Am I damaging myself by keeping going?
In general the answer is no but there are a few things to be aware of. When the injury has just occurred it is likely there is tissue damage and inflammation. During this period it is useful to reduce the vigorousness and frequency of activities to allow the injury to heal itself.
However there is good scientific evidence that bed rest is possibly the worst treatment for low back pain episodes. Scaling down activities and gradually building them back up again as soon as possible to normal levels is the best treatment.
Even though the initial onset of low back pain may be due to tissue damage in many cases, once back pain has persisted longer than three months there is no evidence of ongoing tissue damage. In these cases avoiding activities and resting may be damaging in the long term.
However, the opposite approach of pushing yourself hard to get things done usually results in greatly increased pain and is also unhelpful.
Should I rest for my back pain?
Scientific work done over the last 10 to 20 years has repeatedly confirmed that rest is not a useful treatment for low back pain. In fact it may be counterproductive, leading to more pain, more episodes over the years, more time off work and increased disability.
The advice now is never rest unless you absolutely have to, if forced to by the severity of the pain. 2 to 3 days is the maximum amount of bed rest recommended if the person has to lie down. If the pain is not bad enough to force you to lie down, don’t.
Do I need an operation?
Most people with back and leg pain are never going to have an operation as surgery is just a small part of the management of these conditions.
Discectomy is a treatment for severe and persistent leg pain, not back pain.
Decompression is used in older (>60 years) people who complain of leg pain on walking.
Fusion is used to treat back pain but is complex and needs careful assessment and explanation. Most people with back pain do not have surgery, even if the pain is severe. See Spinal surgery.
Do I need an x-ray?
X-rays of the lumbar spine rarely show anything unexpected when the examination by the doctor has not thrown up any worrying features. Studies have shown the ratio of useful x-rays to non-useful ones to be 1 in a 100 to 1 in 2500.
The usefulness of xrays in normal back pain has not been demonstrated, especially since many of the abnormalities present are also present in people who do not have back pain. The doctor may order xrays in certain circumstances such as after a fall etc.
Xrays very rarely show the cause of back pain.
Do I need a scan?
There are two main reasons in the UK for ordering an MRI scan:
- If an operation is planned, to either check for a disc prolapse or to check the condition of the discs in general
- If an unusual cause of back pain is suspected
Because of the high incidence of “false positive results”, ie changes on the scan which are of no relevance to the pain, the interpretation of scans is difficult.
An MRI scan often does not show the cause of back pain.
Is it serious?
Back or leg pain is rarely medically serious, even if the pain is severe. There are a few things to be aware of which may indicate a serious reason for back pain:
- The first episode of back pain comes under 20 years of age or over 55 years
- There is significant unexplained weight loss (for example more than a stone per month)
- The person is unwell
- The pain is progressively worsening and not affected by changes in activity or posture
- The pain is worse at night
- A traumatic onset, such as a fall from a height
- Previous medical history of cancer, steroid use, drug abuse, HIV
- Widespread or progressive leg weakness, numbness, pins and needles
- Numbness or pins and needles around the anus or genitals
- Difficulty with or incontinence of bladder or bowel
If you have any of these problems you should see your medical adviser without delay.
Do I need to see my doctor?
If you feel you should consult your medical adviser, you should do so. However, if you have regular or chronic back pain there may be little point in consulting a doctor. Once it has been established that you have mechanical (non-serious) back pain, much of the management of your problems will be up to you. If things change, or you have some of the symptoms above, you should attend your medical adviser.
Have I got arthritis?
The normal age-related type of arthritis is osteoathritis, and is not especially relevant to back pain. There are several arthritic diseases which may be important in the diagnosis of different types of back pain.
The symptoms of arthritis are different from normal back pain:
- Gradual onset of problems before 40 years of age
- Significant morning stiffness, taking more than an hour to go off
- The spine may be stiff to move in many directions, not just one
- Other body joints may be involved
- There may be iritis (eye inflammation), skin problems eg psoriasis, colitis (bowel problems), urethral discharge
- A family history of this kind of condition is important
It is important to consult a medically qualified person before assuming you have a particular diagnosis because skill is often required to make the correct conclusion.