10 back pain facts and figures
We will now describe 10 facts and figures about back pain.
1. Back pain is normal
2. It is very common
In fact 80% of the population have it at some point in their lifetime. And it is responsible for 40% of all lost work days.
3. So when and how should I see a doctor or physio about back pain?
If it continues, many GPs have someone called a NHS musculoskeletal (MSK) ‘first contact physio’ (therapist) you can see, without seeing your GP at all. See if there is one at your local surgery. Many MSK physiotherapists operate a self-referral pathway online, or by telephone – i.e. you do not have to see the GP first.
They will be able to assess your symptoms, examine you, and recommend some useful exercises to help to alleviate pain – and organise an MRI if needed. They will also be able to arrange any necessary investigations and onward referral to a specialist (a spinal surgeon) if necessary.
4. Do you need to have an MRI or see a surgeon?
A large majority of people with back pain do not need an MRI, or to see a spinal surgeon (e.g. neurosurgeon or orthopaedic surgeon).
5. How long should I wait for, before I see a doctor or physiotherapist?
If you have new back pain (and it is not too severe), unless you have one of the red flag symptoms below, it is often best to wait two weeks before seeking help, as it often corrects itself.
6. What is the best treatment for back pain?
Here are seven things you can do for yourself
- Lose any excess weight – use a healthy weight calculator to find out if you’re a healthy weight for your height. Keep BMI under 30 if you can. This is the most useful thing you can do to help yourself
- Exercise – your back regularly. Walking, swimming (including front and back stroke) and using exercise bikes and cross-trainers, are all excellent ways to strengthen your back muscles. Running, particularly on hard surfaces and for long periods, is likely to exacerbate back pain. So finding a way of staying fit without repetitive impact on your lower back is essential
- Movement techniques – bend, lift, carry, posture
– Bend your knees and hips, not your back
– Lift heavy objects using the correct lifting technique
– Carry larger loads in a comfortable rucksack using both shoulder straps, and avoid sling bags
– Posture – maintain a good posture – and avoid slumping in your chair, hunching over a desk, or walking with your shoulders hunched. If you work at a computer for long periods, ensure your chair and screen height are optimised - Breaks – take a short break from sitting every 30 minutes
- Stop smoking – it is thought smoking reduces the blood supply to the discs between the vertebrae, and this may lead to these discs degenerating (causing prolapsed or ‘slipped’ discs .. see below)
- Bed – check that your bed provides the correct support and comfort for your weight and build, not just firmness. An ‘orthopaedic’ (or lordotic) pillow may help to maintain a healthy overall spinal alignment
- Learn relaxation techniques – such as this breathing exercises to help manage stress. Stress is a major cause of back pain. Acupuncture may help.
But .. remember sometimes back pain is a sign of a more serious problem. Here are some ‘red flag’ symptoms that are a concern. If you have these as well, it is important to see a doctor soon.
Back pain red flag symptoms
- Age <18 years and >60 years
- Bladder, bowel (inability to control your wee-ing or poo-ing) or sexual dysfunction
- Weakness or loss of sensation in the legs or arms
- Fever or weight loss
- Pain at night
- Trauma, or recent back surgery or epidural
- Other diseases – e.g. cancer, TB or HIV
- Drugs – including, anticoagulants, immunosuppression (drugs that suppress the immune system) and IV recreational drugs
- Severe new pain lasting over two weeks.
Most back pain is multi-factorial, and may originate from any of the structures in and adjacent to the spine including: muscles, ligaments, bones (vertebrae), and the intervertebral discs (cushions which sit in between each of the vertebrae). Injury to any of these structures may precipitate an episode of back pain.
What are causes of back pain I should look out for? Here are two important ones.
8. What is a prolapsed (‘slipped’) disc?
A ‘slipped disc’ occurs when the gel-like centre of one of the cushions between the vertebrae (building locks of spine) escapes from its outer casing. A fragment may cause pressure on one or more of the nerves which supplies the legs causing leg pain (‘sciatica’). As with most low back problems, the vast majority will rectify themselves with time.
Prolapsed disc
Spinal MRI: Prolapsed disc touching spinal nerves (not everyone needs an MRI)
In fact, 90% are better by six weeks. Those cases of sciatica which do not resolve with time and exercises, may benefit from an ‘epidural’ injection of anaesthetic and steroid medication. This can be a useful test both to confirm the cause of pain, and to provide long enough symptomatic relief for the problem to rectify itself.
Surgery to decompress the nerves may be offered when conservative treatment (rest, injections etc) has failed. Normally this can be done through a small cut in the lower back but it does carry some risk. Rarely, metal implants may be recommended if there is an underlying instability of the spine.
9. What is Cauda Equina Syndrome?
In extreme circumstances, compression of the nerve roots in the lower back which supply the legs, bowel and bladder can result in a condition called ‘cauda equina syndrome’. Urgent surgery is usually indicated. So if you have a rapid onset of severe back pain (especially if it spreads into both legs) associated with leg weakness and/or bowel, bladder or sexual dysfunction, you should go to your local A+E Department. Do not wait for appointment with your GP or anyone else.
After that, you need an MRI and to see a senior orthopaedic or neurosurgical doctor (consultant or registrar) ASAP, to plan an operation that may need to be done soon.
10. Are back x-rays useful?
Rarely. The best test to diagnose a more serious problem is a spinal MRI. If you have any of the red flag symptoms above, you may need one soon. If you do not, your physiotherapist will normally arrange an MRI scan if your symptoms are persistent and do not respond to standard non-surgical treatment. Simple x-rays may be of additional use in selected cases.
Summary
We have described 10 facts and figures about back pain. We hope it has been helpful. There is a lot you and the NHS can do.
Other resource
Back Care UK is a national back pain charity.
