Back pain

Back pain is very common and has a variety of causes. Fortunately, there are many things that can be done to recover and prevent pain from returning.

Back pain – most commonly of the lower (lumbosacral) spine – affects 4 out of 5 people at some stage of their life. It is the second most common cause of missed work (the most common cause is the common cold) and costs the country hundreds of millions of dollars a year through ACC payments and sick leave costs to businesses. There is also a personal cost to individuals and families through lost income, pain and suffering.


Video about low back pain by Associate Professor Dr Mike Evans, 2014

Key points:

  1. Keeping active and maintaining good posture are two key activities that help prevent back pain.
  2. When you have back pain, avoid bed rest. This does not help and can make symptoms worse. Keep as active as you can whilst avoiding any heavy lifting or twisting movements.
  3. See a doctor straight away if you have any weakness in your lower legs, develop any bowel or bladder problems (such as incontinence) or numbness over your buttocks and anal region.
  4. If you have pain lasting 12 weeks or more (chronic back pain) see your doctor or a physiotherapist for a thorough assessment.

Causes

Most back problems are not due to any serious injury or disease. Rather they are the result of bending, twisting, lifting and other mechanical actions we put our backs through on a daily basis. Poor posture, lack of physical activity or incorrect lifting can make you prone to back problems.

If your back pain is not settling, other possible causes include:

  • Back injuries – most often from lifting, sports or accidents at work or home.
  • Herniated disc – this can present with sciatica pain radiating down your buttock and thigh.
  • Ankylosing spondylitis – this is a type of arthritis that causes back pain.
  • Osteoarthritis – this is the most common type of arthritis.
  • Spondylolisthesis – this is a slipping of one vertebra on the other, often at the base of the spine.
  • Spinal curvature disorders – some people develop lordosis, kyphosis or scoliosis due to misaligned curvature of the spine.
  • Spinal stenosis – rarely, the spinal canal narrows resulting in back pain.

Symptoms

Back pain can can start suddenly after reaching or twisting or come on slowly over a few days or weeks.

Short term (acute) back pain often caused by simple muscle strains or spasms. It usually lasts less than 3 months, after which normal function returns.

Long term (chronic) back pain tends to develop over time and last more than 3 months. It can cause ongoing physical, mental and social disabilities.

When to see a health professional

Although rare, back pain can be a sign of a more serious condition. If you experience any of the following 'red flag' symptoms with your back pain then please see a doctor urgently:

  • numbness in the groin 
  • loss of bladder or bowel control 
  • redness or swelling on your back 
  • difficulty walking 
  • constant pain, especially at night
  • pain that is getting much worse, or spreading up your spine
  • numbness or pins and needles in both legs.

You should also see your doctor if you have back pain which is not getting better after a few week of trying simple exercises such as shown in the back pain video above.

Treatment

Back pain is one of the most common reasons for time off work, but research shows that staying at work improves recovery although you may need to modify some tasks. 

One of the most common treatments for back pain is physiotherapy. Physiotherapists are able to assess your back, identify actions or habits that may be adding to your pain and provide you with exercises and advice to reduce pain and prevent further episodes.

If your back is uncomfortable, regular pain relief such as paracetamol can help. However, if you have severe pain or any of the red flags listed in symptoms above, see your doctor straight away.

Self care 

What we do day to day is very important to help keep our backs strong and supple. Three tips for healthy backs:

  • Keep active – regular exercise such as walking, swimming and dancing are excellent.
  • Maintain good posture – sit up straight and review how you sit or relax.
  • Take extra care with lifting – bend your knees, keep your head up, back straight and be sensible about what you lift given your age, size and general health.

If you have recurring back pain, the following may help:

  • Exercise regularly – people who do regular exercise have less back pain than those who are inactive.
  • Lose weight – the more overweight someone is, the more strain this put on all your joints, muscles and back.
  • Avoid activities that cause sudden movements and muscle strain – squash and physical contact sports are less ideal as we get older.
  • Review your footwear – flat shoes with good arch support and cushioning can help.
  • Manage stress, mood and anxiety – low mood, anxiety and stress can all increase muscle tension and back pain. Find ways to manage these or talk with your doctor/nurse.

Check with your physiotherapist or health provider what preventive exercises and stretches are best for you.

Learn more

Back pain Ministry of Health (NZ)
How physio can help back pain Physiotherapy New Zealand
Back pain – range of resources Medline Plus (US)