Low back is a common condition. Unfortunately, it is only possible to accurately diagnose a very small number of patients with back pain. This can lead to frustration for both patient and clinician.
Roughly 1% of back pain problems are due to a complex cause, e.g. infection or a rare form of arthritis. The remaining 99% of patients have some type of mechanical fault, but current clinical tests and imaging techniques cannot always tell us exactly where the problem lies.
In fact x-rays provide very little information and too much exposure to radiation can be harmful. MRI scans only tell us what is worn, not necessarily what is damaged enough to cause pain.
Some clinical tests are more accurate than others. Tests for sciatica (pain in the leg coming from the back) are quite sensitive, but tests for joint or other problems in the back are not so reliable.
Pain in the back or neck could be coming from a disc (discogenic pain), a joint (arthrogenic pain), muscles (myogenic pain) or inflamed nerves (neurogenic pain). Often pain comes from more than one source.
Surgery is only appropriate for less than 2% of patients with back pain, although non-surgical procedures such as injections can help some patients, particularly those with sciatica.
The worst thing a patient can do during a back pain episode is to completely rest the back. This may do more harm than good. Short walks interspersed by equally short periods of rest are recommended by most experts. Paracetamol is often as effective as most prescription painkillers (never exceed the recommended dose).
A TENS machine can be a useful alternative to medications for some patients, but these devices lack strong evidence for their use. If you are keen to purchase one, I recommend the Boots model using programmes A and B. However, don't expect an instant cure!
It is important to stretch your back muscles as you recover from a bout of low back pain. This may involve slowly touching your toes on a regular basis. Contrary to popular belief, this exercise is safe if you do it slowly and gradually.
Often advice on back care is inaccurate. You don't need to bend your knees every time you pick something up off the floor, unless of course it is heavy, in which case you should bend the knees and keep the load close to your body (watch out for slippy floors!).
One last point. Self-employed people with back pain recover quicker than other patients. There is a message there somewhere!
How to Manage Back Pain
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