Back pain is a common complaint or reasons that people visit the Dr and/or physiotherapist. It is the leading cause of disability amongst adults globally and affects around 80% of the population at some stage in their life. It costs millions of rands yearly in healthcare and also has a high impact on work absenteeism.

Back pain (or backache) is simply a description of a symptom. It is the term attributed to pain felt along or around the spine, from the thoracic area all the way down to our tailbone (coccygeal area). Now this pain may be originating directly from the bones or joints themselves or the muscles, tendons and ligaments around in the area. This being said it is important to highlight that back pain is not a diagnosis but merely a description of a symptom, hence why it is important to get a correct assessment and identify the underlying cause in order to treat it correctly and prevent reoccurrences.

Types

Back pain is often divided into 3 types:

Acute – this is the kind of pain that lasts a week or less and then goes away.

Sub-acute – This type can last anywhere between a week and 12 weeks.

Chronic – This is the kind of pain that lasts for more than 12 weeks.

It is important to monitor the duration of the symptoms because these classifications determine how these are managed.

Warning signs

Before we discuss causes, if you have back pain in conjunction with any of the following symptoms, please consult a medical practitioner immediately:

• Unexplained weight loss
• History of cancer
• Loss of bladder and bowel control
• Loss of sensation in limbs (arms, hands, legs or feet, especially if these occur bilaterally at the same time)
• Loss of power on arms and/or legs

Causes

Back pain can be caused by a variety of reasons. Pain can come directly from the physical structures such as bone, muscle, nerve, tendons, ligaments or discs; or indirectly through other conditions i.e. psychological conditions, inflammatory diseases, etc. Some of these causes and conditions are:

• Disc pathology: this can be Intervertebral disc degeneration (when discs start losing their cushioning ability), hernias or ruptures (when the disc starts bulging our tearing).
• Skeletal abnormalities: these may be seen with the naked eye such as in scoliosis (curving of the spine). There are conditions which may need further assessment such as with fractures, displacements such as spondylolisthesis, or even conditions such as spinal stenosis
• Soft tissue: this can be sprain and strains of muscles, ligaments and tendons that run along or attach to the spine. Some muscle imbalances, muscle spasms, etc. These are commonly a result of sudden movements, poor ergonomics and biomechanics or combination of movements (i.e. bending and twisting).
• Nerve: these are conditions where the nerves running from or through the area are affected. This can be conditions such as radiculopathy, sciatica being one of the most common.
• Traumatic injuries: this occurs through sudden/forceful movements and impact, as in accidents, sports injuries, falls, assault, etc., which then may affect any of the abovementioned structures.
• Other conditions: mental health issues, auto-immune diseases, infections, cancers, fibromyalgia, osteoporosis, endometriosis, inflammatory diseases such as arthritis, spondylitis, etc.

Risk Factors

• Age – the risk of backache increases with age
• Occupational Hazards – there is a higher incidence in backache in certain professions, this relates to the exposure to stress, poor working conditions, heavy lifting and vibrations.
• Sedentary Lifestyle – people with a sedentary lifestyle are more prone to getting back ache, this also relates to muscle strength and posture.
• Excess weight – people who are overweight, obese or experience sudden change in weight, specifically weight gain, have a higher risk of getting back pain due to the load on the spine and the muscles and ligaments in the area.
• Pregnancy – this is generally due to the increase in load in the abdominal area and pelvic floor as well as the hormonal changes that occur.
• Mental health problems – there are many studies that show the link between psychological and physical symptoms. Mental health issues such as stress, anxiety, depression have been shown to increase back pain and are also correlated to the experience, beliefs and chronicity of the pain.
• Poor biomechanics – poor biomechanics means poor movement patterns which influence how people perform different activities such as lifting and loading objects, and even how they do simple things such as walking. Using poor techniques and wrong muscle groups increases the risk of injury and therefore pain.
• Incorrect ergonomics – this is especially true when it comes to back pain in children, which main cause is poor backpack ergonomics. Other examples are office workers, domestic workers, construction workers, that have stations that are not appropriately set for the tasks at hand.
• Smoking – there is a correlation between back pain and smoking shown in research.

Treatment

There are different modalities used for the treatment of back pain. This invariably depends on the cause of the back pain as the diagnosis dictates what the treatment should be. Some of the treatment modalities used are:

• Hot or cold packs – these are used to ease the pain as well as to ease the inflammation (mainly ice) and relax the muscles and increase circulation to the area (hot packs).
• Activity – one of the main things to do is to keep active. It was previously believed that bedrest was the solution to back pain, but it has been shown that in some cases it can delay recovery or even make it worse.
• Exercises – these function to strengthen, stretch or retrain the muscle groups according to the need. They also assist in preventing back pain from happening or reoccurring. It is important to have trained guidance when it comes to what exercises are safe to do at different stages.
• Physiotherapy – uses different modalities including the abovementioned to not only assess, diagnose and treat the back pain but also to assist in its prevention. Physiotherapy also uses other modalities and includes advise and education around a specific issue.
• Medication – different medications can be used to treat back pain, from pain killers, anti-inflammatories, muscle relaxants to other types depending on the underlying cause. It is important to exercise caution when using medication, and to do so under the guidance of a medical practitioner.
• Surgery – in some severe cases surgery may be advised.

Prevention

Below are some of the things you may do to prevent back pain:

• Exercise regularly
• Maintain a healthy weight
• Take regular breaks from long standing, sitting or from performing repetitive movements
• Use correct ergonomics, especially in workstations, school desks and sleeping which is where most people spend majority of their time.
• Use correct biomechanics during physical activities
• Wear comfortable and supportive shoes
• Use correct training shoes and gear for sporting activities
• Perform regular stress relief exercises
• Stop smoking

This is by no means a comprehensive list and description of back pain and all the factors relating to it, as there are way too many to list and mention but it should shed some light and help educate you a bit more on this symptom that plagues most of the world’s population.

Feel free to contact us should you have any queries or require further assistance.