Back pain is a very common condition and is a frequent cause of workplace absence and. It is also the leading cause of disability worldwide. In most cases, it is not a result of anything serious and will improve over time. Fortunately, there are things you can do to relieve or prevent pain. If prevention fails, home treatment will usually heal your back within a few weeks. However, if that fails, surgery is an option, although this is rarely necessary.
Symptoms
Most people have experienced back pain at some point in their lives. There are many different causes; some are self-inflicted, and others are caused through accidents, muscle strains and sporting injuries. Although the cause may be different, in many cases, they share the same symptoms. These include:
- Dull aching pains in the lower back
- Shooting or stabbing sensations that can radiate down the leg to the foot
- Difficulty standing up straight without pain
- Limited range of motion
- Continuous aching or stiffness from the neck to the tailbone, along the spine
- Sharp, targeted pain in the neck, upper or lower back
- Lingering aches in the middle or lower back
- Pain that spreads from the lower back down the back of the thigh, and into the calf and toes
Pain gradually improves within a few weeks with home treatment and self-care; however, it is important to contact your doctor if you show the following symptoms:
- Pain persists after a few weeks of rest
- Pain spreads down one or both legs, particularly if the pain spreads past the knee
- Weakness, numbness or tingling in one or both legs
- Fever
- Loss of bladder or bowel control
- Pain occurs following trauma such as a blow to the back
- Severe, continuous pain that gets worse at night
- Unexplained weight loss
- Throbbing sensation in the abdomen
Contact your doctor if your pain does not improve within two weeks of developing. In some cases, it can be a symptom of a serious medical problem.
Causes
Back pain can affect people of any age for many different reasons, from injury to medical conditions. As people age, the risk of developing back pain increases due to degenerative disc disease, previous occupations along with a lifetime of bad habits.
The human back supports the body and enables mobility and movement using a complex structure made up of muscles, ligaments, tendons, discs, and bones. Problems with any of these components can cause back pain.
The majority of back pain is referred to as non-specific (no obvious cause) or mechanical (pain that originates from the bones, joints or soft tissues in and around the spine). It is not always possible to identify the cause of pain but it is rarely anything serious. The most common causes of include:
Slipped disc
A slipped disc, also known as a herniated or prolapsed disc, occurs when the soft tissue between the bones in your spine protrude and press on the nerves, resulting in pain, numbness, tingling and weakness in other areas of your body. A bulging disc pressed against your nerve that travels from your back and down your leg can result in sciatica or irritation of the sciatic nerve.
Sciatica
Sciatica occurs when the nerve running from the lower back to your feet becomes irritated. This can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet. Sciatica commonly occurs when a herniated disc, narrowing of the spine (spinal stenosis) or bone spur on the spine traps part of the nerve.
Ankylosing Spondylitis (AS)
Ankylosing spondylitis is the swelling and inflammation of the joints in the spine as well as other areas of the body. This long-term condition causes pain and stiffness that is typically worse in the morning and improves with movement throughout the day. AS is found to be more common in men than women and tends to first develop in teenagers and young adults.
Spondylolisthesis
Spondylolisthesis is a spinal condition that affects the lower vertebrae (spinal bones) and occurs when one of the vertebrae slips out of position on the bone directly below. It often appears in the lower back but can also develop in the mid to upper back or at the top of the spine. Spondylolisthesis typically causes lower back pain and stiffness as well as numbness and a tingling sensation.
A broken or fractured bone in the spine
Thirty three bones form the backbone and protect the spinal cord. A fungal or bacterial infection of the vertebrae can weaken the bones and cause them to fracture. A weakened immune system, cancer, malnutrition, trauma and obesity can also increase your risk of a break or fracture. Depending on how severe the damage is, you may experience pain, difficulty walking or inability to move your arms or legs (paralysis).
Infection
A spinal infection is a rare but often serious form of disease that occurs when fungi, bacteria or viruses attack the spinal tissues. An infection can occur following surgery, typically within 3 days to 3 months. Vertebrae osteomyelitis is the most common form of vertebrae infection, developing due to infection spreading from a surrounding area or from direct spinal trauma.
Cauda Equina Syndrome
Cauda Equina Syndrome (CES) is a rare and severe condition that usually requires urgent surgical treatment. CES is a form of spinal stenosis where all the nerve roots in the lower end of the spinal cord suddenly become severely compressed. Symptoms include sciatica on both sides, severe numbness and weakness in either legs or numbness around the genital area. You may require rapid treatment to prevent lasting damage, resulting in incontinence or permanent paralysis of the legs.
Muscle or ligament strain
Lumbar muscle and spinal ligament strains are very common injuries that frequently occur due to repeated heavy lifting, incorrect lifting or a sudden awkward movement. If you are not in good physical condition, constant strain on your back can result in painful muscle spasms. Other symptoms that are noticeable with a strain include pain that increases when you move, or reduced range of motion. In some cases, you may feel a tear or pop at the time of the injury.
Bulging or ruptured discs
Discs act as a cushion between the vertebrae in your spine. They are made up of an outer layer of strong cartilage that encompasses softer cartilage in the centre. If the discs protrude outward and they press on the nearby spinal nerves, known as a ruptured, herniated or slipped disc. A ruptured disc can cause severe lower pain and in some cases, it will radiate down the back of the legs (sciatica). However, in some cases, bulging or ruptured discs can occur without pain.
