ARO-HEALING

Our backs are complex structures which are involved in virtually every move we make, so it's hardly surprising that back pain is so common. In fact, doctors see more patients for back pain than any other ailment.

Eight out of ten of us will suffer from pain or aching in the back at some time in our lives. Lower back pain is most frequent between the ages of 35

and 55 and it is responsible for more lost days at work than all the other causes put together.

Pain in the lower back, or lumbar region, is the most common form of back pain as this part of the spine takes the most stress and strain.

WHAT CAUSES PAIN?

There are so many different causes of back pain that it's often hard to pinpoint a single factor. In the first place, walking on two legs instead of on all fours, as our ape ancestors did, means that a lot of extra strain is put on the spine.

Other factors are involved too. If your job requires. heavy work; being in the same position for long periods of time; lots of bending, twisting and lifting; or repetitive movements or having to stoop, you are likely to experience back pain. Manual workers, office workers, nurses, drivers, mothers of small children and the elderly are all at risk. Even something as simple as poor posture can give you aches.

What's the best way to lift objects so as to avoid back pain?

Never stoop to lift an object. Stand by the object, with your feet about 12 inches apart, and bend your knees, keeping your spine straight.

Pull the object close to your body when lifting it, avoiding any jerking or sudden movements.

PHYSICAL PROBLEMS There are several physical causes of back pain. A nerve trapped between two vertebrae can be very painful, as can arthritis in the spinal joints. Inflamed or strained muscles or tendons, restricted joints and problems with the ligaments can all cause discomfort.

Stress can contribute to back problems and, if your back muscles are tense, you are more likely to injure your back. Illnesses can also be responsible, such as shingles, gynaecological and kidney problems and, very rarely, cancer.

IS BACK PAIN SERIOUS?

Most causes of back pain are not serious. In fact, in nine out of ten cases, no single cause of the pain can be found, and doctors refer to the pain as 'non-specific'.

Your back is made up of some 50 bones, 100 joints, 1,000 muscles and 1,000,000 nerves. The spine itself is rather like the central pole of a tent, supported by ligaments and muscles which act as guy ropes. If these become tense or distorted, they pull on the 'pole' and make the back ache.

The spine itself consists of 24 small bones, or vertebrae, stacked one on top of the other. Because of the way our bodies are made, the vertebrae in the lumbar, or lower, region take the most strain, which is why low back pain is so common.

Many more NHS hospitals are now running pain clinics, designed to help people with persistent or chronic pain to live normal lives. They offer a multi-pronged approach towards pain. They are staffed by a number of experts including doctors, anaesthetists, physiotherapists and psychologists, and the clinics sometimes offer alternative therapies such as acupuncture, hypnotherapy, massage and so on. In cases where your pain can't be cured, you'll be taught ways of managing it, so that you will be able to enjoy life to the full. One aim is to cut down on the number of painkillers you are taking, since research has shown that the more you take, the less effective they become. You will be taught relaxation and breathing teachiques which are designed to help you avert pain and exert more control over it. Your family may also be involved in helping you to reach your goals and encouraging you not to feel defeated by your pain. Research shows that back pain sufferers can show a significant improvement after a six to eight week programme, and the majority of those who are unemployed because of pain are able to return to work.

THE SPINAL DISCS

The vertebrae are joined in front by an intervertebral disc - a tough fibrous ring containing a jelly-like substance which acts as a shock absorber. Pressures on the disc caused by moving incorrectly are among the biggest causes of back pain. In fact, even simple things like reaching up to a high shelf can place extra pressure on the discs in the lower back and cause pain.

MOVING JOINTS

The vertebrae are joined behind by a pair of small joints, called posterior vertebral joints, which help the body in weight-bearing and also help us to move. When we move, the surfaces of these joints are pushed together, pulled apart, angled to each other or slid across each other - all of which can put strains on different parts of the spine. Pain can occur if anything interferes with these joints

The joints in turn are held together by a network of ligaments - tough bands of fibre which hold the bones together - and a series of 'facet' joints. Each joint is surrounded by muscles and tendons - the 'ropes' which attach the muscles to the bones.

The spinal cord runs through a hole in each of the vertebrae The body's nerve roots are attached to the cord, which is an extension of the brain. Pressure on the cord, for example from a damaged disc, can cause pins and needles, acute pain, and, in extreme cases, paralysis.

What happens when someone a disc'?

term 'slipped disc' isn't accurate ­discs don't slip but they can stick out from between the vertebrae. This usually happens when the disc has been damaged and the jelly­like core has been squeezed out into the spinal canal, pressing on the nerves.

How can I avoid an aching back during the later stages of my pregnancy?

