It’s thought that nine out of ten of us will experience back pain at some point; and although it’s rarely permanent, it can be extremely debilitating. Happily, diagnosed back pain can be healed, often with minimal intervention.
Your back is an incredible part of you. It supports you, enabling you to stand upright. It’s strong, so you can lift and carry weights. It’s also supple and flexible, allowing you to move and bend and twist and do all manner of movements. Like all essential equipment, when it stops working so well, we can really struggle.
Pain in your back is your body telling you that something isn’t right. Back pain can be called “acute” or “chronic”, depending on how long it lasts (acute is short-term, chronic is long-term or persistent), with “sub acute” somewhere in the middle. The pain itself varies depending on the cause or whereabouts in your body you’re feeling it. Back pain is variously described as dull, piercing, tingling, shooting, or burning; and it can suddenly move down into your limbs, hands, or feet. The back pain could be coming from nerves, bones, muscles, ligaments, or joints. The cause may be obvious (pregnancy) or harder to determine (tension related).
Different types of back problem affect different areas of your spine. For diagnostic purposes, the back is divided up into four main sections: cervical (the neck), thoracic (the middle of the back), lumbar (the lower back), and sacral or tailbone (the coccyx, right at the base of the back). Pain in the lumbar area, sometimes called lumbago, is the most common form of back pain.
Whatever the cause or wherever exactly the pain is, it can be at best uncomfortable and at worst excruciating. Here’s a closer look at why many of us struggle with back pain at some time in our lives.
The term “back pain” actually covers a number of conditions. It can be difficult to pinpoint the exact cause of an individual’s back trouble; however with accurate testing and the right questions, we can get to the root of the problem and work towards an effective treatment.
Here are some of the most common causes of back pain that we see at Mir Neurology. They range from mild and temporary to extremely uncomfortable and chronic – and all can be treated.
Non-specific back pain
Most cases of back pain we see are non-specific, meaning there’s no real underlying condition. This back pain is likely to do with inflammation of muscles or ligaments; and we use nerve function tests to help us find out more.
This is more commonly known as a “slipped disc” and can be caused by a range of factors from age to accident. Contrary to its popular name, the spinal disc hasn’t actually slipped but is pressing against a nerve. Painful but easy to identify through nerve tests, and there are a variety of treatments available depending on the severity. There is also a condition called spondylolisthesis, where a vertebra does actually slip out of position. Again, there are various ways to treat it, and we always check for this.
This is an irritation of the nerve which runs from the lumbar region right down to your feet. The sciatic nerve is the longest nerve in your body, so there are a whole load of areas that are affected if it’s compressed. Sciatica is painful, and can also cause tingling and numbness in the lower back, legs, buttocks, and feet.
Ankylosing Spondylitis (AS)
AS is a chronic condition which causes inflammation of the spine; and occasionally other joints are also affected. People with AS usually experience back pain, stiffness, pain and swelling elsewhere in the body, along with fatigue. It can improve with time, but in some cases it actually worsens, so it’s always worth getting checked out if you have these symptoms.
We’re all getting older, and sometimes parts of us just start to get a little tired and worn out. Older people can develop osteoarthritis, which happens when the cartilage between the joints in the spine breaks down. This can worsen over time, and needs pain-relieving treatment. Other conditions that affect elderly people include spinal stenosis and degenerative spondylolisthesis, which place pressure on the nerves and can result in leg pain.
Sometimes, the pain is the result of an injury, such as a pulled muscle. If you have back pain following an accident such as a car crash or a bad fall, we need to make sure that there isn’t a fracture.
Constant lifting and twisting can have an impact on our poor, hard-working backs. We see a lot of people who have repetitive jobs, or regularly perform heavy lifting tasks.
Stress and tension-related back pain
Back pain can be caused by stress, possibly due to work or family issues. We appreciate that sometimes this can be tricky to talk about, but please be open with your medical professional. Tension can have real physical impact, and realizing this can be the first step to a cure.
Back pain in pregnancy
Many women experience lower back pain during pregnancy. There are several reasons for this. Your center of gravity changes and your posture with it. Normal pregnancy weight gain puts strain on your lower spine. The pregnancy hormone relaxin loosens pelvic area ligaments, to prepare your body for the birth; however sometimes relaxin also causes ligaments in the back to loosen resulting in back pain. In some cases, the rectal abdominis muscles (which run downwards from the ribcage) separate, and this can also affect your lower back. Pregnancy-related backache usually ceases after baby arrives.
A sign of other conditions
Rarely, it can be a sign of a more serious condition. This isn’t common; however if you or your family have a history of cancer, we’d like to see you to rule this out.
