Back pain is one of humanity's most frequent complaints and does not always reflect any underlying condition.

Back pain that does not improve after a few days can sometimes indicate significant and serious conditions which might not otherwise be diagnosed. Back pain is very rarely a sign of a serious medical problem. It is however important that the treatable medical causes are identified early on. Typical warning signs are bowel and/or bladder function disturbance, severe pain spreading along a nerve (e.g., a radiculopathy - pain spreading down the back of the leg to the outside of the foot) or severe pain occurring with other signs of severe illness (e.g., fever, confusion).

Underlying causes

Frequently, pain will be triggered by strenuous lifting that is uncharacteristic - that is, that follows a previous period of inactivity.

Incidence of back pain in Western countries has increased in recent years. Most back pain is not caused by damaged intervertebral discs or any underlying physical cause. Instead, it is thought to be linked to a relatively inactive lifestyle, with people doing less exercise and less physical activity in their work.

Common back problems are understandable given the evolutionary history of bipedalism, which leaves humans not quite adapted to upright movement, and not at all well adapted to modern inactivity that allows muscles to become deconditioned. The amount of time spent in chairs for which human bodies aren't particularly well adapted, can also contribute to back pain.

Management

Lower back pain is the single most common chronic pain syndrome seen in pain clinics in the Western world. 90% of patients with acute back pain improve within one month, the 10% who do not improve account for 85% of annual expenditures on back pain.

The management goals when dealing with back pain are to achieve maximal reduction in pain intensity as rapidly as possible; to restore function; to help the patient cope with residual pain; to assess for side effects of therapy; and to facilitate the patient's passage through the legal and socioeconomic impediments to recovery.

Back manipulation and spinal manipulation

Back manipulation, as performed by osteopaths and chiropractors is thought to be beneficial in some people. Back surgery is only considered to be necessary in very few cases of back pain — around one or two percent.

The Medical Journal "Patient Care" August 2005 found that spinal manipulation performed by osteopaths and chiropractors was an effective treatment for lower back pain.

Chiropractic, exercise, and behavior modification

Chiropractic, physiotherapy and exercise are important in reducing back pain. According to the National Center for Complementary and Alternative Medicine, back pain is the most popular condition treated with alternative medicine. Fifty percent of all patients in the United States use alternative medicine to treat back pain. Postural re-education or exercises, such as the Alexander Technique, may also be recommended.

Back pain sufferers are sometimes advised to use an ergonomic chair or to use a standing desk on a regular basis.

In the past, sleeping on a firm mattress has been recommended. A recent study suggested that a medium-firm mattress may give better results than a firm mattresses. (Kovacs et al., 2004)

Back Pain, Core Stability and Gymballs

Studies have shown that if back pain is present there is inhibition of the nerve impulses that activate the transverse abs, ie when there is back pain this muscle switches off. The studies went on to show that unless this muscle was specifically restrengthened it doesn’t just come back on by itself – specific retraining is required. This has begun to explain the phenomenon of chronic back pain, and is believed to be one of the reasons that once someone has injured their back, the chances of reinjury are significantly higher.

Further studies that worked on restrengthening this muscle have shown fantastically positive results in reducing the incidence of reinjury (from 83% to 30%) (Hides, Jull and Richardson, 2001).

So if you have had back pain, or currently suffer any form of back pain, it is highly likely that your transverse abs aren’t working as well as they should.

A recent study showed that working on a gymball showed significantly faster improvements in stability than exercising on the floor (Cosio-Lima et al). Significant improvements have been seen in 6 week gymball training programs (Stanton et al).

Medical procedures

The pain itself is caused by strong muscle spasms severely tightening back muscles. The best immediate treatment for such spasms is the application of cold, such as by an icepack or bag of frozen vegetables wrapped in a towel, as opposed to the application of heat.

Though pain, and especially chronic pain is multifactorial in cause, local anesthetics or nerve blocks can be used to facilitate physiotherapy and help gain diagnostic information.

Several medical therapies are used, including:

• Lumbar epidural steroid injections (ESI)
• Zygapophyseal joint injections
• Medial branch nerve block
• Selective lumbar nerve block
• Myofascial trigger injections
• Spinal cord stimulation