Back pain can be caused by a number of reasons. We talk you through different possibilities, when you can treat a symptom at home and when you should go and see a doctor.

What is back pain?

Back pain can be caused by a number of reasons, so it’s advisable to see your doctor if it’s bothering you. Rest up for a couple of days while taking some ibuprofen or naproxen sodium to ease swelling and relieve the pain. Also try the fast-acting solutions below–especially ice and heat–for immediate relief, and gradually move on to stretching and strengthening exercises.

Before you try any home remedies or exercises, see a doctor to find out whether you have a common type of lower back pain or a medical problem that requires specialist treatment. A good physiotherapist or chiropractor can help to stop the back spasm by applying traction and gentle manipulation.

Also see your doctor if pain comes on suddenly, radiates down your leg to your knee or foot, or if it's accompanied by fever, stomach cramps, chest pain or laboured breathing. Doctors often view back pain as a wake-up call, and may recommend an exercise program to stabilise and strengthen the spine to help prevent future problems.

Is it Sciatica?

The roots of the sciatic nerve lie near the base of your spine. They pass through a tunnel in your pelvis called the sciatic notch, then come together like separate lanes merging into highways–the 2 large sciatic nerves that lead all the way down your legs.

When the sciatic roots are pinched–by pressure from a herniated disc, for instance–sensations of pain, tingling or numbness may extend all the way from your buttocks to your legs, feet and toes.

About half the people who have sciatica achieve good results from most of the treatments recommended for lower back pain. If you have sciatica and don't get relief with these treatments, speak to your doctor.

And contact your doctor straight away if your foot is dragging, if you stumble when you walk or if you start to have trouble controlling your bladder or bowels. You may need urgent treatment in hospital and possibly surgery.

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Immediate treatment for back pain

  • Rest up for a couple of days while taking some ibuprofen or naproxen sodium to ease swelling and relieve the pain.
     
  • Doctors used to prescribe muscle relaxants for quick relief, but these drugs are rarely prescribed anymore. They tend to make people tired and contribute to poor muscle tone and coordination, which is just the opposite of what you really need for back-pain relief. These days you are more likely to be given a short course of powerful pain-killers or anti-inflammatory drugs, to stop muscle spasm and relieve the pain.
     
  • As a pain reliever, ice works really well. It temporarily blocks pain signals and helps to reduce swelling. Several times a day, place an icepack or bag of frozen peas wrapped in a towel on the painful area for up to 20 minutes. During the first few days of home treatment, apply the icepack as often as necessary. Later, you may still want to use ice after exercise or any physical activity.
     
  • After about 48 hours, switch to moist heat to stimulate blood flow and reduce painful spasms. Dip a towel in very warm water, wring it out, then flatten and fold it. Lie on your stomach with pillows under your hips and ankles. Place the towel across the painful area, cover the towel with plastic wrap, then put a warm, not hot, heating pad on top of the plastic wrap. Leave it on for up to 20 minutes. You can repeat this 3 or 4 times a day for several days.

Read more: Is Paracetamol effective against back pain?

 

Exercises for back pain

When your back is feeling moderately better, do some stretching and strengthening exercises and in 4 to 6 weeks your back should be back in action.

  • Each morning before you get out of bed, lie on your back and slowly stretch your arms overhead (being careful to avoid any fast, jerky movements). Gently pull your knees to your chest, one at a time. To get up, roll to the edge of your bed, turn on your side, put your knees over the edge, and use one arm to push yourself up as you let your feet swing to the floor. Once you're on your feet, put your hands on your buttocks and lean back very slowly to stretch out your spine.
     
  • The Pilates exercise system is an excellent example of a program designed to help achieve core stability, which in turn supports back function. It is primarily concerned with the strength and control of your torso, specifically the lateral band of muscles known as the transverse abdominals, which surround your waist from front to back. The action of ‘scooping’ is pulling these muscles towards your back in a sucking motion. As you do so, ensure that your upper body does not slouch forwards, nor should your hips jut forwards: the ‘scoop’ is a purely muscular action. (Tip: Say to yourself ‘navel to spine’ and visualise your belly button reversing in a straight line towards your backbone to get the action right).
     
  • Explore postural therapies. If back pain is a recurring problem, you need to learn how to keep your spine and pelvis supple (and supporting muscles strong). Treatments that help restore function and improve posture include Feldenkrais and the Alexander Technique. There is also much evidence to support the notion that the maintenance of strong abdominal muscles is a key to a pain-free back.

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Improve your posture

  • Look for the posture that puts the least stress on your back. Stand up straight with your weight evenly balanced on both feet. Tilt your pelvis forwards, then back, exaggerating the movement. Then settle into the position that feels most comfortable. Now ‘work your way up’ your back, focusing on one area at a time. First concentrate on the area near your waist, then your chest and finally your neck and shoulders. Try to feel which position is most comfortable and least stressful. This is the position to maintain when you're standing, walking and beginning or ending any exercise.
     
