​The spine (or backbone) extends from the base of your skull to the buttocks, consisting of more than 20 separate bones called vertebrae, stacked on top of one another. A flexible disc sits in between each pair of vertebrae, and these are held together by ligaments. The spinal cord and the nerves run through the centre of the spinal column.

Most people suffer from mild back pain from time to time, and the exact cause may be difficult to diagnose. It is usually a sign that one or more muscles, joints, ligaments or discs may be overstretched or twisted by the movement of the back in an awkward position. Severe back pain may be the result of pressure on nerves from the misalignment of the bones in the back, and in this case, you should seek immediate medical attention. Lower back pain afflicts some 80 percent of the adult population some time or other in their lives.

Many episodes of pain last only several hours or a day or two. By and large, 90 percent of patients should recover from their initial attack of back pain about six weeks after its onset.

Slipped Disc

As a person gets older, the nucleus (soft jelly-like core) in the discs in the lower back may begin to dry out. As a result, the discs are less capable of cushioning the spine, especially during repeated stressful activities. The capsule or annulus, the hard exterior that surrounds the core, can then tear and cause pain. This is known as a slipped disc.

In a slipped disc, the annulus tears with different degrees of severity. Small tears heal quickly. Large tears can cause a small portion of the nucleus to herniate through the tear to lie outside the wall of the disc. If this herniation is close to a nerve, intense irritation of the nerve can occur. Sciatica or feelings of pain, aching, numbness, “coldness”, paraesthesia or pins and needles of the thigh and calf may occur. This can involve one or both legs. Properly performed manual treatment using massage, mobilisation and manipulation may often be helpful in reducing the severity of lower back pain.

In most cases, patients recover without the need for surgery. However, in a small group of patients, a significant portion of the nucleus may have herniated out of the annulus of the disc, compressing the nerve. For these patients, removing the herniated fragment of the disc will result in a more rapid recovery of symptoms.

Symptoms of Lower Back Pain

Early medical attention is necessary if these symptoms are present:

• Constant lower back pain with no significant relief when resting
• Aggravated by bending in all directions
• Localisable severe pain to a single spot on the back
• Progressively severe pain over days/weeks
• Persistent nerve pains, pain or sensation of numbness, pins and needles in one or both legs.
• Weakness of legs, difficulty in walking and unsteady walking
• Bladder/bowel problems associated with back pain. (difficulty in passing urine, also known as incontinence)
• General symptoms of poor health like loss of appetite, weight loss, lethargy, fever and chills.
• Previous history of cancer

How to Prevent Lower Back Pain

• Try to modify activities so that you are less likely to strain your back.
• Interrupt a repetitive task frequently by standing and performing stretches for lower back pain. This helps to reduce the stress on the back, keeping it from building up to critical levels.
• Exercise programmes must be balanced to include all parts of the body, including the back.
• Exercises should be carried out frequently in measured doses.

Treatment for Lower Back Pain

Rest is crucial for patients with episodic attacks of back pain. Rest may involve going home and lying down for a few hours or could be as simple as keeping the back straight and avoiding further stress to the back in from bending, lifting or sitting. In severe attacks, lying down for a day or two may significantly reduce the severity of the lower back pain. If it does not help, further bed rest may also not be helpful.

Physical therapy is very important in the treatment and prevention of lower back pain. In the initial period of acute back pain, combinations of heat, traction, manual treatment, and other techniques may help to rapidly reduce the severity of pain and stiffness. As the pain subsides, exercises to relieve stress and strengthen the back should be gradually introduced. Regularity of such exercises can help to further reduce the lower back pain, as well as protect the back from unhealthy stress and recurrent attacks of back pain.

Different types of medication may be also prescribed for different types of back pain.

In acute sciatica or leg pain associated with back disorders, the acute irritation of the nerve may be reduced by taking nonsteroidal anti-inflammatory drugs (NSAIDs) regularly for a short period of time. NSAIDs are often prescribed purely for pain relief rather than for their anti-inflammatory effects and are only prescribed when needed. These drugs are to be avoided if the patient has a history of allergy and kidney problems. In most cases, NSAIDs are well-tolerated, though most of them provoke gastric symptoms. Always consult your doctor before taking NSAIDs.

Muscle relaxants help to reduce muscle spasms and stiffness that occur during a pain attack. In particular, sedatives and tranquilisers may be taken at night to ensure a restful sleep. Ice packs, hot packs or heat lamps, ointments that usually contain methyl salicylate and medicated plasters may also help.

Approximately 30 percent to 40 percent of patients suffer a relapse during the first few months following the attack. Thus, it is important to identify the factors that aggravate the pain.

Here are some frequently asked questions regarding lower back pain.

Aside from a Slipped Disc, What Are the Other Causes of Recurring Leg and Back Pain?

Spinal canal stenosis and spondylolisthesis are two other common causes of recurrent back and leg pain. In older people, a condition termed lumbar spondylosis (where the facet joints of the spine are worn out) can result in episodic back pain. Osteoporosis or softening of the bones can occur in the elderly, resulting in back pain. Patients who have had a previous history of cancer and have persistent back pain should seek a medical opinion. Less commonly, conditions such as rheumatoid arthritis, ankylosing spondylitis and various types of infections can also afflict the spine.

My Back is Often Sore at the End of a Day's Work. How Can I Prevent This?

Modification of activity or the work environment may be required. It is often how the person performs a certain activity that results in unnecessary stress to the back, causing soreness. Specific instructions on how to modify activity or work environment can be provided by the doctor or the therapist, either as an individual or in groups of patients attending Back Care classes.

I am Already Doing a Full Day's Work, and I Jog and Play Tennis. Why Do I Need Other Exercises?

Work, no matter how strenuous, is not exercise. In fact, some jobs, especially those that involve repeated lifting, bending, prolonged standing or sitting, can add to the stress over the spine. Exercises like jogging, racquet games and golf may be good for general health and fitness but do not significantly exercise or strengthen the back. A balanced programme that includes improving the flexibility and strength of the back will help to prevent recurrent injuries.

I Have Severe Back Pain and Sciatica That Have Not Improved Even with Treatment. What Should I Do?

X-rays of the lower back should be obtained. Conditions like spondylolisthesis, infection and tumours should be excluded. Sophisticated imaging techniques such as magnetic resonance imaging (MRI) may be required. MRI scans can show the severity of a prolapsed disc and, more importantly, the degree of nerve compression if any. Other investigations such as bone scan, CT scans or myelograms may be performed in certain conditions.

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