How to beat back pain
Don't go rushing to your doctor, don't take to your bed for days – and do get to know your sacro-iliac joints. Dr David Delvin exposes the myths about lumbar pain and explains what really works
Tuesday 23 June 2009
Every day of the year, the number of Britons who are off work with back pain would fill London's new Olympic stadium. Yes, Britain's got backache – and in a very big way. Yet rather surprisingly, a lot of people have no idea about what causes back pain, or of how to avoid it, or how to treat it. Many of them think, "Oh, it won't happen to me". But it probably will. So here are 10 things not a lot of people know about back pain. Reading it might just save you from a lot of discomfort in the future.
Back pain is often preventable
Back pain doesn't just happen out of the blue. Very frequently, it's caused by doing something that is distinctly unwise. Common examples include: leaning forward to pick something up, without bending your knees – this puts a big strain on your lumbar region; lifting something that's far too heavy for you; carrying something weighty, but holding it away from your body – a load that is held tight against the body will put much less stress on the back; twisting round suddenly – for instance, to get something off the back seat of the car; continuing with what you were doing when the back pain started – if you suddenly feel pain while gardening, golfing, working out in the gym, carrying a toddler or sitting in an uncomfortable chair, then stop. Alas, the British have an endearing tendency to carry on, in the hope that it will all be OK. It probably won't.
You should take care of your sacro-iliacs
Most British people have never heard of the sacro-iliac joints. This is in sharp contrast to Americans, who are forever staggering into their doctors' offices muttering, "I guess it's my S-I joints again, Doc." The sacro-iliacs are a fairly common source of low back pain. There are two of them, and they are located just under the pair of dimples many people have at the top of their buttocks.
They are easily thrown out of kilter by sudden or awkward bending forward. Thus, the last time I had trouble with mine was on the day I tried to trim the lawn using a cheap, nasty, unwieldy strimmer that was much too short for my height.
Bending forward to vacuum the floor is another common cause of S-I joint pain. Typically, this is a dull ache that gets worse whenever you try to stand up from a chair. Happily, it gets better with rest. Manipulation often helps.
In most cases, your doctor can't diagnose exactly what's wrong with your back
At least 80 per cent of the time, it's impossible to make a really precise diagnosis of the cause of back pain. This is mainly because the back is such a complex structure, with so many different joints, muscles and ligaments in it. However, all experts agree that most attacks of backache are due to minor "mechanical" causes, which will generally get better within 10 days or so.
Just a minority of cases are due to a protruding disc (a "slipped disc"). Only a tiny percentage are due to very serious causes, like cancer.
When you get a sudden back ache, there's not much point in rushing straight off to your doctor
Since most backaches get better quite rapidly, why bother to join the hurly-burly of patients who are trying to get an appointment with their GP? Even if you do manage to see your doctor, what is she going to do for you? Most probably, she won't be able to make an exact diagnosis. And it's very unlikely that she will know how to manipulate your back. Yes, she can prescribe you some pills – but you might just as well take the kind that you can buy over the counter from a chemist.
Pills cannot cure back pain
A lot of people have a rather touching faith in the idea that tablets can, by some mysterious process, make back disorders better. But how could they? Years ago there was a wildly successful tablet called "Lobak". Because of its cleverly chosen name, thousands of people – including some doctors – believed that it was a specific treatment for low back pain. In fact, it was just a simple analgesic.
There is certainly a place for analgesics when you have a bad backache, because it's a relief to have the pain eased. However, NICE (the Government's official therapeutics advisory body) has just issued guidelines that say that the initial treatment should be regularly taken paracetamol.
If you get back pain, there's a lot you can do to help yourself
When back pain strikes, that's a sign for you to take action. Stop whatever you're doing and get yourself into a comfortable position. Keep warm. Try putting a wrapped-up hot water bottle on the area. If that doesn't work, try a "cold pack" from the pharmacy. An alternative is to wrap a packet of frozen peas (or whatever) in a towel and apply it to your skin.
Take those paracetamol. If they haven't worked after 24 hours, then consider moving on to a mild anti-inflammatory analgesic, like ibuprofen. But read the contra-indications on the leaflet first. And don't take anti-inflammatories if you have a history of ulcers. At all costs, do not become immobile. That's likely to make your back worse.
If things haven't improved after a few days, consider manipulation
In the UK, the experts in dealing with back pain are the osteopaths and chiropractors – not the doctors. After all, they deal with little else but backache, all day long. They are skilled at spinal manipulation or, as chiropractors prefer to call it, "adjustment". They certainly aren't miracle-workers, as some people imagine. But they usually do help.After long experience of being treated by both osteopaths and chiropractors, I'd say that I have rarely come out of a manipulator's consulting room without feeling quite a lot better.
Most importantly, make sure you choose a qualified practitioner. Trained osteopaths have the letters "DO" after their names. Trained chiropractors have the letters "DC".
If you have a local 'Dial-a-Physio' service, use it
The other group of people who know a lot about backache are the physiotherapists (or "physical therapists"). Until recently, getting to see an NHS physio about back pain took forever. But a far better scheme has been introduced in Scotland, and is slowly spreading into the rest of the UK. It works like this: most general practices have a physical therapist linked to them. If you get a bad back, you can ring the physio and ask her advice. She is trained to ask you certain "Red Flag" questions, in order to make sure that your backache isn't caused by anything really serious, such as malignancy or ankylosing spondylitis.
If she thinks that physical therapy will help you, she will give you an appointment to visit her department as soon as possible.
Exercise is good for your back
In the last 15 years, all authorities, including physiotherapists, osteopaths, chiropractors and doctors, have come to the conclusion that the worst possible thing for a bad back is to lie around or sit around, doing nothing. This is in sharp contrast to the medical attitudes which prevailed in much of the 20th century, when patients were often urged to lie flat on a board, or on the floor, for week after week.
Research has now shown that people get better more quickly if they take gentle exercise. Your GP can advise you about exactly what form of activity to undertake, but good ones include walking, gentle jogging, supervised gym work-outs and swimming – but avoid the breast-stroke, which puts a strain on the neck.
Acupuncture is well worth trying
For generations, western doctors have resisted the exotic allure of acupuncture. But there is no doubt that it does relieve pain, probably by encouraging the release of endorphins (the body's natural painkillers) into the bloodstream.
Whether it can actually do anything to heal a back problem is quite another matter. But in spring 2009, the NICE committee announced that in cases of "non-specific" low back pain (in other words, the usual common-or-garden backache in which no specific diagnosis can be made), then doctors should "consider offering a course of up to 10 sessions of acupuncture needling over a period of up to 12 weeks".
The reality is that in most parts of the country, you would have to get your acupuncture done privately. But if it relieves your pain, the outlay of cash could certainly be worthwhile.
Dr David Delvin is the author of 'Backache – What You Need To Know' (Sheldon Press, £7.99)
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