# Back Pain/Printable version

The current, editable version of this book is available in Wikibooks, the open-content textbooks collection, at
https://en.wikibooks.org/wiki/Back_Pain

# Introduction

Lower Back pain is a major problem in modern society. It affects almost all of us at some time in our lives and frequently leads to pain, distress and time away from work.
The problems with the lower back can be compounded by the fact that almost every specialist or therapist you see will offer a different reason for your symptoms. They often also suggest a different treatment. So who do you believe? Whose treatment tips can you trust?
Do you have a lower back problem? Have you had it previously? What about friends or relatives, do they suffer from pain in the lower back?
If you can honestly answer no to all of these questions then you are quite an unusual person. Lower back problems are very common. In times gone by they were regarded as one of lives "fleeting ills" and was so widespread as to not even be regarded as an illness needing treatment. Little has changed. In 1993 nearly seventeen million people in Britain experienced backpain or lower backache. Recent estimates state that up to six million people in the USA will be experiencing lower-back symptoms at any given time. More than six out of every ten of us will suffer from it at some time during our lives. In one year the UK government spends two thousand million pounds on paying benefits to people with backache and the UK National Health Service spends another five hundred million pounds on their treatment.
New research shows that half of all lower back attacks take more than four weeks to completely go away. Treatment speeds things up but many back-pain sufferers don't seek treatment early enough. One person in twenty will have trouble that goes on for years - whether they get treatment or not.
That's the bad news!
But don't despair! There is some good news too. Simple first aid treatment measures and early hands-on treatment will get most sufferers fit within a fortnight. Many are better even sooner. If you follow sensible treatment advice at an early stage then you have nothing to fear from your lower back. The pages of this website aim to provide exactly the sort of treatment advice that you need.
If you are in lower lumbar pain as you read this then it is likely that you will be feeling a range of different emotions. Frustration, anger, puzzlement and maybe even fear. Often these feelings come about because of a lack of factual knowledge. What is wrong with my lower back? Why has this happened to me? Do I need to stay in bed or is it safe to work? Have I got a serious illness, will I become a cripple? How do I find treatment?
These questions go through the minds of many people with lower back pain. The answers are all on these pages. Sometimes knowing the answers is all that is needed to get rid of the negative thoughts and emotions that can slow down recovery if they persist.
Never allow yourself to get too depressed or worried if you suffer from a back problem. There is always treatment help at hand. In some cases this book will provide it. In others you will be pointed in the direction of help. Remember - DON'T PANIC.
Author: Dr Gordon Cameron

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# Causes

Back pain is caused by a variety of reasons. In a young person, the most common cause is bad posture. Reading in bed in an abnormal tilt of spine or working on a computer in an abnormal posture are the commonest culprits. Injuries are another reason for backache in the young. In developing countries tuberculosis of spine is something to look for. Finally malignancy of spine is also quite common in causing back pain.
In older people, injuries remain one of the most common reasons. The cushion between vertebrae (discs) become frail and tend to protrude in to the space between vertebrae leading to severe pain going down to lower limbs. An emergency may arise if urine retention occurs. In women infection of pelvis is a cause of chronic back ache. Malignancy is kept in mind in all cases.
* Discogenic pain
* Diagnostic work up for acute back pain.

