Low back pain

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Low back pain is the most common form of back pain and most of us will experience it at some stage of our lives. Unfortunately, the fact that it's common doesn't make it any less painful! There is some good news though because most sufferers of lower back pain will experience a significant improvement within a few weeks.

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Much of the lower back is supported by muscles which are attached to the spine and help to protect it. Ligaments are attached to the vertabrae to keep them aligned and to help keep the discs - the gristle like pads which act as shock absorbers between the vertabrae - in place. Most low back pain is caused when the muscles or ligaments are over stretched - a 'sprain'.

This type of 'sprain' can be caused by an accident - in a car or a fall perhaps - or general over exertion. There can be few of us who have not experienced low back ache after digging the garden for example, or moving heavy objects. Generally, we understand the reason for the pain caused in this way and although it is painful, it is less worrying than pain which occurs without obvious reason. However; if the pain is severe - acute - and occurs after an accident, then it would be wise to seek medical advice sooner rather than later.

Current medical opinion is that gentle exercise, not rest, will speed recovery. Your low back pain can be eased with a course of pain killers and Paracetamol is often sufficient if you take it regularly at full strength. The adult dose is 1000 mg - usually two 500 mg tablets - four times a day. Of course, if your pain is severe, you may need to restrict your movements but it will be exercise which eventually works, not rest. You may get immediate temporary relief by laying on the floor on your back, with your legs supported by a chair

You may find that Anti-inflammatory painkillers such as ibuprofen work better for you than paracetamol. If you haven't seen your doctor, discuss your problem with your local pharmacist who will be able to advise you. Be sure to tell him or her if you suffer from asthma, high blood pressure or kidney failure since this may limit your painkilling options. If these fail to ease your discomfort or whenever there is any doubt, see your doctor.

Unfortunately, many people will suffer some reccurence of low back pain, which may become chronic. This often seems to come and go in intensity and it will require modest changes in lifestyle - more emphasis on posture for example - and a realisation that there is a painful price to be paid for ignoring sound advice, if these reccurent attacks are to be managed.

95% of all low back pain is classed as 'simple' or non specific. This doesn't mean it isn't very painful, only that your doctor will not be able to fully establish the cause since X-rays and scans will not show muscle or tendon damage. If the pain persists or if there are other reasons for doubt, he may require further tests.Following a serious accident or where it is known that you have osteoporosis which is more common in older people, particularly women, there is always the possibility of a vertabrae fracture of the lower spine. Damage to the coccyx - the 'tailbone' is also possible.

Very rarely, it may be that you have a 'slipped disc' which is really a nerve in the spinal column which is being pressed on or irritated by the soft inner part of one of your discs. This is termed a prolapse when part of the outer case of the disc has failed. This can cause quite severe pain which may radiate down to the leg or even foot. The pain may even feel worse than the original back pain. Sciatica is one form of trapped nerve. If the problem persists, surgery may be recommended.

In older people the lower back pain may be associated with arthritis which is an inflamation of the joints. Osteoarthritis is the most common form of arthritis in older people. Medication will be helpful. Rheumatoid arthritis may cause low back pain but the pain is likely to be in other areas of the body as well. Tumours, including cancers, infections and pressure near the spine may also cause low back pain but it must be emphasised that these affect fewer than one in a hundred patients.

While most low back pain is simple and non specifc, you should see your doctor if any of the following apply.