Spinal Health
Back pain
Back pain is an extremely common complaint – an estimated 60 to 80% of people in the UK are affected at some time in their lives and it can strike anyone at any age. Each year, close to five million working days are lost due to back pain.
The spine
The spine is composed of a number of elements and therefore there are a number of potential sources of pain.
The spine is made up of many small bones called vertebrae. These are separated by discs, which allow the spine to bend and take the load through the body. Vertebrae and discs are supported along its length by muscles and ligaments. The spinal cord threads through the centre of each vertebra, carrying nerves from the brain to the rest of the body. The joints at the back of each the vertebrae, one on the left and one on the right, are called the facet joints. These can become inflamed easily and have many pain fibres. Arthritis can develop here.
Sources of back pain
Pain can come from disc problems, facet joints, nerves, bone muscle or ligament. Early identification of the sources of the pain helps to provide a focussed treatment plan for short and long-term benefit.
Back pain may be associated with other symptoms: it may radiate into the legs due to nerve irritation. When severe and in certain distributions this can be due to a slipped disc.
In a relatively small number of cases, back pain may have a more serious underlying cause. This includes abnormality of the spine, an infection or a collapse of the vertebrae, fibromyalgia (a condition that affects the muscles), infection or cancer.
When to see a doctor
Most attacks of simple back pain last only a few days and get better on their own. However if you are having repeated episodes, than a clear identification of the specific problem by a medical assessment is appropriate in order to devise customised treatment.
Anyone with the following symptoms in addition to back pain should see a doctor as soon as possible:
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fever,
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redness or swelling on the back,
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pain down the legs and below the knees,
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numbness or weakness in one or both legs,
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loss of bladder or bowel control.
A doctor should also be consulted if:
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pain lasts longer than a week,
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pain is the result of an injury, a fall or a blow to the back,
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pain lasts for more than a few days in someone aged under 20 or over 55.
Diagnosis
In many cases, the doctor will only need to discuss the symptoms and carry out an examination. The doctor may recommend more tests if the pain lasts longer than six weeks, or if he or she suspects there is some underlying cause of the pain.
These tests might include X-rays, CT (computerised tomography) scans, MRI (magnetic resonance imaging), blood tests.
Psychological wellbeing can also play a role in back pain; this aspect should always be considered in your treatment.
Treatment
Stay active
Research shows that bed rest does not help simple back pain – it’s much better to return to normal physical activity as soon as possible. Staying active may hurt more at first, but it helps the back to heal quickly, and reduces the risk of the problem occurring again.
If the pain is so bad that taking to bed really seems the only option, keep bed rest as short as possible before getting up and about again.
Specific exercises are also important to take the load away from the spine. They are not a quick fix solution, although some exercises can provide quick relief. Most patients will benefit form a customised 
Exercise Prescription to treat their complaint.
Medications
Medications of various forms may be appropriate, over the short term and may help to keep you active, which is usually important. Some benefit for longer term medication: you should discuss this with a specialist.
TNS (Trancutaneous Nerve Stimulation)
These are small pain killing units using pads applied to the skin over the painful area. They can be very effective in keeping you mobile and reducing the amount of painkillers you require. You can buy TNS units form your local chemist.
Injections
Local injection therapies, such as Nerve Root Blockade (in sciatica) or Facet Joint Injections and Denervations, can be very helpful for some specific complaints. However, thorough evaluation and a clear diagnosis needs first to be established and further discussions should be held with a specialist. Like medications, injections form only part of a treatment programme.
Manipulation and exercise
Osteopathy and chiropractic are treatments involving manipulation of the spine. They may provide short-term relief for simple back pain within the first six weeks.
The Alexander Technique may help improve posture. Some people find that acupuncture helps with the pain, although there is no definite scientific proof of its effectiveness. And, because back pain can sometimes be related to emotional problems, counselling may also be helpful.
Surgery is necessary only in the tiny minority of cases, for specific situations.
REMEMBER: Good back care can greatly reduce the risk of back pain. To look after your back, make sure you:
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take regular exercise,
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use a chair with a backrest, and sit with your feet flat on the floor or on a foot rest,
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sleep on a firm mattress.
Lifting and carrying tips:
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Lift only a manageable weight, or ask for help.
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When lifting things or putting things down, bend the knees, and keep the back straight and feet apart.
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Do not lift and twist at the same time.
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Lift and carry objects close to the body.
