Back Pain is the most common orthopaedic complaint, and a symptom affecting 80 percent of the Western population at some stage in their lives. In Britain, it accounts for 11.5 million lost working days per year.
Everyone's back pain is different. For some people, back pain involves mild pain (nuisance pain, aching, soreness). For other people, back pain involves severe pain (pain that hurts all the time, even when resting).
Most doctors refer to back pain as acute (generally severe, but short-lived), sub acute or chronic (long-lasting or occurring often). Acute back pain usually lasts from one to seven days. Pain may be mild or severe and occasionally may be caused by an accident or injury. About 80 percent of all back pain is acute. Sub acute back pain usually lasts from seven days to seven weeks and usually is mild; occasionally it's severe. This pain generally is unrelated to other illnesses you may have. About 10 to 20 percent of all back pain is sub acute. Chronic back pain usually lasts more than three months and maybe mild or severe. It may be related to other illnesses you may have or may have no identifiable cause. About five to 10 percent of all back pain is chronic.
The back is held upright by muscles attached to the backbone. Doctors often refer to the backbone as the spine, spinal column, or vertebral column. The backbone isn't one long bone, but actually 24 separate bones called vertebrae. These 24 vertebrae are stacked one on top of another to form the backbone.
The points where two vertebrae or bones fit together are called joints. They make it possible for the spine to move and turn in many different directions. Discs located between each vertebra are made of cartilage which is a soft, elastic material. Discs act as cushions or shock absorbers - much like the shock absorbers in a car. Their main job is to protect the joints from wearing out. Joints contain a slippery substance called synovial fluid that keeps them moving smoothly.
The spinal cord is very important because it transmits electrical signals between the brain and the nerves in your legs, arms, back, and other parts of your body. The spinal cord runs through a hole in each vertebra of the upper and middle parts of your backbone, much like a piece of string through a beaded necklace. The space it runs through is called the spinal canal. At times, a message might signal pain or discomfort. The pain signal is an important one, because pain tells you that some part of your body needs attention.
A serious injury to the neck or upper back runs the risk of damaging the spinal cord, causing paralysis of the parts of the body below the injury. It should be noted that the spinal cord is not present in the lower part of your backbone. Here the spinal canal contains a sack of nerves called the cauda equina.
Your backbone, with all its parts, cannot hold itself upright. It needs strong muscles, tendons, and ligaments for support. Muscles help you move or hold your position. Tendons fasten muscles to bones. Ligaments stretch from one bone to another to hold bones together.
Anything that puts pressure on your back muscles or nerves can cause pain. Any illness or damage to your spine also can cause pain. The cause of most acute back pain is unknown, but is probably due to minor strains, sprains and overuse. Emotional stress may add to the pain, especially since it slows the rate of recovery. Other possible causes of back pain are:
Ruptured Intervertebral Disc - This may be the most painful, yet easiest condition to identify. A ruptured or herniated disc is one that bulges into the spinal canal, pressing on the nerve roots. This causes the nerve roots to become irritated. A disc can rupture after bending over and lifting, or it may occur for no apparent reason. A ruptured disc may cause back pain and muscle spasms, but a more common symptom is sciatic pain. This is severe pain spreading down one leg and often into the foot. Sometimes it is the only symptom of a ruptured disc. A ruptured disc usually can be detected by a physical examination alone. Sometimes a procedure such as a myelogram, Computerised Axial Tomography (CAT) scan, or Magnetic Resonance Imaging (MRI) is needed to confirm the diagnosis and determine if surgery is necessary.
Spinal Stenosis - In spinal stenosis, the spinal canal becomes narrowed. This squeezes the back nerves and puts pressure on them. It is this pressure that causes the back pain. Numbness, pain and weakness in the legs can also occur. The most common symptom of spinal stenosis is pain that worsens when walking and subsides when sitting down.
