Managing back pain costs the State more than cancer and diabetes combined. Most of these costs are related to treating people with ongoing pain.

Scientific research in the area of back pain has progressed in recent times and it is challenging widespread beliefs held about the condition that seems to plague so many people.

1 Back Pain is common and normal

Eighty percent of people will experience an episode of back pain during their lifetime. Experiencing back pain is like getting tired or becoming sad; we don’t necessarily like it, but it occurs to almost everybody at some point. What isn’t common, however, is not recovering from back pain.

Most acute back pain is the result of simple strains or sprains and the prognosis is excellent. Within the first two weeks of an acute episode of pain, most people will report a significant improvement in their symptoms with almost 85pc of people fully recovered by three months. Only a very small number of people develop long-standing, disabling problems.

2 Scans are rarely needed

Both healthcare professionals and members of the public often consider getting a scan “just in case” there is something serious involved in their pain. However, all the evidence suggests scans only show something truly important in a tiny minority (<5pc) of people with back pain.

A brief consultation with a healthcare professional (eg GP, chartered physiotherapist) would usually be able to identify if a scan was really needed based on a person’s symptoms and medical history.

3 Interpreting scans should come with a health warning

We used to think that if we got a good enough picture of the spine with scans that it would be a big help in solving back pain. However, we now know that this is most often not the case.

When people have scans for back pain, the scans often show up things that are poorly linked with pain. In fact, studies have shown that even people who don’t have back pain have things like bulging discs (52pc of people), degenerated or black discs (90pc), herniated discs (28pc) and ‘arthritic’ changes visible (38pc).

Remember, these people do NOT have pain! Unfortunately, people with back pain are often told that these things indicate their back is damaged, and this can lead to further fear, distress and avoidance of activity. The fact is that many of these things reported on scans are more like baldness – an indication of ageing and genetics that do not have to be painful.

4 Back pain is not caused by something being out of place

There is no evidence that back pain is caused by a bone or joint in the back being out of place, or your pelvis being out of alignment. For most people with back pain, scans do not show any evidence of discs, bones or joints being ‘out of place’.

In the very small number of people with some change in their spinal alignment, this does not appear to be strongly related to back pain.

Of course, it is worth noting that many people feel better after undergoing treatments like manipulation.

However, this improvement is due to short-term reductions in pain, muscle tone/tension and fear, NOT due to realigning of body structures.

5 Bed rest is not helpful

In the first few days after the initial injury, avoiding aggravating activities may help to relieve pain, similar to pain in any other part of the body, such as a sprained ankle. However, there is very strong evidence that keeping active and returning to all usual activities gradually, including work and hobbies, is important in aiding recovery.

In contrast, prolonged bed rest is unhelpful, and is associated with higher levels of pain, greater disability, poorer recovery and longer absence from work. In fact, it appears that the longer a person stays in bed because of back pain, the worse the pain becomes.

6 More back pain does not mean more back damage

This may seem strange, but we now know that more pain does not always mean more damage. Ultimately, two individuals with the same injury can feel different amounts of pain. The degree of pain felt can vary according to a number of factors, including the situation in which the pain occurs, previous pain experiences, your mood, fears, fitness, stress levels and coping style. For example, an athlete or soldier may not experience much pain after injury until later when they are in a less intense environment.

Furthermore, our nervous system has the ability to regulate how much pain a person feels at any given time. If a person has back pain it might be that their nervous system has become hypersensitive and is causing the person to experience pain, even though the initial strain or sprain has healed.

This can mean the person feels more pain when they move or try to do something, even though they are not damaging their spine.

Once people with back pain can distinguish between the ‘hurt’ they are feeling from any concerns about ‘harm’ being done to their back, it is easier to participate in treatment.

7 Surgery is rarely needed

Only a tiny proportion of people with back pain require surgery. Most people with back pain can manage it by staying active, developing a better understanding about what pain means, and identifying the factors which are involved in their pain.

