This information may be useful for those who have new back problem. It is common for patients with a diagnosis of previous back pain to have a flare up. In some people however, pain can last longer than a few weeks, and in these cases back pain can be managed well through advice and remaining active.
Back pain is common and often starts for no obvious reason. Although sometimes distressing, the spine is strong, and back problems are rarely due to any serious disease or damage.
Back Problems can cause a range of symptoms, including:
- Stiffness
- Muscle spasms
- Hot, burning, shooting or stabbing pains in your back and sometimes into both of your legs or feet
- Pins and needles, numbness or weakness likely due to irritation or compression of the nerves of the back.
In many cases, new or flare up of long standing back problems should begin to settle within 6 weeks without the need to see health care professional.
What causes back pain?
Although most back problems start for no obvious reason, back pain can be influenced by:
- Staying in one position too long
- Lifting something awkwardly
- A flare-up of an existing problem – by “protecting’ the back and avoiding movements.
- Fear of damage and not getting better – therefore causing more stress and feeling down
- Doing more activity than you normally would
- General health and lifestyle – life being tired and rundown, not getting enough quality sleep, being overweight or not getting enough physical activity.
- Social triggers, such as difficult relationships at work or home, low job satisfaction or stressful life events, like a family death or illness.
Each of these factors can turn up the volume on your pain.
Different Types of Back Pain
1 – Sciatica (nerve root pain)
A small number of people (1 in 20 people with low back pain) get sciatica. Sciatica is caused by physical or chemical irritation of one of the nerve roots in the lower back. It can cause leg pain. You might also have numbness or pins and needles in the leg.
2- Serious Spinal Pathology (Red Flags)
Less than 1 in 100 people with low back pain have symptoms that need urgent medical attention. These are known as red flag symptoms.
3 – Non-specific low back pain
This is the most common type of back pain. It is not possible to diagnose the exact cause of this back pain in most people. This is why the word ‘non-specific’ is used.
When to seek professional advice
Cauda Equina Syndrome – is a rare but serious back condition which can lead to permanent damage or disability. If you develop this condition you will need to be seen by emergency specialist spinal team.
Call 999 or visit the Emergency Department
If you have any of these signs or symptoms, it is important that you tell your GP or another medical professional straight away.
- loss of feeling/pins and needles between your inner thigh or genitals
- numbness in or around your back passage or buttocks
- altered feeling when using toilet paper to wipe yourself
- increasing difficulty when you try to urinate
- increasing difficulty when you try to stop or control your flow of urine
- leaking urine or recent need to use pads
- not knowing if bladder is either full or empty
- inability to stop a bowel movement or leaking
- loss of sensation when you pass a bowel motion
- change in ability to achieve an erection of ejaculate
- loss sensation in genital during sexual intercourse.
- You have had a trauma, or injury, within the last 7 days.
Contact you GP if:
- you have back pain that is persistent (longer than 6 weeks) and unchanging after flowing self-care advice
- the level of pain is not affected by movement
- the pain levels are worse at night.
What to expect in the GHA - Spinal Pathway
The GP will refer into a Spinal Pathway that will ensure you see the right professional at the right time.
This may be the physiotherapist or a member of the Spinal Team. This is NOT a referral pathway for a spinal surgeon
Self Help: What can I do to help my back pain?
1 – Exercise
Keeping active is an essential part of your treatment and recovery and is the single best thing you can do for your health.
If you have to sit or rest, try to change positions regularly and find one that reduces any pain in your back or legs.
It’s beneficial to do specific exercises that can help in your recovery. They may be challenging at the beginning so just do what you can and try to build it up over time.
Click on the following link for exercises and advise on how to manage your acute back pain:
- Exercises for Low Back Pain
- NHS back pain pilates video workout
- Chartered Society of Physiotherapy: video exercises for back pain
- BackCare: exercises for back pain
DO NOT – stay in bed for long periods of time. The spine is designed to be moved therefore keeping as active as possible is important. Resting and avoiding any painful activities for more than a day or 2 might actually make your pain last longer.
Once you are able to manage your back pain – it doesn’t matter what type of exercise you do, as long as you stay active and try to move little and often, it is important to choose something you enjoy so you are more likely to keep doing it.
2 – Work
Staying at work or returning to work quickly, has shown to help people’s recovery. You do not need to be pain free to be at work.
If your job involves sitting at a desk a lot, try to get up regularly and walk about every half an hour.
It might be possible to change your work activities in the short term to help you return to work sooner.
3 – Pain Treatment
The following can help to reduce the pain:
- pain medication – this can help you move more comfortability, which can help if your recovery. If you are not sure what medication to get follow the link or consult with GP or Pharmacist
More information about taking painkillers
- heat or ice packs – should apply to the area not more than 15 mins and can be used as many times per day as required. This will help to relieve joint stiffness or muscle spasms
Frequently Asked Questions
Will I need surgery for my lower back pain?
Most people with low back pain do not require surgery
90% of the case resolve with exercise, education and medication (National Institute for Health & Care Excellence, Lower Back Pain Guidelines 2016).
2 years after a spinal operation for leg pain the improved outcomes are the same as having not had an operation.
In the UK population, 1540 patients per year are seen by a Spinal Specialist, only 33% (508) need imaging investigations and only 23% (354) go on to have an injection.
Will I need an MRI for my lower back pain?
A MRI is rarely indicated and would take place after a musculoskeletal assessment.
A MRI scan is used mostly to identify if a nerve is trapped (which would result in arm or leg pain) not to identify the source of lower back pain.
- 70% of trapped nerves causing leg or arm pain will settle within 4 months.
- 90% of trapped nerves settle within 1 year
8000 Spinal patients are treated in Physiotherapy Out-patients per year, only 19% (1540) need to be seen by a Spinal Specialist.
What can an MRI diagnose if I have lower back pain?
The only causes of lower back pain that imaging investigations can identify are fractures, tumours or inflammatory arthritis like Ankylosing Spondylitis. These are relatively rare or very rare to occur.
Nerve injections are for leg/arm pain only NOT numbness/tingling or weakness as they do not help.
20% of patients following spinal surgery for leg pain need a repeat operation within one year.
In the UK population, 1540 patients per year are seen by a Spinal Specialist, only 6% (92) go on to have surgery.
Won’t an MRI scan show disc wear or bulges?
People with low back pain with or without leg pain who are being referred for specialist opinion, may not need imaging (National Institute for Health & Care Excellence, Lower Back Pain Guidelines 2016).
80% of 50 year olds will have disc wear on a MRI scan and have no symptoms, these findings are normal.
40% of 30 year olds and 50% of 40 year olds will have a disc bulge on a MRI scan and have no symptoms. Disc bulges are common findings.
How successful is surgery or injections at treating low back pain?
Surgical treatment for lower back pain has only a 50% success rate and is limited to either.
- Killing the nerve that serves the small joints in the spine.
- Fusing the spine at one or more levels.
Injections for lower back pain are not recommended by National Institute for Health and Care Excellence, they only have an approximate 30% success rate, reducing the pain only on average 2-4 months.
Lower back pain is common, 80% of the UK population will have an episode in their lifetime.
Do I need ‘hands on’ treatment for my back pain?
Hands-on treatments have been shown to have a small benefit to back pain, and only when used as part of a whole treatment programme which includes exercise.