Also, if your back pain is alongside other symptoms including numbness or tingling around your genitals or buttocks, difficulty in urinating, incontinence, chest pain, a temperature of 100.4F plus, unexplained weight loss, or swelling in the painful area, please seek medical advice as soon as you can. It may be nothing to be concerned about, but it’s always good to eliminate other conditions.
Again rarely, people can experience something called “central sensitization”. This is when an injury or illness has cleared up, but the patient continues to feel sensitive towards pain. This can occasionally manifest itself in the back.
Do any of these descriptions sound familiar? If so, it’s always worth having your thoughts confirmed with a proper diagnosis. At our Mir Neurology clinics, Dr Mir uses the latest tests to look at nerve function in the spine. This plus a physical examination and lots of questions, makes sure that you have the correct diagnosis of your back problem.
Back pain can be relentless, and we know how hard it is when you simply can’t get comfortable. There are a few self-help approaches you can take to relieve your back pain. Here are a few tried-and-tested remedies that may help you feel a bit better –although please, speak with a medical professional before trying them out, as every case is different.
It may feel counter intuitive when you’re hurting, but please keep moving when your back hurts. Naturally, don’t lift heavy weights or take up a new extreme sport; however, keeping active will prevent stiffness, and staying still can actually make the pain worse. Gentle exercise can help, and swimming is great as the water supports your aching body. Stretching exercises designed for back pain are ideal (we can recommend these, or speak with your doctor or physiotherapist).
If you think you may need medication to help with your back pain, you can buy anti-inflammatories (NSAIDs, non steroidal anti-inflammatory drugs) without a prescription. Common NSAIDs include ibuprofen and aspirin, both medicine cabinet staples in most homes. These work by blocking prostaglandins, which increase pain during inflammation.
They are great for backache, headache, arthritis, and because they reduce body temperature, fevers. Some people find that they get minor stomach problems with anti-inflammatories, but you can reduce the risk of this by taking the drugs with food or milk. If you have or have had a stomach ulcer, are pregnant or breast feeding, asthmatic, or have had any problems with any of your internal organs, speak to a medical professional before taking NSAIDs.
Please remember that anti-inflammatories aren’t designed for long-term use; so if your pain hasn’t improved within around three days, seek advice. However, they are fast-acting, and hopefully you’ll experience pain relief soon after taking the first dose.
If you are taking any other medication, please speak to your doctor or pharmacist before taking anti-inflammatories: it’s possible there could be interactions.
Hot and cold treatment
Hot and cold treatment can really help with back pain. This is simply applying heat or cold to the painful area (you may need help, as many parts of the back are hard to reach on your own, especially if you’re sore). But how do you know when to go hot and when to go cold?
Broadly speaking, ice is good for reducing swelling or treating inflammation, and is often used on injuries. Heat is soothing for stiffness and muscle pain. You can use ice packs or heat pads; or for a more home-based approach, a pack of peas from the deep freeze or ice in a zip-lock bag works really well for cold treatment, and a towel that’s moist from hot water can be used instead of a heat pad.
As ever, if you have any pre-existing conditions, are taking medication, or are pregnant, seek advice before trying hot and cold treatment.
These home-based remedies can really help to relief your discomfort. However, if the back pain is severe or simply not going away, you may need to seek specialist help.
We’ve all heard that old saying that prevention’s better than cure; however it’s not easy to stop back pain from occurring. But, there are a few simple things to bear in mind that can help to keep your back healthy, and you should definitely do these if you’ve already experienced back pain.
Try some back exercises
A regular daily routine of simple stretching exercises can work wonders. Stretching exercises prevent stiffness developing, and if you are currently experiencing back problems, there are stretches you can do to relieve the discomfort. Please speak with us or with your physiotherapist before starting a back exercise regime. Every back is different, so you need to make sure that the program is tailored for you.
Take regular exercise
Staying active can help to keep your back strong and healthy – plus exercise has all sorts of other benefits too. Complement your back exercise routine with water-based activities such as swimming or aqua aerobics, walking, and depending on your level of fitness, cycling. Maintaining a healthy weight can also prevent back pain; and a combination of regular exercise and a good diet helps us all to keep fit.
Stay a healthy weight
Excess weight can put extra pressure in your back, making it work harder as it has to support more. Maintaining your ideal BMI can really help to keep your back and knees in good condition. Try those exercises we mentioned above, and eat a sensible, well-balanced diet. Take a holistic approach to back pain, and remember that good general health will help every single part of you, back included.