This should help them continue their usual daily tasks, without having to resort to surgery.

On average, the results for spinal surgery are no better in the medium and long-term than non-surgical interventions, such as exercise.

8 Schoolbags are safe – worrying about schoolbags might not be

Many people believe that children carrying a heavy schoolbag might cause back pain. However, research studies have not found this link, revealing no differences in schoolbag weight between those children who do and do not go on to develop back pain. However, if a child – or their parent – believes that their schoolbag is too heavy, the child IS more likely to develop back pain, highlighting the importance of fear in the development of back pain.

Given concerns about inactivity and obesity in children, carrying a schoolbag may actually be a simple healthy way for children to get some exercise.

9 The perfect sitting posture may not exist

Should we all sit up straight? Contrary to popular belief, no specific static sitting posture has been shown to prevent or reduce back pain. Different sitting postures suit different people, with some people reporting more pain from sitting straight, others from slouching. So while slouching gets a bad press, there is no scientific evidence to support this. In fact, many people with back pain can adopt very rigid postures (eg sitting extremely upright) with little variation.

The ability to vary our posture, instead of maintaining the same posture, together with learning to move in a confident, relaxed and variable manner is important for people with back pain.

10 Lifting and bending are safe

People with back pain often believe that activities such as lifting, bending and twisting are dangerous and should be avoided. However, contrary to common belief, the research to date has not supported a consistent association between any of these factors and back pain.

Of course, a person can strain their back if they lift something awkwardly or lifting something that is heavier than they would usually lift. Similarly, if a person has back pain, these activities might be more sore than usual. This, however, does not mean that the activity is dangerous or should be avoided.

While a lifting or bending incident could initially give a person back pain, bending and lifting is normal and should be practiced to help strengthen the back, similar to returning to running and sport after spraining an ankle.

11 Avoiding activities and moving carefully does not help in the long-term

It is common, especially during the first few days of back pain, that your movement can be significantly altered. This is similar to limping after spraining your ankle, and generally resolves as the pain settles. While initially hard, getting back doing valued activities which are painful, or feared, is important. Many people, after an episode of back pain, can begin to move differently due to a fear of pain or a belief that the activity is dangerous. Such altered movement can be unhealthy in the long term and can actually increase the strain on your back.

12 Poor sleep influences back pain

When someone has pain, a good night’s sleep can be hard to get. However, it works both ways as sleep problems can lead to back pain in the future. In the same way that poor sleep can make us more stressed, give us a headache, make us tired or feel down, it can also cause or prolong back pain. So, improving sleeping routine and habits can be very helpful in reducing pain.

13 Stress, low mood and worry influence back pain

How we feel can influence the amount of pain we feel. Back pain can be triggered following changes in life stress, mood or anxiety levels.

In the same way that these factors are linked to other health conditions like cold sores, irritable bowel syndrome and tiredness, they have a very large effect on back pain. As a result, managing our stress, mood and anxiety levels through doing things we enjoy, and engaging in relaxation can be really beneficial in helping back pain.

14 Exercise is good and safe

Many people with pain are afraid of exercise and avoid it as they think it may cause them more problems. However this is not true! We now know that regular exercise helps to keep you and your body fit and healthy, and actually reduces pain and discomfort. It relaxes muscle tension, helps mood and strengthens the immune system once started gradually.

All types of exercise are good, with no major differences in effectiveness between them – so pick one you enjoy, can afford and which is convenient.

Walking, using the stairs, cycling, jogging, running and stretching are all good and help relax all the tense muscles in your body.

When you are in pain, starting exercise can be very hard. Under-used muscles feel more pain that healthy muscles. Therefore, if feeling sore after exercise, this does not indicate harm or damage to the body.

15 Persistent back pain CAN get better

Since back pain is associated with many factors that vary between individuals, treatments that address the relevant factors for each individual can be effective. Failing to get pain relief after lots of different treatments is very frustrating and cause people to lose hope.

