If you have back pain as you are reading this you are certainly not alone. In fact, four out of every five adults in the UK will experience back pain at some point during their life. If you are aged between 35 years and 55 years you are especially likely to be affected. Persistent back pain (lasting more than 3 months) has a significant impact on the sufferer’s quality of life; affecting social and family relationships. So what exactly is back pain and is there anything that can be done to prevent it? To answer these questions we have to examine both the nature of pain and the way that our backs work. This allows us to investigate some of the potential causes of back pain and, perhaps more importantly, the ways to prevent it.
The perception of pain
The highly respected International Association for the Study of Pain (IASP) defines pain as follows, ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage’
So, the perception of pain is not as simple as knowing that something is hurting you! Certainly, pain is a physical response to tissue damage (e.g. cutting your finger) however chronic pain, in particular, is strongly influenced by emotions. Individuals who have a more positive attitude towards pain and a clear understanding of their pain’s origins tend to cope better than individuals who do not.
The mechanics of the human spine
The human spine is an amazing structure that has to fulfil many functions all at once. It has to be strong enough to provide postural support to all other parts of the body yet flexible enough to allow movement in many different directions. It is able to achieve this because of its structure (anatomy) and the way that it works (physiology).
In terms of structure, the spine is made up of 33 small bones (vertebrae) which are separated by pads of a soft jelly surrounded by a fibrous coating (discs). Discs act as shock absorbers in between the vertebrae. The spine is described as four sections and each vertebra is given a number within that section. Your doctor or physiotherapist is likely to use these terms to describe the location of your back pain:
ä Cervical (C1 to C7) – vertebrae in the neck.
ä Thoracic (T1 to T12) – middle section, attached to ribs.
ä Lumbar (L1 to L5) – lower back – typical region for ‘lower back pain’.
ä Sacral (S1 to S5) – the low vertebrae which are fused together as your sacrum.
äCoccyx (4 fused vertebrae) usually called the tail bone.
The vertebrae are arranged in a column or chain and are connected and supported by ‘soft tissue’ structures which are muscles, tendons and ligaments. Back pain can be caused by a problem with any of the vertebrae, discs, muscles, tendons or ligaments.
The physiology of the spine can also be an important element of back pain. Blood flow is a part of this and a decrease in blood flow to parts of the spine contributes towards back pain. That is why smokers (who have more restricted blood flow) are more likely to have back pain. The second important factor is the nervous system relaying messages to and from the spine. Pain messages can be both amplified and reduced in a series of complex reactions.
The Causes Of Back Pain
The cause of back pain is exceptionally difficult to diagnose. The usual diagnostic tests such as X-rays, MRI scans and CT scans often do not identify any abnormalities yet the pain persists. It’s true that there are some specific causes of back pain such as:
ä Muscle sprain (small tear in the muscle).
ä Spinal stenosis (narrowing of the spinal column causing trapped nerves).
ä Collapsed vertebrae (e.g. in osteoporosis).
ä Disc problems (where the disc bulges and may even put pressure on the spinal nerves).
However, these conditions only account for a small fraction of all back pain. For most people who suffer with persistent back pain it is necessary to try and do something about it without necessarily knowing exactly what the cause is!
Preventing Back Pain
Physiotherapists treat hundreds of people with persistent back pain every year. The Chartered Society for Physiotherapy gives the following advice on how to prevent and help back pain:
ä Exercise and activity are vitally important for both preventing and alleviating back pain. Activities such as walking and swimming are particularly helpful.
ä To help you carry out these activities more comfortably you may want to take pain killers as advised by your GP or physiotherapist.
ä Do not sit down for long periods of time; take breaks and get up and move. around. If you are driving long distances, make regular stops and get out of the car.
ä Stretch gently to prevent stiffness.
ä Use the correct position when lifting objects; bending at the hips and knees.
ä Keep an eye on your posture when at home and at work; use an appropriate chair and a desk that is adjusted to your height.
ä Check that your mattress supports you properly when you are asleep.
ä Strong trunk muscles help to prevent back pain. Get some advice from your physiotherapist on how to achieve this.
ä Maintain a healthy lifestyle. Both smoking and being overweight increase the likelihood of persistent back pain.
Back Pain & The Feet
So the official advice is to keep walking but what if the origins of the problem are actually in the feet. Can this be possible? Well, yes it can and for many people this is the final link in a very important chain. The chain is called the lower kinetic chain and comprises the thigh, leg and foot.
If your feet are over-pronated (i.e. roll too far inwards or ‘flat-footed’) the lower kinetic chain can be internally rotated (bend inwards) and this in turn can cause the pelvis to rotate. The forces exerted on the spine are altered causing inflammation and pain in the lower back. The feet also do not absorb shock effectively.
If your foot is under-pronated (does not roll inwards enough when walking) the forces that are transmitted up into your spine when you walk or run are increased. The muscles and discs are put under more strain and pain can result.
People who run or jog as a hobby or who spend a lot of time on their feet may want to discuss this possible origin of pain with their therapist.
This is one cause of back pain that can be tackled. Appropriate footwear and orthotics to alter the position of the foot can reduce the forces on the spine and so reduce back pain.