By Dr David Delvin
Every day of the year, the number of people who are off work with back pain would fill several Olympic stadiums. Yes, we've got backache - and in a very big way. Yet, rather surprisingly, a lot of people have no idea what causes back pain, 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 nine things not a lot of people know about back pain.
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.
You should take care of your sacro-iliacs.
Most people have never heard of the sacro-iliac joints.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, unwieldy trimmer 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 percent 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 backache, 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 can'not 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. There is, however, certainly a place for analgesics when you have a bad backache, because it's a relief to have the pain eased.
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 such as 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.
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.
Exercise is good for your back.
In the past 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 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 another matter.
- Dr David Delvin is the author of Backache - What You Need To Know (Sheldon Press) - The Independent