Osteoarthritis - Osteoarthritis is just one form of arthritis that can cause back pain. It breaks down the cartilage (soft, elastic material) that cushions the spinal joints and other joints in the body. Lower back pain can become more intense when osteoarthritis affects the hips or the knees. Osteoarthritis can also directly affect the spine, causing muscles, tendons, or ligaments to become strained, which can lead to back and/or neck pain.
Ankylosing Spondylitis - This form of arthritis causes the joints in the spine to become stiff and swollen. In time, stiff joints can fuse together. The most common symptoms are pain and stiffness in the buttocks and lower back (particularly in the morning) that continue for more than three months.
Injury or Accident - Many back injuries are caused by an unexpected twist or sudden motion - often while moving heavy furniture or other such manual action. This often results in muscle strain. With either an injury or accident, severe muscle spasms usually last 48 to 72 hours. They generally are followed by days or weeks of less severe pain. It usually takes two to four weeks to heal completely from a mild back injury. It could take from 6 to 12 weeks if there are strained ligaments or if the strain is more severe. Severe back injury from a fall or accident may require hospitalisation and a longer recovery period.
Osteoporosis - This is a type of bone disorder that causes bones to become thin and weak due to calcium loss. Fragile bones; especially the bones in the spinal column, can break more easily, and there is an increased tendency for this to happen in older women. Osteoporosis also contributes to compression fractures, or spinal fractures in which the vertebrae become flattened. Falls, lifting heavy objects or moving the wrong way can result in a compression fracture.
Rheumatoid Arthritis - This form of arthritis causes any joint to become stiff, painful and swollen. It can affect the neck but almost never the joints in the lower back.
Polymyalgia Rheumatica (PMR) - This rheumatic disorder causes muscle pain, aching and stiffness in the neck and shoulders, lower back, thighs and hips. It can last a few months or many years. Most people experience severe stiffness in the morning.
Fibromyalgia - People with fibromyalgia feel pain and stiffness in muscles and tendons, especially in the neck and upper back. The pain can last for weeks, months or years. The symptoms may disappear by themselves. This condition is often related to sleep problems, poor conditioning or an old injury.
Paget's Disease - This is a type of disorder in which the calcium in the bone spreads unevenly. The bones most commonly affected are in the lower back, pelvis, tailbone, skull and the long bones of the legs.
Sometimes pain felt in the back actually originates elsewhere in the body. Such problems may include:
. Prostate trouble in men
. Problems with reproductive organs in women
. Kidney diseases, such as an infection or kidney stone
. Diseases of the intestines or pancreas, such as cancer or a blockage
. Cancer that has spread to the spine
. Multiple myeloma, a form of cancer of the bone and bone marrow
. Curvature of the spine
. Rarely, a tumor on the spinal cord
Factors that can make back pain worse are stress, poor posture, lack of exercise and being overweight. In terms of stress, people react to it in different ways. Some may feel tired, sleep poorly, overeat or feel irritable. Some clench their jaw. Others tighten their neck and shoulders. Others may get a headache or an upset stomach when they are tense. Many people tighten their back muscles when they are worried or tense. This can make existing back problems worse.
Being overweight can put added pressure and strain on the back and stomach muscles, causing those muscles to stretch and weaken. Weak back and stomach muscles cannot support the back properly. Poor posture can shift your body out of balance. This forces only a few muscles and joints to do all the work. Without proper exercise, muscles become weak and tire easily.
The causes of back pain according to Western medicine include muscle spasms, prolapse of lumbar discs, infection, arthritis and occasionally such disorders as aortic aneurysm and pancreatic cancer.
However it is often difficult for doctors to find the exact cause of back pain, especially since there are so many possible causes. If the cause is unclear, your family doctor may suggest that you see an orthopaedist, rheumatologist, neurosurgeon, neurologist, physiatrist or other medical specialist for diagnosis.