However, this is very common as most treatments only address one factor, for example someone goes for a massage for their sore muscles, but doesn’t address their sleep or fitness or stress levels.

By identifying the different contributing factors for each individual and trying to address them, pain can be significantly reduced and people can live a happier and healthier life.

* Mary O’Keeffe (University of Limerick), Dr Kieran O’Sullivan (University of Limerick), Dr Derek Griffin (Tralee Physiotherapy Clinic)

Thanks for that. Actually very useful for me as I’ve got back pain at the moment, which I was already sure wasn’t caused by anything fundamentally structurally wrong, but still afraid of making it worse by doing stuff.

Yes thanks but annoying that the excuses for letting the abs go are all exposed 😉

That’s rather good 🙂

I abandon hope on cure a very long time ago 🙁

Have you got one just the same, but for plantar faciitis?

Really, I want to start running again but I am scared.

Thanks for that,as a long time sufferer i have worked out there is no golden ticket.

Since taking up weight lifting 2.5 years ago, I’ve not had any back pain bar the odd muscle pull from over doing it occasionally.

Yep same here to be fair , ive suffered since I was 13years old skateboarding ,cycling and football have taken there toll, My latest bout of back pain started 4 weeks ago bending under the desk at work to fix a router, I struggled to walk for the next few days and even now as im typing this its sore/stiff.
I have learned to live with it when it starts ,in the past week ive cycled to work everyday , done over 80 miles in three days on the bike and planning a big ride Sunday, 27 years of it and the best thing ive found is hanging upside down from my knees to stretch my back then heat and ice in that order.

An interesting read though

Yup that makes for sensible reading.

I’ve got a spinal fracture and slipped vertebrae, and going back to more riding and exercise generally helps alot with relieving pain!

my back is terrible at the moment. Need to do something about it, no idea where to start though!

Have you got one just the same, but for plantar faciitis?

Possible causes of plantar fasciitis are flat feet, sudden increase in activity (like running) and your calf muscles being too short. What treatment and advice have you had so far?

A brief consultation with a healthcare professional (eg GP, chartered physiotherapist) would usually be able to identify if a scan was really needed based on a person’s symptoms and medical history

I agree with this, but if you’ve been in constant, serious pain for months and it seems to be getting worse not better despite loads of physio, insist on a scan. Mine was caused by an infection in a damaged disc. Apparently very rare in otherwise healthy youngish people who aren’t vocally complaining. No-one had suggested the idea, the guy who looked at the scan told me to go home, pack for 3 weeks in hospital and he’d see me before my operation the next day!

🙂

wolfenstein – Member
I abandon hope on cure a very long time ago

benw – Member
Thanks for that,as a long time sufferer i have worked out there is no golden ticket.

bigjim – Member
my back is terrible at the moment. Need to do something about it, no idea where to start though!

The ex had long standing back pain, through a long process with physio’s & other people got it back to a managed state. A lot was down to finally getting to the root of the problem. Taking lots of small steps from there with movement, straightening and care and maintenance. A lot of the advice above is very good but if you are in long term pain you need to get through the issues to whats causing it. It can take a long time and things like doing the exercises make a difference.

the %scans etc is an interesting point, looking at that sort of thing from an overall health point of view, how do you know which of the 5% would benefit, as a diagnostic tool using it to rule things out is a valid use – if you scanned everyone because it was cheap and easy then you could rule out anything serious in 95% of people then send them down treatment route A.

Antibiotics may help some people with chronic back pain.

I thought it all read as common sense and widely accepted knowledge anyhow?

the % scans bit is the least convincing section. if “evidence suggests scans only show something truly important in a tiny minority (<5pc) of people with back pain” then almost 1 in 20 scans do show something truly important. Given we’re talking about a non-invasive diagnostic procedure, i.e. very low-risk, that sounds like an argument in favour. What’s far more enlightening is the next bit, about the rate of scan findings in those without back pain.

if you scanned everyone because it was cheap and easy then you could rule out anything serious in 95% of people then send them down treatment route A.