Think about your sitting posture at work
If you work at a desk, make sure you have a proper operator’s chair, and think about how you’re sitting. Your screen needs to be at eye level so you’re not forever looking downwards, and adjust your chair height so your forearms are straight. Your feet should be flat on the floor or on a footrest. Take regular breaks away from your desk to stretch and move around. Several, shorter breaks a day are better for you then just one or two longer ones.
Are you sitting comfortably?
Of course, it’s not just office workers who need to think about this. If you’re on the road a lot, again, take regular breaks, and make sure your car seat is set to a position that supports your lower back. Don’t hunch over the wheel. Away from work, think about how you sit while you’re watching TV or eating a meal. Are you slouching? A cushion behind your lower back can make a real difference.
Make sure your bed’s comfy
It can be so hard to get to sleep if your back’s aching. A supportive mattress is essential for a good night’s sleep, while also helping to prevent future back aches. You’re looking for a combination of comfort and back support; and many people find that a medium-firm mattress works for them. If your back needs a lot of support, get a firm mattress and add a softer topper so your shoulders can still sink in slightly. We appreciate that it’s not always possible to dash out and buy a new mattress, and this is just one of several ways that you can look after your back.
Think about how you lift
We see a lot of people who lift as part of their job, and repetitive movement can take its toll on your body. Seek advice on best practice for your particular role, and always be back-conscious when you lift. The most important things to remember are not to bend to lift (always squat when possible), make sure you’re standing in a stable position, don’t twist, and know your own lifting limits. This is as essential at home as it is in the workplace.
These lifestyle changes can’t guarantee that you’ll never have a bad back – but they will improve your chances. Also, if you’ve ever experienced bad pain, it’s worth trying preventative measures to lessen the risk that you’ll go through it again. After we’ve treated our patients, we always give them this advice, and hopefully we won’t need to see them again (in the nicest possible way).
Sometimes back pain will gradually ease on its own. However, if the pain is preventing you from leading your daily life, keeping you awake at night, or you think it’s getting worse, please get in touch with a specialist. Most back pain can be easily treated, so never feel you have to struggle on.
Getting a diagnosis for back pain
When someone comes to us with back pain, we start off by taking a history and asking lots of questions. The next stage is to run a series of tests, including nerve function tests. All the time we’re building up a picture of your spine and working towards a diagnosis.
Once the cause of your pain is established, there are many treatment options. Sometimes, the back pain will resolve itself with time and the home-based pain relief methods we outlined above. In our clinics, Dr Mir will always advise on the best course of action if something more involved is required. It could be that you need a course of physiotherapy to help straighten you out, or manual therapy from an osteopath. Occasionally, surgery is required and the patient is referred to a neurosurgeon, but this is pretty rare. Seeking specialist help means that you know your diagnosis is as accurate as possible, and that you’ll be given the most appropriate treatment pathway to follow.
When to act fast
We do have to add that sometimes, emergency treatment is needed. These incidences are rare, but you need to be aware of them. If your back pain is accompanied by numbness or tingling around your genital or buttock area, difficulty in using the bathroom, incontinence, chest pain, a temperature over 100.4F, weight loss that you can’t explain, or the back pain is accompanied by a swelling, it’s time to seek immediate advice. Also if you suspect trauma to your back (you may have been involved in a road traffic accident or a fall), please see a medic as soon as possible. Any of these could be a sign of a more serious condition, so please contact your doctor as soon as possible and get yourself checked out.
Just please, never suffer in silence. Back pain can feel like it’s taking over your whole world. It doesn’t have to be like this.
If you’re currently experiencing back pain, we know how uncomfortable you must be. But please don’t despair: a diagnosis from a neurologist will take away any fear of the unknown, and set you on the treatment path to recovery. Sometimes, time is the greatest healer (helped by heat pads and NSAIDs), and on those occasions when that isn’t the case, physiotherapy, manual therapy, and surgery are also options. In the case of degenerative conditions, a pain management program can make sure you lead an active life, not worn down by debilitating back pain.
If you’re experiencing back pain, please call us for an appointment. There are Mir Neurology and Spine Center clinics in Hagerstown and Cumberland MD, and we’re committed to seeing patients as quickly as possible. Dr Mir starts with a 30 minute consultation, and then runs the latest diagnostic tests to establish more about the cause. Based on the results, Dr Mir will then give you recommendations about what the next steps could be.
If you’d like to book an appointment or find out more about our Mir Neurology and Spine Center clinics, please get in touch with us on (301) 797-7600 (Hagerstown) or (301) 722-3777 (Cumberland). Or, you can complete the contact form on our website. Dr Mir is here to help you get your back back to normal.