If your back pain is accompanied by any of the following, it would be preferable to see a doctor without delay:
-Weakness or numbness in one or both legs
-Pain going down one leg below the knee
-Back pain from a fall or injury
-Back pain accompanied by fever without flu-like aches
-Pain that continues to interrupt sleep after three nights
-Back pain that remains after six weeks of home treatment.
X-ray - Studies show that in many cases of routine back pain, X-rays may not initially be necessary. However, the signs and symptoms will determine what type of study should be done. In certain cases, X-rays might indicate that pain is due to:
Injury in one or more of the back bones
A tumor in the spine
A deformity in the spine
CT Scan - Only a few people with lower back pain need a CT (Computerised Axial Tomography) scan. If your doctor advises a CT Scan, a special machine will take an X-ray scan of the area. A computer turns this scan into a three-dimensional view of the back. This helps the doctor see if there is a ruptured disc that can't be seen on regular X-rays. Other conditions that a CT scan can help to detect are spinal stenosis, tumors and infections of the spinal cord.
MRI - MRI (Magnetic Resonance Imaging) is another way to make very clear pictures of parts of the spine. The MRI does not use X-rays or radioactive dyes. It can provide clearer pictures of soft tissues such as muscles, cartilage, ligaments, tendons and blood vessels, in addition to bone structure.
Myleogram - During a myelogram, a special liquid dye called a Contrast Medium is injected into the spinal canal. X-rays are then taken of the area. The Contrast Medium can make problem areas show up more clearly on the X-ray. A doctor may order a myelogram to detect problems such as spinal stenosis or spinal cord tumors. If surgery is being considered, particularly for a person who has had a serious back injury, many neurosurgeons will require a myelogram beforehand.
Bone Scan - During a bone scan, a very small amount of radioactive liquid is injected into a vein and this concentrates in the bones for a short time. A special radioactive detecting machine will then scan the area of concern to produce a picture. Occasionally bone scans are done to look for damage or tumors in the bones themselves. However, back pain is rarely due to diseases of the bones.
Electrodiagnostic studies - Electrodiagnostic studies are used to help confirm the presence of nerve compression in the spine. An electrodiagnostic study consists of two tests. One is an electrical test which is designed to study nerve conduction. In this test the nerve is given an electrical stimulation, and the speed of the impulse is measured. The second test is a needle test called an electromyogram, or EMG. The purpose of this test is to study the muscles for primary disease or for the effect of nerve compression on the muscle. The compression is especially seen in herniated discs or spinal stenosis.
Blood tests - If your doctor orders blood tests for you, a laboratory technician will carefully draw a small amount of blood from a vein in your arm, which then will be tested in the laboratory. Ask for an explanation of the tests which can vary greatly.
Doctors generally prescribe one or more of the following treatments:
-Heat and cold
For some back conditions, the doctor may refer you to another specialist such as an orthopedist, rheumatologist, physiatrist, physical or occupational therapist, psychologist, psychiatrist or surgeon.
For many people, the key to a healthy back is proper exercise. Some exercises are designed to strengthen your back and stomach muscles, while other exercises are designed to improve your posture. A 30-minute aerobic conditioning program three times a week is ideal for overall fitness. Walking and/or swimming are highly recommended for most people with back problems.
The right kind of exercise program may help to keep your back problem under control. It can make it easier for you to continue doing your daily activities. You may need to take a break from vigorous exercise if it makes your back pain worse. Ask your doctor and physical therapist which exercises you can do to relieve back pain, stay fit, and prevent injuring yourself again.
If you have any leg pain or other evidence of nerve injury, consult you physician before beginning exercises. DO NOT carry out any exercise that makes your back pain worse.
The most common treatment doctors recommend for severe back pain is bed rest - especially in the most acute phase. However, it is best to start moving around as soon as possible. Different people require different amounts of rest. Usually, two to three days of staying in bed, except to go to the bathroom, will be enough to ease your back pain. You may want to ask the doctor if special pillows or devices are necessary to support your neck, back or feet while you are recovering.
