Spinal pain

What is my spine?

The spine, also known as your back bone is a strong and flexible column of bones (called vertebra) that run from your skull to your pelvis. Your spine allows your body to bend and twist and provides protection to the spinal cord and nerves.

spine diagramWhat does my spine look like?

The spine is divided into several sections, the neck (cervical spine), middle back (thoracic spine), lower back (lumbar spine), back of the pelvis (sacrum), and tail bone (coccyx).

Between each of the vertebra in your spine are pads of tough connective tissue (intervertebral discs) that cushion your spine, absorb shock and allow movement. The joints of the spine (facet joints), which allow the spine to perform a wide range of movements are formed where the vertebra sit on top of one another.

Through the middle of your spine is a tunnel, called the spinal canal, through which the spinal cord runs. The spinal cord is part of the central nervous system, and refers to a bundle of nerves that runs from your brain through your spine. Its main function is to relay information to and from the brain, and allows the brain to control the body.

The rest of your body is connected to your spinal cord by nerves that leave the spine through holes in the side of the spine (intervertebral foramen). These nerves travel all over the body and tell different parts of our body how to behave, such as the muscles in our arms and legs, genitals and anus.

The spine is connected by thick connective tissue called ligaments that provide support and muscles that make the spine very strong.

Facts about back pain

Spinal pain is a very common and affects a large amount of the population; about 80% of people will experience spinal pain at some point in their lives. For the vast majority of people it is not serious and normally the pain will resolve naturally over 2-12 weeks. There are a lot of misconceptions that still exist around back pain:

  • ‘I hurt my back, so I will probably have back pain from now on’ – Only a very small number of people develop longstanding / persistent pain, which is usually related to factors other than structural damage. Following the simple advice detailed on this website can help you manage your pain and reduce the risk of long term problems
  • ‘I have back pain, so I should stay in bed and rest’ – Although avoiding activity may help reduce pain in the first few days of having spinal pain, there is good evidence to show that undertaking exercise and returning to normal activity actually speeds up recovery. People who excessively rest and avoid activity, actually have worse long term outcomes.
  • ‘Moving my back will make my pain worse’ – It is common that people fear twisting and bending with back pain, but it is essential to keep moving. Avoidance of movement and use of devices such as back braces has actually been shown to make pain worse in the long term.
  • ‘The more back pain I have, the more my spine is damaged’ – The amount of pain felt can vary according to a number of factors. Abnormalities are seen on approximately 90% of Magnetic Resonance Imaging (MRI) scans of the spine, yet there is a very poor relationship between these “abnormalities” and pain. Research has shown that people without back pain who have undergone an MRI scan, also have these abnormalities (such as disc bulges, disc annual tears, facet joint osteoarthritis…) and do NOT have pain. The amount of pain you experience is dependent upon a number of factors such as mood, fear, fitness, stress and coping style
  • ‘My back pain is due to something being out of place’ – There is no evidence that LBP is caused by a simple joint in your spine or your pelvis being out of place. Research using MRI scans has also shown that manipulations do not change the position of your spine. Even if you feel better after having your back manipulated, nothing has been ‘put back in place’, as nothing was “out of place” in the first instance.
  • ‘I need a scan or X-ray for my back pain’ – In most cases of back pain scans and X-rays are not needed and will not show you the cause of your back pain. Many people who have no back pain will have normal ‘age related changes also known as wear and tear’ on an MRI scan. A clinical examination is able to identify the majority of problems, only in a small number of specific cases is a scan required.
  • ‘I need an operation to cure my persistent back pain’ – Only a tiny proportion of people with back pain require surgery, and when compared with physiotherapy, the long term outcomes are similar. Surgery for persistent back pain is a high risk treatment and is only considered if all other treatments have failed. Unfortunately surgery for persistent back pain has a very poor outcome. The vast majority of people with LBP can manage their problem by staying active and addressing the factors involved in their pain.  Only when very specific problems are found, such as nerve compression (radiculopathy), stenosis, cord compression or fractures is surgery considered a viable option. This is only in 10% of the cases. The majority of the time surgery is not an option.

