The basics of back pain – some key points from types of pain to when to worry

Back pain is the leading musculoskeletal complain int the UK, but it seems that we really don’t know what to do about it. For starters each pain experience is individual and there is no one solution. So when do we know when we might need more help? And where do we look?

This post is derived from the helpful information on the NHS website that gives a brief overview of some key causes of back pain. It is important to know it's not an exhaustive list and doesn't cover the more muscle and movement conditions that your physiotherapist might find. However, it talks a little about non-specific low back pain (nslbp) and some bone conditions.

There is also some information regarding Cauda Equina syndrome (CES) which is a rare condition where the lower spinal nerves are severely affected and requires immediate medical attention (read: these symptoms mean head straight to A&E). The following has been taken directly from www.NHS.co.uk as it is a reliable source of information and always check with your GP, 111, or physiotherapist if you have any concerns.

Most back pain will settle with a little care

Most back pain is what's known as "non-specific" (there's no obvious cause) or "mechanical" (the pain originates from the joints, bones or soft tissues in and around the spine).

This type of back pain:

1. Tends to get better or worse depending on your position – for example, it may feel better when sitting or lying down

2. Often feels worse when moving – but it's not a good idea to avoid moving your back completely, as this can make things worse

3. Can develop suddenly or gradually

4. Is sometimes the result of periods of immobility or a sudden movement, but often happens for no apparent reason

5. May be caused by a minor injury such as sprain (pulled ligament) or strain (pulled muscle)

6. Can be associated with feeling stressed or run down

7. Will usually start to get better within a few weeks

Conditions related to back pain include:

1. a prolapsed disc (a disc of cartilage in the spine pressing on a nerve) – this can cause back pain and numbness, tingling and weakness in other parts of the body. Importantly, not all disc bulges are the cause of pain, they are very normal and will occur with the process of time, much like changes to hair colour and skin elasticity.

2. sciatica (irritation of the nerve that runs from the lower back to the feet) – this can cause pain, numbness, tingling and weakness in the lower back, buttocks, legs and feet

3. ankylosing spondylitis (swelling of the joints in the spine) – this causes pain and stiffness that's usually worse in the morning and improves with movement

4. spondylolisthesis (a bone in the spine slipping out of position) – this can cause lower back pain and stiffness, as well as numbness and a tingling sensation

5. These conditions are treated differently to non-specific back pain.

Very rarely, back pain can be a sign of a serious problem such as:

1. a broken bone in the spine

2. an infection

3. cauda equina syndrome (where the nerves in the lower back become severely compressed)

4. some types of cancer, such as multiple myeloma (a type of bone marrow cancer)

5. If you see a GP with back pain, they'll look for signs of these.

Cauda equina syndrome

Cauda equina syndrome is a rare and severe type of spinal stenosis (narrowing) where the spinal cord in the lower back suddenly become severely compressed.

Symptoms can include, but are not limited to:

1. Pain in both legs

2. Weakness or numbness in both legs that is severe or getting worse

3. Numbness around or under your genitals, or around your anus

4. Finding it hard to start passing urine, unable to pass urine, sudden incontinence, a change in sensation when passing urine.

5. A change in the sensation of the back passage, reduced control in passing a bowel movement or passing wind, incontinence.

6. Changes in sexual function - the change to a morning erection, maintaining an erection or the ability to ejaculate. Changes in sensation of sexual function or the ability to climax.

Cauda equina syndrome requires immediate assessment at the Accident and Emergency department of a hospital, followed by a Magnetic Resonance Imaging (MRI) scan and -if confirmed - emergency surgery. The longer CES goes untreated, the greater the chance it will lead to permanent, life changing damage in function to the nerves.