# Treatment-First Aid

First Aid Treatment for Lower Back Pain
First aid for back pain - treating yourself
For most people, most of the time, lower back pain is easily defeated when it strikes. Here are “Cameron's Rules” for winning the battle with low back pain. They apply to the most common type of low back attack which is pain mainly in the back with some pain in the buttock or thigh. Nerve irritation - shooting pain down the leg as far as the ankle - needs a slightly different plan of campaign.
* Rule One - DON'T PANIC!
Remember that most people who suffer from an attack of lower back pain will improve within a week or so - although it can take up to a month to go away completely. Avoid getting into a negative state of mind at the outset and the battle is half won.
* Rule Two - Give your back a chance
All attacks of low back pain benefit from an initial short period of rest to allow them the best chance of recovery. It's important to spend as little time as possible in bed as the muscles and bones of the spine will begin to lose some of their natural strength. Forty eight hours is the maximum you should allow yourself and if you can get up sooner then so much the better. Some will find lying on their back most comfortable, others will prefer lying on their side with knees curled up and a pillow between the legs. Try to lie on a firm high bed if possible. Getting up off the floor can be very difficult and rolling like a log out of a high bed is much easier. Keep things like a flask of tea or coffee by the bedside so that you can minimise the time you spend up and about. When you are on your feet then encourage circulation of blood around your spine by gentle back and forward movements.
* Rule Three - Try to ease the spasm
Even though a facet joint or a lumbar disc is probably triggering the pain, it is often muscle spasm which keeps the lower back pain going. If you can begin to release this spasm then things will settle more quickly. Some prefer ice, others like heat - I find a combination of the two works well. Use a hot water bottle wrapped in a towel to apply heat for up to twenty minutes. Gently mobilise the spine afterwards by encouraging slow, small back and forward movements and then apply ice. Frozen peas make a better ice pack than ice cubes because the latter melt into a puddle within five or ten minutes. The peas can be re-frozen ready for use again later. Do mark the bag with a pen though - otherwise they may end up accompanying your fish and chips at a later date!
Should you try a back support?
I'm often asked this question by patients and to be truthful it's never easy to be dogmatic about the answer. Many patients with acute back spasms seem to benefit from wearing some kind of support strapping (strapping with magnets in the support seems particularly helpful). But I've yet to find a foolproof way to predict which back pain patients will benefit. These devices are fairly inexpensive however so my advice usually is "try it and see." A good example of this kind of Magnetic Back Support is available from Amazon.com - click on the blue words above to check it out.
* Rule Four - Medication often helps
I know many of you worry about using pain killers or muscle relaxing tablets in case you become addicted. True, this can be a problem if the medication is taken continuously over a period of months but will not happen with short term use. Try simple paracetamol (tylenol) or aspirin - despite glossy adverts from drug companies there is no evidence that any other drugs are better. If this is not helping in twenty four hours then your doctor should be able to prescribe something a bit stronger.
Take your pain killing medication regularly - every six hours is a good idea. Don't wait for the pain to get bad before you reach for the tablets - this is a classic mistake. It is much easier to stop a pain from coming than it is to get rid of it once it arrives. Don't be a “brave soldier” - you'll get better much quicker if you can break out of the pain cycle.
* Rule Five - Get the circulation going again
After an initial time of rest you must get blood flowing around the spine again. The heat and ice described above will help but nothing beats gentle movement - discs depend on it to keep them nourished. When pain strikes then the sooner normal mobility returns the better. The fluid which feeds discs is squeezed in and out as the bones move.
If possible, get someone to gently massage the tight muscles of the spine. Then, still lying in bed, begin to move. Lie on your side and to start by curling up the legs towards your tummy. Go as far as you can without causing a lot of pain. Gently unwind again and then go in the opposite direction by slowly arching your back. Again, stop short of causing pain and try to repeat this process six times every hour if you can. You should notice benefit quite quickly. Keep this type of spinal movement going for several days once you are back on your feet again. Even a pain free spine will enjoy this as a warm up routine first thing every morning and a cool down last thing at night. Get into this habit and you may prevent further problems.
If you find it difficult to arrange a lower back massage or if you experience repeated attacks of this type of low back pain then you might want to consider investing in a Shiatsu Massaging Low Back Cushion - I was lucky enough to have one on trial during a recent bout of my own low back pain. What can I say - wonderful, bliss, fantastic - it would be easy to run out of adjectives. Take a look at this type of product on Amazon by following the link above.
* Rule Six - look at your lifestyle
Smoking at any time is bad for your back. I know doctors always say that but it's true. The chemicals in the smoke lessen the bodies ability to repair damage and make attacks of back pain more common and longer lasting. Smoking during an acute attack is crazy.
Small amounts of alcohol can ease pain and spasm but avoid the temptation to use it as a pain killer. We all know the morning after feeling of thirst that a boozy session can produce. An inflamed disc needs as much water as it can get to speed recovery but alcohol causes fluid loss from the body. Drinking more than a glass or two of wine in a day will slow down the recovery process.
If you are stuck in bed for a day or two then take the opportunity to reassess your overall lifestyle. Are you overweight. Do you really get as much exercise as you should. Make a few resolutions as you lie there and turn the negative experience of back pain into one with a positive long term outcome.
And on the subject of bed - if you are prone to recurrent spells of back ache then you should be taking a close look at your either your bed or your mattress or both. Too firm, too soft? The eternal dilemma for the back pain sufferer. Before spending a fortune on a new bed, take a look at this Foam Memory Mattress from Amazon.com. I know about a dozen patients of mine who have tried it recently with good results. No promises of course but it might be worth a try before spending a fortune on an entire new bed.
* Rule Seven - seek help from an expert
Following the simple guidelines above will see most of you well on the way to recovery within two or three days. If you are not getting better by that stage then seek the help of someone trained in “hands on” manual therapy for your back. This could be an osteopath, a chiropractor or a physiotherapist depending on local availability or your preference.

# Treatment-Behavior
## Home Exercises and Stretching

A highly recommended book to start with is Robin McKenzie's "7 Steps to a Pain-Free Life: How to Rapidly Relieve Back and Neck Pain". These exercises don't help everybody, but for a sizable portion of the population they do a great deal of good.
Also, consult Pete Egoscue's "Pain Free: A Revolutionary Method for Stopping Chronic Pain". You can also receive expert advice from Postural Restoration Therapists and Posture Alignment Specialists (PAS). See egoscueuniversity.com and posturalrestoration.com

## Other Behavior Modifications

Many people with lower back pain find that bad posture while sitting contributes to their pain. A good chair can help alleviate this problem, but a cheaper and more universal solution is a lumbar support roll. These come in many forms, from the home-made to professionally designed solutions sold in most back-pain stores.
A lumbar roll is placed just above the belt line, while sitting up straight in a normal chair. It causes your spine to bend forward in the same way it should naturally, but is often lost with age.
Two easy home alternatives to a lumbar roll is a roll of paper towels (Small sizes work best) or a rolled up towel.