Many people have found that hot and cold treatments help relieve back pain. You might try both to find out which works better for you.
Heat relaxes muscles and soothes painful areas. There are many ways to apply heat. Some people like hot showers or baths, while others prefer using heat lamps, heating pads or warm compresses. If you have arthritis, heating your muscles first might make it easier for you to do back exercises.
Cold has a numbing effect. This often helps relieve pain. You might try one of these methods for applying cold:
-An ice bag
-A large ice cube used to massage the area
-A frozen package of vegetables (peas work best)
-A commercially made cold pack.
Be sure not to leave ice on after the skin becomes numb. This could lead to localised frostbite. Do not use cold if you are especially sensitive to it or have decreased circulation or sensation.
If poor posture is a factor, then posture training may help relieve your back pain. During posture training, an occupational or physical therapist will teach you healthier ways to sit, stand, sleep and lift objects.
If applicable, your doctor may recommend weight loss as one way to reduce your back pain and improve your general health. The best way to lose weight is with a balanced diet along with regular exercise.
A doctor may prescribe medication. The medication chosen depends on the back pain. For example, medications called analgesics can help relieve pain. Other medications called muscle relaxants can help relax tight muscles. If your back pain is caused by arthritis, your doctor can give you medication that will reduce inflammation as well as relieve your back pain. The most common medications prescribed are called nonsteroidal anti-inflammatory drugs (NSAIDs). These medications can reduce inflammation without working like cortisone, the body's anti-inflammation steroid hormone. Aspirin and Ibuprofen are NSAIDs. Other NSAID medications are prescribed when needed.
People with sciatica or spinal stenosis often benefit from surgery. A few people with tumors within the spinal canal require it. Other than that, few people with back pain need surgery. Most people can be treated with rest, exercise and medication. Surgery does not always work for many common kinds of back pain, and it is difficult to know who will be helped and who will not. An orthopedist can help you decide if a back operation is necessary. It is recommended that you also seek a second opinion.
Acupuncture has a proven therapeutic effect on back pain* and is listed as an approved treatment by the World Health Organisation.
According to Chinese Medicine, some of the main causes of back pain are:
Poor posture or injury can lead to a blockage and stagnation of Qi and blood in the back. ‘Qi’ is the body's essential energy - the life-force - that circulates throughout your body. This Qi flows through a network of channels and meridians. Left untreated, the Qi stagnation can lead to blood stagnation, and what was a dull ache can become a very sharp fixed pain. Qi stagnation of the lower back pain is sometimes found in women who have painful periods. In this case, acupuncture may be offered by CM as the treatment of choice.
Another cause of Qi stagnation is the invasion of cold or dampness into the acupuncture channels that go up and down the spine. In Western culture this is generally what is known as catching a cold, and in Chinese Medicine theory we can catch a damp too. This damp and cold can end up in the meridians and slow the flow of Qi and cause pain. For instance, if cold or damp weather aggravates the condition, then it is likely that you've got some cold or dampness stuck in the channels of the back impeding the flow of Qi.
Any specific trauma to the back can give rise to what CM theory calls ‘blood stagnation’. The treatment principle is the same as with Qi stagnation: the blood system needs to get moving again, and the pain should lessen or go away. According to CM theory herbs can be prescribed to dispel the blood stasis and heal bruising. Blood stasis is the local inflammation and bruising that is found at the site of a trauma.
Damp Heat - In the context of Chinese medicine’s understanding of back pain, this pathology can cause radiating pain that actually circles the lower back and down into the groin area, and is often associated with an infection in the urinary tract or other area in the lower abdomen. This might be kidney stones or possibly a bladder infection. Chinese herbs can be used according to CM theory to dry the damp and clear the heat.
According to CM theory, back pain (especially lower back) can be caused by a Kidney deficiency (usually due to excessive sexual activity or fatigue). If this is the case then the doctor will usually prescribe herbs to clear this deficiency.
