It doesn’t have to be backs to the wall
Back pain can be debilitating for sufferers but only a minority actually seek help, says Victoria Goldman…
Around 80 per cent of British people have experienced back pain at some point in their lifetime, but only 10 per cent of them have sought help, according to the British Chiropractic Association. Nearly half (46 per cent) of people do not taking any steps at all to tackle their symptoms.
Non-specific low back pain can affect all aspects of life, from day-to-day activities to social interactions and mental health. National Institute for Care and Excellence (NICE) guidance updated in December 20201 states that this condition causes more disability worldwide than any other.
Most episodes of low back pain get better within a few weeks or months without the need for investigation or referral to specialist services. However, up to one-third of people say they have persistent low back pain of at least moderate intensity each year, and episodes often recur.
Low back pain
Low back pain is defined as soreness or stiffness in the back, between the bottom of the rib cage and the top of the legs. Mechanical pain is caused by repeated trauma or overuse and is affected by movement and posture. Acute low back pain lasts for fewer than six weeks, while chronic low back pain is present for more than six weeks.
Sciatica is due to an irritated sciatic nerve, which runs from the back of the pelvis through the buttocks and down to the feet. The most common cause is a herniated or bulging lumbar intervertebral disc. Sciatica symptoms may be worse when twisting, bending, sneezing or coughing.
“Symptoms of sciatica can range from moderate to severe pain in the lower back region and can often extend to the patient’s legs and feet,” says Catherine Quinn, president of the British Chiropractic Association.
“This can be accompanied by pins and needles, tingling, numbness and weakness in all or part of the leg and foot. More severe symptoms include the inability to flex the foot and reduction in the knee-jerk reflex.”
Assessing the symptoms
When assessing back pain, it’s important to ask customers:
- when the pain started
- if the pain was sudden or gradual in onset
- where the pain is and whether it radiates anywhere
- whether they have had back pain before
- their occupation, hobbies, sports and lifestyle
- whether they take corticosteroids (which can increase the risk of osteoporosis)
- how they have been managing their symptoms.
Anyone with new or changed low back pain symptoms should speak to their GP to rule out other causes, such as an infection, a fracture, prolapsed intervertebral disc or a disease such as spondyloarthritis or cancer.
The Chartered Society of Physiotherapists (CSP) recommends that if low back pain isn’t settling or is getting worse over two to three weeks and affecting normal activities, patients should speak to their GP or a physiotherapist. If the pain persists for more than six weeks, even if it isn’t affecting their normal activities, they should also seek advice.
Red flag symptoms include:
- difficulty passing urine
- numbness/tingling in the genitals or buttocks
- loss of bladder or bowel control
- loss of sensation during sex
- loss of power in the legs
- pain that runs down the back of both legs
- feeling unwell or having a fever with the back pain.
If people with low back pain feel they need to rest, they should do for no longer than 48 hours. According to the CSP, they should continue with their this normal activities as much as possible, as gentle exercise can speed up recovery time. A physiotherapist can recommend suitable exercises and stretches.
An October 2021 study published in the Journal of Physiotherapy found that Pilates was particularly effective at managing chronic low back pain.2 Manual therapy – spinal manipulation, mobilisation or soft tissue techniques such as massage – may also help but should be used alongside exercise. Psychological therapies, such as cognitive behavioural therapy (CBT), may help people cope with chronic back pain.
For sciatica, Catherine Quinn recommends avoiding exercises that can cause more pain on the sciatic nerve, such as weighted squats, cycling, high impact sports, burpees and hurdler stretches. “There are a number of exercises that can be done to ease symptoms of sciatica, such as using a foam roller to massage the glute area, and a variety of yoga poses,” she says.
Treatment tips for managing back pain
- Use hot or cold packs to ease pain and reduce inflammation
- Avoid any triggering activities or prolonged sitting/standing
- Practise good, upright posture
- Engage in exercises to increase core strength and gently stretch the spine
- Try regular gentle exercises such as walking, swimming or aquatherapy
- Use proper lifting techniques
- Put a small, firm cushion between the knees when sleeping on the side, or several firm pillows underneath the knees when lying on the back.
A review published in the journal Pain Therapy in June 2021 found that non-steroidal anti-inflammatory medicines such as ibuprofen and naproxen are the preferred analgesics for low back pain, due to their anti-inflammatory action, as long as these are appropriate for that patient.3
Paracetamol is less likely to be effective. Heat pads may help to ease back pain and associated sciatica symptoms.
However, Bridlington physiotherapist David Wilson says that analgesics shouldn’t be used as a first-line measure. “It is more important to encourage movement and exercise for back pain and sciatica, depending on the cause,” he says. “If someone can’t take NSAIDs, a low dose opioid may get them moving again, but these medicines are only for the acute phase.”
If exercise, self-help measures and analgesics aren’t easing non-specific back pain, a GP may refer a patient to a hospital specialist for epidural corticosteroid injections as a short-term measure.
For ongoing sciatica, some people can have a procedure to seal off some of the nerves in their back or an operation called decompression surgery to treat compressed nerves in the lower spine.
1. Low back pain and sciatica in the over 16s: assessment and management. NICE Guideline NG59. National Institute for Health & Care Excellence (NICE). https://www.nice.org.uk/guidance/NG59, last updated December 2020
2. Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, Yamato TP, Saragiotto BT. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother. 2021 Oct;67(4):252-262. doi: 10.1016/j.jphys.2021.09.004. Epub 2021 Sep 16. PMID: 34538747.
3. Peck J, Urits I, Peoples S, et al. A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain. Pain Ther. 2021;10(1):69-80. doi:10.1007/s40122-020-00209-w
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