What can I do to help myself to get better?

Getting the balance right

When you have back pain it is important to keep a balance between rest and activity. Research shows, those people who excessively avoid or are fearful of movement and activity are at risk of developing long term pain problems. However the pain can be severe and will be self-limiting.

In the short term, it’s ok to adapt any movements that might be causing your pain or making it worse. People who remaining active within their pain limits recover more quickly.

Remain positive

Although it can be difficult to be cheerful or optimistic if you are in pain, it’s important to stay positive as this can help you recover faster. Low mood, stress and anxiety are all known to increase pain and are shown to negatively influence recovery.

Taking steps to identify and manage factors that contribute to pain, such as stress and being proactive with self-care reduces long term pain and disability.

Exercises

Exercising with pain may seem daunting, but it is one of the most important elements of managing spinal pain. Undertaking gentle exercises to improve your flexibility, strength and fitness will help you recover quicker.

If your pain increases when exercising, stop and rest for a few days. When your back pain is better, try to resume doing your exercises to stay strong and mobile. These simple exercises may be helpful:

Using a warm heat pack on your spine before exercising makes you feel more comfortable. It is important to perform your exercises regularly through the day.

You may find the exercises uncomfortable at first, this is normal. Use the pacing principles to judge how much exercise you should start with, and to increase your exercise over time. It is better to do a few exercises several times a day rather than all at once.

At home / work

Here are some tips to help you day to day

  • Pacing is a strategy to increase activity without increasing your symptoms. It involves spacing activities throughout the day in a manner that helps to avoid aggravation of pain.
  • Take regular breaks from your desk, driving or any activity where your spine is held in the same position for a long period of time. Correcting your posture may feel awkward at first because your body has become so used to sitting and standing in a particular way.
  • A firm supporting pillow may help some people when sleeping.
  • Don’t spend too much time looking at tablets or mobile phones. Use a stand for them or place them on a table to reduce neck strain.

Pain Killers

Over the counter painkillers may be helpful, such as paracetamol, ibuprofen or creams that you can buy at the chemist. Your pharmacist will be able to give you expert advice. Discuss nerve pain modifying drugs with your GP if you have severe nerve pain in your arm or leg that is referred from your spine.

Posture

There is no evidence that slouched postures contribute to back and neck pain. However we do know that staying in one posture for too long will put strain on your back or neck. Therefore take steps to change your posture regularly by adapting your seating position and getting up.

Sleep

Ensuring that you have good sleep hygiene and thus having a regular sleep pattern is very important. Therefore taking steps to reduce stress, such as relaxation and mindfulness can help you to better manage your symptoms. Research has shown that lack of sleep will “wind up” your nervous system (a bit like turning up the amplifier) causing you to feel more pain.

Lifestyle

Lifestyle can significantly impact upon the amount of pain and physical restrictions mechanical pain can cause. Sedentary and inactive lifestyles increase the risk of developing pain in the spine.

Being overweight can be a risk factor for developing longer term pain. Even if you have pain, you can still lose weight by reducing the calories you consume and increasing exercise.

Smoking causes the release of harmful chemicals into our bodies that slows healing and makes nerves more sensitive to pain. Smoking also increases the level of stress hormones, which also increases nerve sensitivity.   Visit www.smokefreewestsussex.co.uk to find out more about stopping smoking.

When do I need to see someone about my back pain?

Most cases of spinal pain get better on their own or with simple self-help treatments. You should see your doctor if:

  • Your pain is severe
  • You have tingling or numbness in your hands, feet, arms or legs
  • Your limbs feel cold / or you experience odd sensations
  • You have had an obvious injury such as a fall or other trauma
  • You have had spine or pain radiating into the limb for longer than 6 weeks

Useful Resources

PAIN-ED is a great source of health information and patient stories which highlight ways of managing persistent back pain

You may also find these videos helpful:

Here are some leaflets to help you manage your condition, these have been reviewed and approved by our clinical staff to be the best information for patients.

If you have a diagnosis which does not have a leaflet above, then please contact our clinical support team on 0300 303 8063 and they will work with our clinical team to find you some more information.