The Chinese Medicine doctor will determine the cause of your back pain, and recommend a course of treatment. Usually, acupuncture is used for pain relief. Treatment may also involve moxibustion (the use of dried herbs burnt close to the skin) and Chinese herbs for patients whose system has been unbalanced by the pain and suffering from weakened Kidney and deficiency of Qi in the organ. Chinese deep tissue massage (Tuina) can also be highly effective in easing back pain.
AcuMedic is an integrative medicine clinic that promotes a complementary medical approach. Our services can be safely combined with conventional medicine. Thus, whether you are suffering from back pain or any other condition, please bring with you any medical information (scans, medications you are taking, etc.) that you have from your Western doctors to your appointment at AcuMedic.
Because of the lower eye level of the screen, laptop computers are some of the primary culprits for back and neck aches and strains in modern life. There are many ways to minimize computer strain. Taking a moment to correct your posture, taking small breaks and practicing some very basic head movements and stretches can minimize suffering. If you have continuous pain from years of excessive laptop use, acupuncture and Tuina massage are very effective, natural therapies that have been shown to bring instant relief.
Exercise is necessary to keep the back strong and limber. A good conditioning (aerobic) exercise program led by a trained instructor can be particularly helpful. An effective program includes a warm-up period; about 30 minutes of aerobic activity (exercise that results in a sustained heart rate of l00 or more beats per minute); isolated muscle group work (including abdominal muscle toning); and a cool-down period. Over a period of time, the rewards of regular aerobic workouts can include a slimmer waistline and healthier back.
Techniques for Good Posture when sitting:
-Sit in a firm chair with arm rests to relieve pressure in your back and shoulders.
-Keep your upper back straight and shoulders relaxed.
-Keep stomach muscles pulled in, and maintain the proper curve in your lower back. You can do this by tightening your stomach and buttocks. Some people are more comfortable sitting with the back of the chair at a 15- to 20-degree angle. A small cushion behind the lower back to maintain the natural curve of the back also can be quite helpful.
-Keep your knees slightly higher than your hips.
-Use a footstool or book under your feet if necessary.
-Keep your feet flat on the floor or other surface.
-Don't sit for a long period of time. Stand up every now and then to stretch tight muscles and give them a chance to relax.
Techniques for Good Posture when standing:
-Stand with weight equal on both feet.
-Avoid locking your knees.
-Ease tension in your back by placing one foot on a footstool.
-If you stand for long periods of time, wear flat or low-heeled shoes.
-Keep your back straight by tightening your stomach muscles and buttocks.
Techniques for Good Posture when sleeping:
-Lie on your side with your knees bent.
-If more comfortable, place a pillow between your knees while sleeping on your side.
-If you sleep on your back, ask your doctor or physical therapist if placing pillows under your knees would help your lower back pain or make it worse.
-Use a firm mattress.
To keep good posture while in motion is to use good body mechanics. In lifting, this means that the object lifted is held close to the body and that lifting is done with your legs. The normal back curves are maintained and the legs lift the load. Avoidance of twisting, particularly when carrying a load, is also important for good body mechanics. Move your feet, do not twist as you lift.
-When bending down to lift an object, bend with your knees instead of your back.
-Hold the object close to you.
-Straighten your legs to lift the object.
-Get help with an object that is too heavy.
The type of shoes you wear can also affect your posture. For women, high heels may put more stress on your lower back by changing your posture. You might find it more comfortable to wear low or flat heels. Cushioned-soled shoes also provide shock absorbency for your spine.
Every day of our lives is filled with some kind of stress. In fact, any situation can cause stress such as work, personal relationships, raising children, paying bills, the death of a loved one or a new experience. Even very happy occasions such as a family wedding, birth of a new baby or family vacation can be stressful. For many people with back pain, the greatest stress comes from unwanted changes in their lives caused by the pain itself.