Did you miss the part about there not really being much of a convincing link between “damage” to the spine and pain?

We used to think that if we got a good enough picture of the spine with scans that it would be a big help in solving back pain. However, we now know that this is most often not the case.

When people have scans for back pain, the scans often show up things that are poorly linked with pain. In fact, studies have shown that even people who don’t have back pain have things like bulging discs (52pc of people), degenerated or black discs (90pc), herniated discs (28pc) and ‘arthritic’ changes visible (38pc).

Remember, these people do NOT have pain! Unfortunately, people with back pain are often told that these things indicate their back is damaged, and this can lead to further fear, distress and avoidance of activity. The fact is that many of these things reported on scans are more like baldness – an indication of ageing and genetics that do not have to be painful.

Experiencing back pain is like getting tired or becoming sad; we don’t necessarily like it, but it occurs to almost everybody at some point.

I went on an interesting conference where one speaker explained that ‘being tired all the time surely is a normal state of human functioning’.. I found that hard to disagree with.

There was a really interesting programme on radio 4 t’other day about chronic pain, and how chronic pain is essentially a different condition to acute pain. Worth a listen.

Re the “why not scan everyone” approach – have a read up on sensitivity and specificity, and have a think about the ‘dangers’ of scanning everyone based on that notion… essentially, you’re unlikely to pick up a significant number of serious and problem causing pathologies, and more likely to identify situations and conditions that AREN’T problematic, but treating them is likely to cause more harm than good.

The name for scanning/testing everyone to look for a condition is SCREENING – and the ‘SCREEN’ must meet strict criteria, otherwise without thinking about it you’re causing more harm than good. This is generally bad in medical terms…

DrP

‘being tired all the time surely is a normal state of human functioning’

If you have kids yes, if not then something is a big wrong.

Obviously each case is individual, but with the stresses of modern life, poor/hectic sleep patterns, ‘go go go 24/7 TV and internet’, I think if you ask around, most people without any serious illness or psychological condition, are ‘tired all the time’.

Yes, each case is individually assessed, but for the most part at the end of the day, most cases are just ‘normal’..

DrP

I like the bit about sitting positions – the upright position that H&S prescribe is a non starter for me.

I don’t necessarily like the bit about back pain not being caused by things ‘out of place’.

It seems to me that there is a ‘viscous circle’ formed between muscle imbalances and things ‘out of place’, with causation being one or the other.

For instance a lot of sitting badly can result in me feeling like things are ‘out of place’ between my shoulder blades. This happens to a lot of computer users who sit twisted, looking at something on one side whilst they face the other way.

This can become painful as the muscles on one side of my back tighten up.

A good crack from a manipulator can relieve this pain, but sometimes I need a strong massage to free up the muscles.

Other times I have fallen from my bike and knocked something out of place – and end up with pain about my ribs at the front – which is costochondritis I believe. Then the muscles tighten up as well and I need a manipulation to put it all back in place.

And look at these pictures – the guy has scoliosis but my regular osteo straightened him up (eventually).

I have an “ultimate back stretcher” which can be useful in keep my back loose :

and recently I had a very sharp pain in my sternum, probably from another fall, but I accidently self-manipulated my way back to straightness whilst swinging my macebell, experiencing a nice ‘crack’ as I used it :

There are lots of good websites run by pain consultants and other professionals in the UK. http://paintoolkit.org is more aimed at patients and http://paincommunitycentre.org is more for professionals.

As it happens, whilst working on the Pain Community Centre website, I prolapsed a disc. Being surrounded by pain doctors, chiropractors, nurses etc was brilliant – pretty much every progress meeting, at lunchtimes I was dragged off for various treatments all for free and my back recovered well.

Rachel

See that picture of the guy with “scoliosis” – why is his left hip higher than his right hip? Looks like a set up to me.

misleading pictures on the internet? say it ain’t so! 😆

why is his left hip higher than his right hip

maybe other musculature issues ?