  • When you're sleeping, lie on your back or your side (unless you have sciatica). If you're more comfortable on your back, place a pillow under your knees as well as under your head to relieve pressure on your lower back. If you prefer to sleep on your side, place a pillow between your legs. If you have sciatica, the recommended position is on your stomach.
     
  • If you like to sit up in bed to read or watch television, buy a large foam wedge that supports your upper body in a comfortable position. For added comfort–and to keep your neck in the proper position–use a foam or inflatable neck support when you are sitting up.
     
  • When you are sitting on an office chair or at home, keep your feet flat on the floor, with your hips slightly higher than your knees. Use a lumbar support behind your lower back. The lumbar roll is a chair's-width foam cylinder about 12 cm in diameter. You can improvise with a rolled-up towel, but the foam version is lighter, easier to position and usually has straps that attach it to the back of the chair.
     
  • Try and stay out of the car, but if you must drive, place a foam wedge behind your lower back.
     
  • If you're accustomed to walking around with a wallet in your hip pocket, take it out whenever you're sitting. Even though it feels like a small lump, it's big enough to tilt your backside, throwing your spine ever so slightly out of alignment.
     
  • When you're standing at the sink washing dishes, or waiting in a bus queue, raise 1 foot higher than the other. In the kitchen, keep a low sturdy box or a couple of old books by the sink, and put up a foot while you're standing there. Waiting in a queue, use a step or curb. Periodically change position by putting up the opposite foot. This shifting of weight gives alternating back muscles a chance to relax.

Read more: What does your body language say about you?

 

Home remedies for back pain

  • Take up to 500mg of bromelain 3 times a day on an empty stomach. Derived from pineapples, this enzyme promotes circulation, reduces swelling and helps your body to reabsorb the by-products of inflammation. (Caution: Because bromelain is a blood-thinner, it should be avoided by anyone taking anticoagulant drugs, such as warfarin).
     
  • Try taking valerian tablets or capsules. Some scientists claim that this herb's active ingredient interacts with receptors in the brain to cause a sedating effect. Although sedatives are not generally recommended, valerian is much milder than any pharmaceutical product.
     
  • Arnica gel or ointment helps to ease muscle pain and soreness. Homeopaths claim it has anti-inflammatory properties and that it helps speed recovery from illness. Massage into sore area 2-3 times daily. (Caution: Do not apply arnica to broken skin).
     
  • Ease soreness with aromatherapy. Soak in a hot bath to ease pain. Add epsom salts to help reduce muscle spasm, plus 3-5 drops of any of the following essential oils: rosemary, to soothe stiffness; lavender, a mild antiseptic; or marjoram, which is warming and relaxing.
     
  • Prevent stiffness with peppermint oil. Combine 10 drops of peppermint essential oil with 30ml almond oil in a dark glass bottle. Shake well before applying, then use a little to rub into the affected area twice a day.
     
  • Ask a partner or close friend to massage the aching area. If you want to use a cream or ointment sold as a back rub, then do so, but with care–these topical creams tend to cause skin irritation after a few applications. For a simple back-massage aid, stuff several tennis balls into a long sock, tie the end of the sock and ask someone to roll it up and down your back.
     
  • Make the mind-body connection. Research indicates that daily relaxation, meditation or guided imagery can reduce pain perception. A Swedish study of people with recurring back pain found that relaxation techniques both reduced pain and increased feelings of wellbeing.

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Back pain creams and gels

  • Rub on an old-fashioned liniment. Choose a cream containing methyl, diethylamine or glycol salicylate, such as Deep Heat. All are similar and have pain-relieving properties. (Caution: Do not use a liniment if you are also using heating pads or hot compresses on the area.) When you use these creams, you're also giving yourself a massage which provides a double benefit.
     
  • Try a non-steroidal anti-inflammatory gel such as Voltaren Emulgel or Feldene gel. These topical treatments penetrate the skin to reduce inflammation in the deeper tissues.
     
  • Your doctor may prescribe a cream that contains capsaicin–the heat-producing substance in hot chillies. Applied to your skin, capsaicin depletes nerve endings of a neurochemical called substance P, which researchers have found is essential for transmitting pain sensations to the brain. When there's less substance P in circulation, pain is reduced. It may take several weeks to feel the full effect. Stop using it if you begin to feel any skin irritation.
     
  • A mustard poultice works like capsaicin and other counter-irritants. To make a poultice, mix 1 part powdered mustard with 2 parts flour, adding water until you have a paste. Spread it on an old tea towel, then fold the cloth over and apply it like a compress to your skin; the mustard paste will seep through. Mustard can burn if left on for too long, so remove it if you feel skin discomfort. Don't use a mustard poultice more than 3 times a day. (Caution: Protect the skin with petroleum jelly when using a mustard poultice.)

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