Why does my back hurt?

June 30, 2008, Editor MCR,

Back pain is one of the common ailments suffered today. In fact, almost 20% of the entire Singapore population suffers from back and neck pain at any one point in time.

Despite it being such a common ailment, determining the exact cause of back pain is often difficult. By breaking down back pain into stages, Physiotherapy treatment and Core Stability training can help alleviate pain and work towards preventing recurring back pain over the long term. Today, conservative treatment is able to resolve some 95% of back pain cases when attended to at the right time. Only 5% of patients really need surgery.

Complex interplay of structures

Your back is a complex supporting assembly, made up of a set of interacting structures such as joints, discs, ligaments, nerves, vertebrae and muscles. Pain is rarely a result of just one of these structures failing. More often than not, it is a combination of physiological and environmental conditions. Unless you address these conditions, you can expect recurring back pain.

This makes treating back pain a challenging problem. The cause of back pain is normally multi-faceted, requiring a multi-pronged treatment approach. It is therefore necessary to accurately assess and treat the underlying cause and contributing factors in stages. Before we look at the different stages, it is important to understand first why your back hurts.

Why does your back hurt?

A common direct cause of back pain is the stress we place on our spine. To get an idea of the amount of pain that stress can cause, bend your index finger as far as it can go, away from the palm of the hand and hold it there. How does it feel? Now think about how the same happens to your spine when you sit slouched for long periods at a time, bend over to pick something up or play sports, like golf.

The repeated and prolonged stress that is placed back affects our spine structures in a whole lot of different ways. It may cause our discs to bulge, our ligaments to over-stretch, muscles to strain and joints to wear down a lot quicker.

Your spine is capable of a great deal of movement. However, to keep that mobility and freedom, all of the structures must work together smoothly and efficiently, like a ‘well-oiled machine’. Pain arises when one of these parts fails, such as when a bulging disc, bony spur or inflamed ligament irritates or traps a nerve.

Good Back Health

In order to have good back health, the spine needs to be mobile in all its segments, not stiff or excessively loose. The muscles around the spine, hips and legs should be strong, flexible and balanced. Whenever there is poor alignment, weakness, tightness or imbalance in these areas, the spine is vulnerable to injury. This instability, better known as “core instability” often predisposes to back pain.

Poor core stability amongst low back pain sufferers

Studies have found that sufferers of chronic low back pain have delayed contraction of the deep abdominal muscles with movement. Subjects in the study without back pain were able to activate the core muscles first, in anticipation of movement, showing that deep abdominal muscles or core muscles served to stabilise the spine.

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The activation of the core muscles is effective in relieving back pain and preventing recurrences by providing the necessary support. Exercises that improve the strength and control of these deep core muscles are known as core stability exercises.

Three stages back pain

There are 3 different stages to back pain – acute, sub-acute and chronic. It is important that you seek the appropriate treatment for each stage.

Acute stage (The first few days)

In the first few days of a back pain episode, the main objective is to relieve pain and inflammation. Physiotherapists perform gentle hands-on techniques and teach the patient pain-relieving postures and exercises that reduce pressure on the painful structures. They may sometimes use Traction to relieve nerve compression. To release a locked segment of the spine, it is important to note that only some physiotherapists trained in manipulation are able to do so safely.

Physiotherapists also relieve pain and inflammation using special machines such as shortwave treatment (deep heat), interferential therapy (involving cross electric currents), ultrasound (using ultrasonic waves to promote healing) and TENS (Transcutaneous Electrical Nerve Stimulation – electric stimulation that blocks pain impulses to the brain).

Sub-acute stage (from 3 days to 3 months)

When the pain and inflammation have subsided, this is the time to mobilise stiff spinal joints, restore correct alignment, stretch tight muscles, strengthen weak muscles and start on a core stability programme. The goal at this sub-acute stage is to restore a flexible and balanced, yet strong and stable spine. If imbalance and weakness remains, the pain will take longer to resolve and chances of injury reoccurring are very high. It is important to address contributing factors such as flat feet, poor ergonomics or sporting technique.

Chronic stage (more than 3 months)

When the pain has lasted so long, there are usually mal-alignments and biomechanical factors that have not been properly addressed. The spine or pelvis may be out of alignment or causative factors may still be present, for example working on a laptop for long hours. Pain-sensitive scar tissue will have built up over time because of the repeated injury and this will need to be broken down by deep tissue massage. The core muscles, which act like a natural corset, are likely to be switched off and will need to be re-activated through core stability training.

This work by Musculoskeletal Consumer Review is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License. This article was contributed by Core Concepts - Back and Neck Pain Specialists. In the spirit of promoting health education, you may copy, distribute and transmit the work under the conditions specified by the license. For articles re-printed with permission, copyright remains with the original copyright holder (author or publisher). MCR's Creative Commons License does not apply in such cases.

Filed Under Spinal Conditions

Comments

revolution9

I always get back pains if I sleep in an uncomfortable bed, I do all I can to avoid sleeping anywhere that isn't my lovely tempurpedic mattress bed! My back pain became much easier to cope with since I got it.
Zach Smith

Back pain can be induced or alleviated by mattresses. If you are using a lumpy and uncomfortable mattress, you can experience back pain. Since comfort preferences are different from person to person, it is better to personally pick your mattress from the store so you can try it out. Firmer mattresses like memory foams can provide better back support for upper back pain sufferers. However, semi-firm mattresses prove to be better choices when it comes to lower back pain. You should know first your body type and your comfort preferences when you are buying so you can find the most ideal mattress for your sleep needs.
tazz73

all sound easy but here in nsw of australia,the worker compensation is so much of a mess that workers doesnt get the right treatement on the right time.i have a back injury since 8 months,being to two physios,one was mc kenzy ,and i still have problems with pain.i done pool therapy,and doesnt feel better. the therm musculoskeletal is too complex ,doctors here doesnt know what to do,doesnt communicate either.
karl

my back hurt so much i don't know what do do. . is this because i use computer all the time? i work in my computer for almost all the time. . . plz answer me . . thanks. .
cindy.tan

Dear Superman,

I do agree with you that sleeping on a good bed is one of the solutions for back pain sufferers but it is not the only solution as there can be various contributing factors to back pain other than the bed.

When choosing a mattress, select one that is firm enough to provide good support and alignment. Stomach sleepers would require firmer mattresses than back and side sleeper. Mattresses with convoluted foam usually provide sufficient support and comfort. Most importantly, try out mattresses for personal comfort before purchasing. Specialty memory foams and custom options are not always the most comfortable choice.

If the pain persists even after changing the mattress, you might want to consider consulting a specialist to find out the cause of your back pain.

Best Regards,
Editor, MCR
Superman

Yes... my back often in pain. And I think one of the solution is to sleep with a good bed. The mattress is the solution. Any recommendation?