I know the osteopath and there is no way he would have set that up – he is very far from being a shyster – an hours session with him involves about 45 minutes of a deep tissue massage followed by a short manipulation in case anything isn’t ‘in place’ – he drinks loads as he is working so hard and had to take time off recently with a rotator cuff injury – he certainly earns his money and maybe is his own worst enemy – his clients don’t come back that often as he does such a good job.

In stark contrast to the chiros at the clinic my wife works at – £37 for something stupid like 10 minutes and then you might only get one of those clicky pens and maybe attached to one of those electrical stimulation machines. Constant queues of OAPs and other fools though, that come back every couple of weeks.

TurnerGuy – I’m not saying you don’t get good results from this guy but I don’t see having a drink problem as a great recommendation in anyone. YMMV

I don’t see having a drink problem as a great recommendation in anyone

he drinks water – I tried drinking a beer before my last appointment – worked quite well 🙂

ah, I see. I’d imagined him breaking off from giving a massage to swig from a hip flask!

an hours session with him involves about 45 minutes of a deep tissue massage followed by a short manipulation in case anything isn’t ‘in place’ –

I’d be hoping that he was doing treatments based on assessment and not doing manipulations “just in case”.

..I think if you ask around, most people without any serious illness or psychological condition, are ‘tired all the time’

Never experienced the TATT thing myself, and that’s with a high pressure day job and a self run small business.
Eat well, sleep well, exercise daily, lay off the booze (and other recreational poisons) and learn the ability to “let things go” – happy days every day 😀

Its a great article an mainly chimes with my experience

But on the other hand it doesn’t really change anything. Most people get back ache. Most people get better

So that leaves the people who don’t get better in long term pain. So what do we do about that? I’m not sure the article tells us.

On the question of scans. I think we are getting better at understanding scans and knowing that things can be wrong and not matter. But of course some times they will find things that do matter

I had an ankle injury. My physio said before we get this joint working I need to know what that huge lump of bone on the top of your Tibia is.

So I had an X-ray discovering 4 faults on my ankle including calcification, 2 bony growths on my Tibia and a floating bone island. But we decided non were caused by the accident and non were in the way of the joint.

So now I have an ankle at least as good as before the accident

BigBummy would still be in pain if he hadn’t had a scan wouldn’t he

I’d be hoping that he was doing treatments based on assessment and not doing manipulations “just in case”.

well maybe he is.

Normally at the start of the session there is the usual checking of mobility, etc, followed by prodding around looking for sore bits. Lifting your legs up, looking for imbalance, etc.

My mate went used to be a big runner and has been struggling to get his running ability back. Was complaining of a big imbalance in power from one leg.

Went to a different osteo in London, although he has been a lifelong skeptic. A few cracks later and the imbalance in power was apparently gone, he came back muttering about magic… Seemed to be something to do with misaligned hips preloading one hamstring. Anyway – it worked for him.

Most people get back ache. Most people get better

regression to the mean…

The guy I the photo probably has a muscle spasm. I get that occasionally with the same result. It is a symptom, not a cause.

Eat well, sleep well, exercise daily, lay off the booze (and other recreational poisons) and learn the ability to “let things go” – happy days every day

Indeedy….
Most people don’t eat well.
Some people don’t sleep well….
Often people drink too much….

You see where this is going?!!

Stay helfy kidz……

DrP

After knackering my back a few years ago and after various other injuries I was always paranoid about any twinge or ache I felt. Then I spoke to a physio friend and he said ‘You’re 40 years old, doing active/dangerous sports where you fall off and stress your body, it’s going to hurt a bit every now and again, just get on with it’. Since then I’ve never looked back. In the past if my back was sore I’d stay off the bike for a bit, now I just get on with it and invariably the pain disappears after a day or two. I’ve come to the conclusion that a lot of this is in the mind.