Back pain

Causes and duration of lower back pain | Symptoms and examination | Treatment | Exercises to relieve sudden back pain | Exercises in the neutral position of the back

Lower back pain is a common condition. 80% of adults have lower back pain at some point in their lives, some several times. The majority of lower back problems disappear spontaneously, often in just a few days or within a few weeks at the latest. Persistent back problems are treated as team work, which means that patients play the most important role in their own rehabilitation.

Causes and duration of lower back pain

The causes of back pain may vary. Physically strenuous work, uncomfortable positions, heavy lifting and continuous sitting are risk factors for back problems. Structural factors affecting the spine, postural stress (poor posture, sitting with the lumbar spine curved) or poor muscle support of the trunk may also predispose to back pain. Back problems are associated with lack of exercise, overweight, smoking, stress and dissatisfaction with work. More serious causes are rare. Most back problems are non-specific and while their exact cause is difficult to determine, they are benign, not serious.

Lower back pain falls into three categories based on its duration. In sudden, acute pain, the symptoms persist for less than 2 weeks, in prolonged pain for 6 to 12 weeks and in chronic pain longer than 3 months.

Symptoms and examination

The main symptom is pain. Benign back pain is usually caused by minor tissue damage in the structures of the back, such as intervertebral discs, joints or muscles. Pain occurs during back movements, can be felt in the lower back and may radiate to the buttocks and thighs. The pain may be severe but the patient's general health is usually good. Sudden lower back pain (called lumbago) usually disappears within a couple of weeks.

Lower back pain may also involve compression of a nerve root. Sciatic pain radiates to the lower limb, usually to below the knee. This may be caused by an intervertebral disc prolapse ("slipped disc"). Sciatic symptoms usually disappear within 1 to 3 months. Surgery is seldom required, but if the patient experiences difficulty urinating, loss of sensation in the anal and genital region, or numbness or weakness of the legs and feet, surgery is performed as an emergency.

You should see a doctor if more serious symptoms than the ones mentioned above occur, the pain is persistent or the pain is due to high-energy trauma. An exact description of symptoms and clinical examination are the primary examination methods. X-rays are rarely taken nowadays. An MRI scan (magnetic resonance imaging) and other examinations are necessary if there is reason to suspect more serious causes of the back pain or if the sciatic pain symptoms are so troublesome or persistent that surgery is considered.

It is the doctor's job to identify serious conditions, which may include serious diseases, such as spinal tumours, ankylosing spondylitis or vertebral fractures. In these conditions, back pain is continuous, even at rest, and gradually worsens. The patient's general health may be impaired and the patient may have lost weight. Vertebral fractures are rare in young people and are usually connected with strenuous, repeated sporting activity (such as artistic gymnastics) or accidents.

A functional back examination performed by a physiotherapist focuses on the examination of functional capacity, postural problems and problems with moving about. Home exercises are compiled based on the examination findings.

Treatment

Bed rest is not usually necessary in those with sudden back pain, in fact it may even slow down recovery. Moving about helps. It is important to move about lightly (e.g. walk) as the pain allows based on your condition and how you feel. Sitting, standing and lying down (i.e. being still) for long periods should be avoided.

Painkillers may help at the beginning because they enable more normal use of the back in the daily chores and make sleeping easier. Paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for acute back pain. In cases of severe back pain, it is important to take the medicine regularly for 4 to 7 days according to the dosage shown in the package. However, painkillers should not be used for long periods as they may irritate the stomach.

Cold therapy can also be applied to the pain area (15 minutes with an ice cube bag wrapped in a sock or a thin towel, for instance) several times a day as necessary.

Sufficiently intensive and long-term muscle and general exercises can reduce back pain and improve functional capacity. If possible, a visit to a physiotherapist during the acute phase is recommended to receive guidance on suitable exercises. Exercises that improve the trunk and leg muscles and the patient's general condition are added gradually, taking into account the symptoms. In persistent back pain (duration 6 to 12 weeks), further examinations to make a diagnosis, treatment assessment and rehabilitation plan require multidisciplinary collaboration, personal guidance (ergonomics, pain control, exercises) and an assessment of the fitness to continue studying.

Daily exercise is important right at the onset of back problems. Rehabilitation is required if the problem persists. Rehabilitation is based on the patient's individual needs and current situation. The patient's input is very important. Correcting poor working positions and adopting a correct lifting technique are necessary both in prevention and in rehabilitation.

Article written by physiotherapists Päivi Hamari and Anne Friman, 2011
Article updated Feb 2014


Avainsanat: Physiotherapy, Back, Back pain