Hey there Guys,
Today I wanted to talk about the common problem of back pain, and in particular, lower back pain.
Within Australia four out of five men will suffer with lower back pain at some point in their life. Thankfully for most people this is a short episode with the back pain gone after six to seven weeks. Long term back pain is less frequent with approximately 20% of back pain sufferers having pain that lasts longer than one year.
Risk factors for lower back pain include work that is either very strenuous or sedentary, being a smoker, obesity, depression and anxiety, getting older and workplace factors that may impact on healing from both a physical and emotional perspective.
The back is a complex organ made of the bones of the spine, discs between each of the spinal vertebrae, the spinal cord and the muscles and ligaments that support these structures. While in many cases doctors struggle to pinpoint an actual cause for back pain there are a few symptoms that may indicate lower back pain has a more sinister cause.
Important signs in lower back pain that indicate you should see a doctor straight away.
- Back pain that is associated with weight loss, fevers, past or recent cancer or long term use of steroid medications.
- Lower back pain with changes your ability pass urine, open your bowels, change in sensation in the buttocks or weakness or inability to move the legs.
- Any back pain associated with recent falls, car accidents or other significant trauma.
- Any back pain where it does not feel better when in bed or if it wakes you at night.
- Back pain that does not resolve after 6 weeks.
- And any new back pain in persons over the age of 50
If any of the symptoms mentioned above apply to you or concern you it’s vital you go to see your doctor immediately.
Common causes of low back pain.
Most lower back pain is caused by strain of the muscles, tendons or ligaments that support the spine.
The second most common cause is damage to the discs that sit between each of the vertebra of the spine. With wear and tear they can become worn, inflamed and sometimes bulge outwards to push against the spinal cord and nerves as they exit the spine.
If the discs are flattened there is risk of the bones of the spine rubbing against each other, leading to osteoarthritis with changes in the bones from long term bone-on-bone rubbing.
Less common is the vertebrae being out of place, fractures of the vertebrae, infections or deposits of cancer in the bones of the spine.
The good news is that for most people there is no need to be exposed to radiation with X-rays. Talking with your doctor about how your pain came about and an examination of your back and legs will normally be able to differentiate the common causes from the nasty causes. Of course if your pain is getting worse or not settling your doctor will be able to help with further investigations.
What treatments work best for low back pain?
Keeping active: Current research shows that bed rest for longer then 1-2 days can delay healing of lower back strains. Gentle movement such as walking, pool walking and returning to day to day activities helps reduce muscle spasms and encourage blood into the area to allow healing.
Applying heat or cold: Application of heat packs can help increase blood flow to the lower back to increase healing. Interestingly there is some emerging evidence that use of ice packs in the early phase of back pain, the first day or so, can decrease inflammation which can shorten the time of pain. With both heat and cold be sure not to leave packs on the skin for longer than 20 minutes, and if you notice any changes to the skin be sure to stop immediately.
Over the counter pain medicines: Simple analgesia like paracetamol (Panadol) or ibuprofen (Nurofen) can help decrease pain and inflammation. Be sure to follow the instructions on the packets and if you are already taking medicines be sure to talk with your doctor.
Massage and manipulations: Gentle massage and manipulation of the tissues of the back can help with healing. Probably best avoided in the early phase of your injury, these therapies can help low back pain if done carefully by a professional.
Exercise: Return to normal activities and the addition of exercise can help strengthen the back and the supporting structures. Stretching can help keep muscles supple and reduce tightness with low back pain. Recent studies from the UK have shown yoga as a useful treatment for low back pain.
How to avoid low back pain.
One of the best ways to help reduce the risk of lower back pain is to aim for keeping your weight within the suggested ranges. Because men tend to hold weight on their belly this pushes the centre of gravity forward with puts strain on the lower back. Reducing tummy size can help reduce back pain significantly.
Increase your core strength. The muscles of the abdomen work together with the muscles of the lower back to support the spine. Having increased core strength helps reduce the risk of strains and damage of the lower back structures. Your local gym instructor, doctor or physiotherapist can help you with exercises to work on your core. One simple exercise that you can do when standing on the bus, sitting at home or even when at work is to imagine the sensation of pulling your belly button towards your spine. Gently pulling your navel inwards can help strengthen the core muscles and is simple and easy to do on a frequent basis during the day.
One final thought that will help reduce the risk of back strains is to ensure you have safe lifting techniques. Below is a video that demonstrates safe lifting technique that can help protect the lower back.
I hope you have found this a helpful introduction to lower back pain. Over the next week I’ll be sharing a few more posts about care for your back when you are injured, as well as an interview with a rehabilitation specialist who has been kind enough to share his thoughts on care for people with lower back problems.
I look forward to sharing these soon.
If you have any questions or comments please feel free to share them below.
Yours in good health.
Dr George
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