Arthritis
Osteoarthritis is the most common form of arthritis found in the spine. It typically affects the lower back and occurs through wear and tear; causing inflammation and pain as the cartilage between the joints gradually deteriorate. Arthritis is a common problem in older people; it can also affect obese people, heavy labourers and those who have previously had a spinal injury. In some cases, people experience a burning sensation after physical activity, or wake up with a stiffness in the area.
Osteoporosis
Osteoporosis is a bone disease that occurs due to loss of bone density and the thinning of the bones, or in some cases, both. If your bones become porous and brittle, your spine’s vertebrae may break from a fall or, in serious cases, from sneezing or slight bumps.
Diagnosis
Your doctor will begin by asking you about your symptoms and medical history. They will then carry out a physical examination to assess your ability to walk, stand, sit and lift your legs. Your doctor will generally be able to make a diagnosis following a physical examination. However, if your doctor needs help to eliminate other problems or confirm a diagnosis, they will order further tests. These tests include:
X-ray
X-rays on the spine enable the doctor to see the alignment of your bones and check for breaks and arthritis. However, an X-ray will not show any issues with your spinal cord, muscles, nerves or discs.
MRI
MRI scans create images that reveal herniated discs or issues with tendons, tissue, ligaments, nerves, blood vessels, bones and muscles.
Blood Tests
Blood tests can help your doctor determine whether you have an infection or other condition that may be causing your pain.
Bone Scan
Occasionally, your doctor might order a bone scan to detect for bone tumours or compression fractures caused by osteoporosis. A small amount of a radioactive substance called radiopharmaceutical or dye is used to help the doctor detect bone problems, with the aid of a special camera.
Treatment
Pain typically improves within a month of home treatment; however, it is a complex condition. Everyone is different, and for many the pain does not go away for a few months; however, only a small majority of people suffer with severe, persistent pain.
One of the most important things you can do is keep active, continue with daily routines and exercise as much as possible. Your pain should start to improve gradually. Over the counter pain medication and the use of heat may also help with recovery. Bed rest is not recommended.
If home treatments are failing to relieve your symptoms, your doctor may suggest stronger medications or other therapies.
Surgical Treatment
Back surgery can help relieve certain causes of back pain, although it is rarely necessary. Surgical treatments are typically reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disc that failed to respond to other therapy.
Kyphoplasty or Vertebroplasty
Vertebroplasty involves an injection of glue-like bone cement into your vertebrae to repair a collapsed vertebra. This may be caused by trauma or disorders such as osteoporosis. With Kyphoplasty, the surgeon inserts a special balloon to elevate the vertebrae before injecting the cement.
Lumbar Discectomy
A lumbar discectomy is a surgical procedure used to remove a herniated (slipped, ruptured) disc from the spinal canal. The procedure involves removing the fragment of spinal disc that has slipped out of place and is triggering the pressure on the nerve.
Radiofrequency Denervation
Radiofrequency denervation uses radio waves, delivered through a needle to disable the nerves that are causing pain around the facet joints in your back and neck. These nerves, known as medial branch nerves, send pain signals to your brain if you are experiencing inflammation in your facet joint.
Spinal Decompression
Spinal decompression or lumbar decompression is a procedure used to treat compressed nerves in the lower spine and help relieve pain in the back of your legs. If lumbar decompression surgery is recommended, you will usually have a combination of other techniques including laminectomy, discectomy and spinal fusion.
Spinal Fusion Surgery
Spinal fusion surgery is the most common procedure used to treat chronic, nonspecific pain. Used to strengthen and stabilise your spine, the surgeon will join two or more of your vertebrae together using bone grafts, screws and rods. This will help to prevent painful movement.
Spinal Injections
Spinal injections are typically used to diagnose a problem or help ease pain. Spinal injections work by administering medication in to or close to the spine, around the cause of the pain. A successful spinal injection may relieve pain for up to 3 months. Spinal injections include:
Facet Joint Injections
Facet joint injections are injected in to or around the facet joint. Usually several injections are used during the same procedure to relieve pain and inflammation. Pain relief may be short lived; however, some people receive significant and long lasting pain relief following the injections.
Nerve Root Block
Your Consultant may recommend a type of injection called a nerve root block to ease pain caused by a trapped nerve in the spine. These injections are highly effective and in many cases help patients avoid more invasive surgery.
Medial Branch Block
Medial branch blocks work very similarly to facet joint injections but delivered to different areas of the joint. A combination of local anaesthetic helps relieve pain and steroid that helps reduce swelling are used to temporarily stop pain signals being carried by the nerve, alleviating the painful symptoms.
Outlook
Back pain is very common, and the older you get, the more likely you are to experience it. With treatment, most cases of back pain ease and vanish quickly, usually within a week or two. Occasionally you will require pain medication or injections, or in rare cases, you may require surgery.
If you have experienced back pain and wish to prevent it, there are steps you can take to prevent it. Daily stretches, strength training and regular exercise can help strengthen your core and back muscles, making them more resilient.
Need Help?
Back pain treatment is available at One Ashford Hospital in Kent with a leading Consultant Spinal Surgeon and we can book you in for a consultation, usually within 48 hours.
One Ashford Hospital is ideally located for patients in Ashford, Maidstone, Dover, Canterbury, Folkestone and all nearby areas. To book an appointment, call the hospital direct on 01233 364 022 or email here.
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