I am consciously sitting up and straightening my back as I sit down to write this article.
Back pain is common and figures in the top seven conditions that bring people to consultation with their GP.
Estimates of figures show that 9 out of 10 people experience back pain at some time in their life and about 1 in 5 experience it at some time each year.
From a GP’s perspective, chronic back pain is 11th most common problem managed in primary care.
So just a quick glance at these figures shows that even though it has significantly high incidence, it must settle itself in quite a few instances and even in the cases that end up in GP’s consulting room, not quite as many progress to chronic disease. Less than 10% cases end up requiring any surgical interventions.
From society’s perspective chronic back pain is one of the most common reasons of missed work in a given year.
Due to the vastness of the topic, I’ll break up the reading on this topic into separate segments over the coming days.
Back pain is said to be acute in the first 12 weeks and thereafter it is termed chronic.
It is termed cervical (neck), thoracic (truncal), lumbar (lower back) or sacral (tail bone), depending on which anatomical part of the back is affected.
It can originate from soft tissue structures of the back which comprise of muscles, ligaments and the protective sheaths called fascia. This tends to be the most common cause of back pain we encounter.
This pain is typically localized only in the area of the back affected which tends to feel quite stiff with significantly reduced range of movement. Those mornings when you wake up with painful and stiff neck or lower back, which seems to come out of nowhere, is the most commonly encountered example of this type of back pain. As the main problem lies with the muscle component, it tends to improve with activity as the day goes on and the gradual warming up of the muscle but then gets worse towards the end of the day due to the fatigue of the injured muscle.
The other possibility of origin of pain may be from the intervertebral discs which are fibrous and cartilaginous structures which lie between adjacent bones of the spine called vertebrae and allow slight movement of the vertebrae and also act as shock absorbers.
These discs can slip (medically termed herniation) at times of unbalanced mechanical pressures such as unusually high demand physical activity, accident or trauma, and the most common cause – chronic low grade trauma which results from poor posture.
This pathology commonly tends to cause radiation of pain down into the buttocks, thighs, legs and even up to the feet. It generally feels different to muscle pain and may be described as burning, stabbing or tingly in nature. It has higher likelihood of being associated with numbness or altered sensations.
It there is any association with problems holding full control of bowel or bladder then it is a very worrying sign and warrants urgent review with your GP.
The remaining possibility of the origin of pain is from the bones called vertebrae. This is uncommon and seen in < 2% cases.
In the next section I will write about treatment modalities with focus on self help strategies.