If your pain is acute, you may be able to reduce your stress by reminding yourself that you just need to wait until the pain disappears. However, if your pain has become chronic, you may need to take a good look at what you want to do, what you need to do and what you actually can do within your limitations.
Since we cannot remove everyday events from our lives, the key to controlling stress is changing how we react to daily living. Think about how you react to everyday events.
There are many ways to relax and relieve stress without using drugs or alcohol.
Tips for Managing Stress:
-Take a warm bath.
-Take 10-15 minutes to sit quietly and breathe deeply.
-Get involved in your favourite hobby or learn a new hobby.
-Find a comfortable place for light reading.
-Meet a friend for a walk or a chat.
-Eat regular meals and take time to enjoy them.
-Plan fun activities with your family or friends.
-Do something nice for yourself.
-Learn relaxation techniques and set aside time to practice them.
-Take a stress management class.
-Learn to accept what you cannot change instead of feeling constantly frustrated.
-Try laughing instead of taking things too seriously. Take a positive outlook.
-Learn to manage your time effectively.
-Get professional help with problems or stresses that continue to bother you.
For personalised advice on diet and lifestyle, please ask the doctor during your consultation.
Please be reminded that we offer free online health advice.
Coan R et al. The acupuncture treatment of low back pain: a randomized controlled treatment. American Journal of Chinese Medicine, 1980, 8:181-189.
Gunn CC et al. Dry needling of muscle motor points for chronic low-back pain. Spine, 1980, 5(3):279-291.
Lehmann TR et al. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Pain, 1986, 26:277-290.
MacDonald AJR et al. Superficial acupuncture in the relief of chronic low back pain. Annals of the Royal College of Surgeons of England, 1983, 65:44-46.
Mendelson G et al. Acupuncture treatment of low back pain: a double-blind placebo-controlled trial. American Journal of Medicine, 1983, 74:49-55.
"I attended the Acumedic centre because I have a chronic back problem. I was treated with acupuncture and herbs mainly, and had a one off treatment of deep tissue massage. My back condition has improved and I have less stiffness in my back and other joints. I was quite impressed with how well I sleep and how my enery levels have improved (I am 60) and was beginning to accept my general tiredness/aches and pains etc as part of growing old. Acumedic has taught me that there is a treatment, outside orthodox medicine that can improve quality of life."
"I received treatment for lower back pain which had bothered me for 3 yrs. The treatment from the doctor cleared the pain and has been much better ever since. I received acupuncture and massage."
"I have been coming to AcuMedic for over 2 years now. I was initially treated for chronic lower back pain with acupuncture and Chinese massage and I felt the treatment was very satisfactory. I feel I have definitely benefited from my initial treatment and subsequent monthly follow up sessions just to keep me in balance and in harmony. Thank you."
"My treatments have helped me a lot. I feel more relaxed and much happier. My back pain is gone and I have more energy."
"I came in for chronic lower back pain on right side. After receiving acupuncture I had my first good night of sleep in months. I was pain free!"
"Chinese herbal medicine and acupuncture at AcuMedic are the only relief from serious pain and weakness in my back after an unsuccessful operation when the coccyx was removed and three vertebrates were fused. I certainly feel stronger physically and mentally. The medicine even helps me to concentrate!"
"Having had a bad back for several years (after a car accident), and having tried various other treatments e.g. physio, I have found the Chinese massage and acupuncture most helpful. My back is less tight after each session."
"I have suffered with sciatica for 20 years and I do a lot of heavy exercises that aggravates it, since I started this acupuncture treatment together with herbal pills, the pain started to vanish and I can finally do stretches again. I'm still feeling as little pain but it's a far cry from what it was before."
"I have had three sessions of acupuncture now at AcuMedic. My sciatica has practically disappeared and the doctor says that is due to the herbs I am taking."
"At AcuMedic I use acupuncture which I find works very well in relieving stress and improving my energy levels. It also reduces back pain and helps me sleep. It complements other approaches I use like yoga."