You can reduce your chances of getting back pain by wearing low-heeled shoes and not hollowing your back when you stand. Support your lower back with a cushion when sitting. When lying down, try lying on your side with your front leg bent and supported by a cushion.

I've 'pulled' a muscle in my back playing sport.

Can massage help?

Massage can relieve back pain caused by muscle tension and stress and strain. As the muscles are eased out, the spine

becomes more mobile. Massage also triggers the release of endorphins, the body's natural painkillers.

MAKING A DIAGNOSIS

To determine the cause of the pain, the doctor will examine your back thoroughly and will feel down your spine. He may apply firm or gentle pressure to ascertain the source of the pain and any tender areas. He may also recommend that you have an X-ray, which can detect any abnormalities in the vertebrae. However, an X-ray won't show up the muscles or ligaments, which may be the root of the problem.

Back pain is complicated to diagnose because problems in the spine can lead to referred pain ­pain elsewhere in the body. Spinal problems, for example, can produce symptoms such as chest pain, which can be mistaken for other illnesses, such as heart disease. Other symptoms such as dizziness and ringing in the ears can also originate in the spine, particularly after a whiplash injury.

Pain from the neck and upper back may be referred down the arm and shoulder, between the shoulder blades or to the chest, abdomen or lower back.

SCIATICA

Pain from the lumbar spine may be referred to the buttocks, coccyx and to either or both legs, causing sciatica - pain that radiates along the sciatic nerve which runs from the buttock to the ankle.

Back pain can be acute, which means coming on suddenly, or chronic, which means constant or recurring. By and large, acute back pain is linked to injury, such as dislocated disc, torn ligament or pulled muscle. Chronic back pain is often the result of poor posture.  

TYPES OF TREATMENT Most cases of back pain resolve themselves with no treatment at all. In cases of acute severe back pain, the doctor may suggest pain-killing drugs plus a short period of bed rest. However, most experts now agree that the sooner you can get moving the better. In severe cases, the doctor may also suggest tranquillizers, anti-inflammatory drugs or strong pain-killing drugs.

In selected cases, physiotherapy can help to relieve back pain. Physiotherapists can give heat and cold treatments and usually offer a range of electrical treatments such as shortwave diathermy, ultrasound and interferential treatment. TENS (Transcutaneous Electronic Nerve Stimulation), which involves applying a mild electrical current to certain points on the back to block pain messages, can be very helpful in some cases.

How to avoid back pain:

• Do household jobs in short bursts to avoid prolonged back strain

• Try to stand up straight when doing jobs around the house. Work surfaces should be near waist level

Divide shopping bags evenly between your two hands

In the garden, avoid stooping and lining heavy loads. Kneel down on a cushioned mat to weed

At work, make sure your desk and chair are set at the right height for you.

Your back should be supported and your head up. Watch your posture and try not to slouch.

Physiotherapists may also perform manipulation and massage and suggest exercises to help strengthen your back. Wearing a collar or a corset can give support.

SURGICAL SOLUTIONS Surgery IS much less often recommended nowadays, except in very severe cases, or where there is a specific known cause that can be corrected by surgery. Rhizolysis and rhizotomy, which involve killing some of the nerve endings, help some people.

Another alternative is nerve root surgery, where the nerve supply to a particular area of the back is cut altogether. Surgeons can also remove disc material which may be pressing on nerves and causing pain. However, surgery should only be considered as a last resort, since it can be risky and may worsen the symptoms.

CHIROPRACTIC

Some of the most successful treatments for back pain are chiropractic and osteopathy.

The theory behind both of these therapies is that misalignments of the spine can cause pain and problems elsewhere in the body. A chiropractor specializes in the spine, while an osteopath deals with the whole skeleton.

The therapist diagnoses the source of pain and then twists, presses or pulls to correct the alignment and restore normal function. Soft tissue work ­massaging the muscles around the spine - may also be performed .

PAIN RELIEF Acupuncture has been used with notable success. The acupuncturist takes a full history of your symptoms and inserts sterilized needles into points on your body. The aim is to restore physical harmony and so treat the pain

The Alexander technique is a method of postural realignment. Teachers believe that almost all of us hold ourselves incorrectly. Learning how to move, stand and sit as we go about our daily lives can relieve strain on the back and so relieve pain.

Lower back pain in the later stages of pregnancy is a very common complaint.

In many cases, the cause of back pain is not easy to determine.

Elderly people in particular tend to suffer from lower pain which can result in reduced mobility.

Physiotherapy is a highly effective treatment for back pain. Here, the physiotherapist is advising the patient how to exercise his back safely, to improve mobility and to help relieve the pain.