Take painkillers and get some bed rest has long been advised by doctors to aid back pain – the top cause of disability in the UK, which costs the NHS £2.1billion a year. But it now seems it’s wrong for one in three sufferers.
Mounting evidence shows massage, exercise and yoga are all preferable treatments.
While researchers at the University of Warwick found many have unnecessary surgery.
“We need to change the way we approach back pain” says the study’s lead researcher, Professor Martin Underwood.
Past studies showed strong prescription painkillers such as tramadol and oxycodone give only “minimal benefit” for lower back pain. Yet recent figures suggest they’re still prescribed to around 40% of patients.
Anj Periyasamy, clinic director of Sprint Physiotherapy in London, says: “One of my biggest bugbears is when patients are prescribed painkillers or bed rest and nothing else. In most cases they need to get their spine moving in a gentle way.
“Targeted exercise, especially when led by a physiotherapist, is one of the most effective ways to ease chronic back pain.” Here is our guide to what really helps.
What causes it?
Back pain that is not the result of a specific injury is generally caused by an ongoing problem with the spinal joints or discs.
Muscular pain often follows as the body tries to compensate for the skeletal problem. “For most, the trigger can be traced back to simple daily habits, such as hunching to read your smart phone, slouching in front of the TV or carrying a heavy bag on one side,” explains Anj.
“Repeating these movements frequently can strain your spine and the surrounding muscle groups, leaving you vulnerable to injury and pain.”
So while you might think your back problem only started when you bent down to pick something up the other morning, it’s actually a result of months or years of repetition which has led to a weakness – with the one-off event being, appropriately, the straw that broke the camel’s back.
How to prevent it
“To stay pain-free and flexible the spine needs to regularly and carefully go through its whole range of movements – bending from side-to-side, rotating and moving forwards and backwards,” advises Anj. She explained: “This stops it becoming stiff and prone to injury.” Here are some of the steps you can take to help with back plain:
- Get moving – Modern life has made us too sedentary, especially the rise in car use which means we no longer walk everywhere, so our spines are not as strong and flexible. Aim to walk for 30 minutes a day.
- Lose weight – Excess weight puts too much pressure on all the joints in the body, including those in the spine. A pot belly is especially bad news as it encourages the pelvis to tilt too far forward, arching the back and leading to stiffness and pain.
- Sort your chair out – A lot of time sitting means your spine is curving forward which puts a strain on the vertebrae and discs.
Think about an ergonomically designed chair that encourages your spine into an ‘s’ shape rather than a ‘c’, which is a less stressful position. You can buy them from around £30.
- Take frequent screen breaks – If you work on a computer, limit your continuous use to one-hour sessions, and take regular half-hour breaks to get up, stretch and walk around.
- Switch shoes – Alternating your heel height between flat and mid-heels on a day-to-day basis can help avoid lower back pain.
- Use the right bag – Carry a rucksack or bag that crosses over the chest to evenly distribute the weight so one side isn’t taking more strain than the other.
What treatments do work?
- Physiotherapy – A study last year by Harvard University in the US found that physiotherapy was a good as surgery and less risky for the most common type of lower back pain. Physiotherapists use some hands-on manipulation and deep tissue work and usually prescribe fitness and exercise programmes to do at home.
- Exercise – This is very important – gone are the days when any back expert worth their salt recommended strict bed rest. The key to both easing existing pain and helping prevent reoccurrences is to strengthen the spine and keep it flexible.
Good fitness choices for this are swimming, brisk walking, cycling and toning classes such as pilates which work on the core muscles that support the back.
- Yoga – Last year a major review of medical evidence by the University of Maryland School of Medicine in the US concluded that regular yoga sessions could improve body function and relieve pain associated with chronic lower back pain.
- Massage – A large US study found massage could effectively treat chronic lower back pain.
It’s thought to work by helping to release natural painkillers called endorphins. A study by Centennial College, Toronto, found massage is more likely to work when combined with exercise such as stretching.
And some you might want to skip
- Painkillers – Even though painkillers can help initially, they should only ever be a short-term approach to acute pain, as they’re masking the problem rather than treating it. They can also lead to stomach trouble
Most back pain is “mechanical” so needs hands-on treatment involving movement and exercise to get to the root of the problem and reduce recurrence.
- Surgery – Back surgery is risky and should be considered only in the most severe cases when all other options have been tried and failed. It also has a 30% failure rate.