and legs on the bed, push up the top half of your body, so arching the low back. Hold for 2-3 seconds and then return to the lying position. Repeat up to 10 times.
  5. Walking, if it doesn't provoke pain, is a good rhythmical gentle exercise to try as soon as possible to maintain mobility and relax muscle. Use this interspersed with the resting positions in lying or sitting described above. Movement ultimately is the way forward and the key to maintaining a fit back.

General advice for preventing back pain

  1. Vary the working position, do not sit for longer than 20-30 minutes without at least standing up. Sitting at a desk can be one of the most stressful situations to put your spine in. The pressure in your back is five times greater when sitting than when lying on your tummy. There are some easy exercises you can do even in an office situation.
  2. Regularly stand and arch your spine backwards. Most of us never move our backs in that direction with the result that ligaments shorten and the discs and joints are denied their normal nutrition.
  3. Maintain good abdominal muscle strength. This does not mean doing loads of sit ups. Tightening your stomach and holding it for 20 second periods is more functional. Most people are unaware that many of the stomach muscles start in the back. They are a key element in maintaining strength and stability in the back. Your physiotherapist will be able to advise you on exercises specifically for your situation.
  4. Keep flexible, both in your back but also your legs, upper back and neck. Remember the old song "your hip bones connected to ......." It is very, very true. There is a strong correlation between back and neck pain.
  5. Do some regular exercise. Walking is fine, but if that is all you do, make sure you vary the speed, overstride and incorporate some steep hills. Again, a physiotherapist will be able to give you individual advice.

Advice for children

Now for the children!!!. Children are naturally flexible. We lose this suppleness as we get older largely because we are not as active. It is important therefore to encourage some form of sport and exercise, particularly in the teenage years when the seeds of becoming a couch potato can begin to grow.

The following is good advice for both children and adults!!

  1. When sitting, children should be encouraged to have the chair as close as possible to the desk, so enabling them to maintain a relatively upright posture. If writing for long periods, an inclined surface is preferable. This is most easily achieved by putting the paper/book etc. onto a clipboard and propping that up. Bring back those old fashioned inclined desks we all know, they are much better than the flat table tops so universally used now.
  2. Most of our children will spend much of their lives working with computers. The ability to touch type will help prevent a lot of neck problems. There are many good software packages specifically designed to teach typing to young children.
  3. Back packs properly used, (ie not slung over just one shoulder) are the best way to carry moderate to heavy weights.
  4. Encourage children to look up and not study the pavement as they walk. (adults could benefit from this also). The tall child often wants to slink into the background and will stand with one knee perpetually bent. This puts a sideways kink in the back and is a difficult habit to break once they have decided being 6ft isn't so bad after all!
  5. Reading in the normal position, with the book on the lap is terrible for the back and neck. A better way is to have a pillow(s) on your lap and rest the book on that. Alternatively children find it comfortable to lie on their tummies or on their back for a time. It is better to vary the position if reading for long periods.

Read about more common conditions, or contact us to find out how we can help.