Back pain is so prevalent that it costs the UK more than cancer and diabetes treatment combined, but there are many myths circulating about the condition. We shed some light on the agonising ailment.
Managing back pain costs the Government more than cancer and diabetes combined. Most of these costs are related to treating people with ongoing pain.
In a health study carried out last year by the Patient Client Council in Northern Ireland, it emerged the impact of chronic pain, such as that associated with back problems, was wide-ranging and did not just affect one aspect of people's lives. Long-term pain impacted on the majority of people's ability to work (70%), their home life (80%) and their ability to take part in leisure activities (83%). 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 85% of people fully recovered within three months. Only a very small number of people develop long-standing problems.
2. SCANS ARE RARELY NEEDED
Both healthcare professionals and members of the public often consider getting themselves a scan "just in case" there is something serious involved in their pain. However, all the evidence suggests that scans only show something truly important in a tiny minority of people with back pain.
A brief consultation with a healthcare professional (e.g. GP, or a chartered physiotherapist) would usually be able to identify if a scan was really needed, based on a person's symptoms and their 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, it would be a big help in solving back pain. However, we now know this is most often not the case.
When people have scans for back pain, the scans often show 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 (52% of people), degenerated or black discs (90%), herniated discs (28%) and visible arthritic changes (38%).
Remember, these people do NOT have pain. Unfortunately, people with back pain are often told these things indicate their back is damaged, and this can lead to further fear, distress and avoidance of activity.
The fact is, many of the things reported on scans are more like baldness - an indication of ageing and genetics that does not have to be painful.
4. SCHOOLBAGS ARE SAFE, BUT WORRYING ABOUT THEM MAY NOT BE
Many people believe that children carrying a heavy schoolbag might cause back pain. However, research studies have failed to confirm 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 a schoolbag is too heavy, the child IS more likely to develop back pain, highlighting the importance of fear in the development of the condition.
Given concerns about inactivity and obesity in children, carrying a schoolbag may actually be a simple and healthy way for children to get some exercise.
5. 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 the pelvis being out of alignment. For most people with back pain, scans do not show any evidence of discs, bones or joints being in the wrong position.
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 such as manipulation.
6. 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 your usual activities gradually is highly important for 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.
7. MORE BACK PAIN DOES NOT MEAN MORE DAMAGE
This may seem strange, but we know that more pain does not always mean more damage. 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, 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.
8. SURGERY IS RARELY NEEDED
Only a tiny proportion of people with back pain require surgery. Most people with back pain can manage the condition by staying active, developing a better understanding about what pain means and by identifying the factors that are involved in their pain.
This should help them continue their usual daily tasks, without surgery.
On average, the results for spinal surgery are no better in the medium and long-term than non-surgical interventions, such as exercise.
9. THE PERFECT SITTING POSTURE MAY NOT EXIST
Should we all sit up straight? Contrary to popular belief, no static sitting posture has been shown to prevent or reduce back pain. Different sitting postures suit different people, with some reporting pain from sitting straight and 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 (e.g. 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 relaxed and variable manner, is important for people with back pain.
10. 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 same way poor sleep can make us stressed, tired or feel down, it can also cause or prolong back pain. So improving your sleeping routine can be helpful.
11. 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 lift something that is heavier than what 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 practised to help strengthen the back, similar to returning to running and sport after spraining an ankle.
12. 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 to doing valued activities that 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.
13. STRESS, LOW MOOD AND WORRIES SHAPE 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 such as 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 because 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 that you enjoy, can afford and that 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 than healthy muscles. Therefore, if you feel sore after you 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 can 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.