The bones of the back, also called the spinal column, support a person’s upper body and give it flexibility. Each area of the back has differently shaped bones that allow for good movement. The spine consists of 24 bones called vertebrae (pronounced ver-te-bray). There are seven vertebrae in the neck, 12 in the upper (thoracic – pronounced thor-a-sic) spine, and five in the lower (lumbar) spine. A triangular bone called the sacrum is immediately below the lumbar vertebrae. The sacrum is actually comprised of five bones fused together. The sacrum and the two pelvic bones form the base of the trunk. The tailbone (coccyx – pronounced cahk-sics) is actually made of three or four very small bones. All the bones in the back are kept in good alignment by support of the muscles in the abdomen. A healthy back is straight, strong, flexible and free of pain.

Back pain is usually defined as either acute or chronic. Doctors may diagnose low back pain as acute if it lasts less than a month and is not caused by serious medical conditions. Most cases clear up in a few days without medical attention, although recurrence after a first attack is common. If the pain persists, it is considered chronic back injury, also called chronic back pain; this constitutes only 1% to 5% of back pain cases.

The most common area of back injury is the lumbar spine. A lumbar strain is said to occur when the muscles of the low back are torn.

Herniated (pronounced her-nee-a-ted) discs are also a common source of back pain. Small cushions of cartilage, called intervertebral discs, separate vertebrae in the back from each other. Inside each disc is a jelly-like substance and 80% of the disc is water, which makes it very elastic. A disc does not contain any blood, and relies on nearby blood vessels to keep it nourished. A herniated disc occurs when the cartilage between the vertebrae tears. As a result the cartilage and its contents will bulge out from between the vertebrae, often putting pressure on the nerves in the area. This may produce muscle spasm at the site, and pain or weakness in the leg.

Back pain is the most prevalent medical disorder in industrialized societies.

Back pain can develop anywhere from the neck to the lower spine. The pain can be localized or spread across a wide area and radiate from a central point. Muscle spasms may occur at the site of the pain. Some people also get pain or weakness in a leg as a result of back injury.

Poor posture is the most common cause of back pain. Having bad posture, such as slouching, combined with weak abdominal muscles, can lead you to have swayback, which is abnormal curving of the spine. This exaggerated curve gradually stretches the ligaments in your back, and over time, the discs between vertebrae become distorted. The resulting pain may first appear as stiffness that disappears when you get up and move around. After months the pain and stiffness may last for longer periods.

Injury due to lifting heavy objects is also a frequent cause of back pain. When you lift a heavy object increased pressure is put on your lumbar spine. If you lift the weight incorrectly and have it positioned far in front of your spine, your back muscles have to exert a tremendous force to keep the body upright. This can cause the muscles to strain or tear or a disc to herniate.

It is believed that as much as 80% of back pain can be attributed to lack of exercise and poor physical fitness. Strong muscles, especially the abdominal muscles, support the back and help distribute weight when you lift something heavy. Back and abdominal muscles that have lost their flexibility and strength cause more stress to be placed on the ligaments.

Excess body weight, which often is carried in a person’s abdomen, also puts extra strain on the low back. Being overweight can make it more difficult for you to exercise and keep the muscles in your back and abdomen strong and flexible.

Emotional stress is usually felt in the part of the body that is weakest. If your back is weak, it may hurt when you experience stress.

Certain sports, activities or jobs may be associated with back pain and injury.

Diseases such as osteoarthritis, ankylosing spondylitis (pronounced ankle-low-zing spond-ill-eye-tiss) and compression fractures may also be a source of chronic back pain. Only about 10% of back pain is caused by an illness or disease.

Your doctor may order x-rays, or inject fluid (such as an anaesthetic or steroid) into the muscles or the joint spaces to help determine the cause. Other more complex tests may be done if the condition persists for a very long time and the cause has not been determined.

Back pain will often go away on its own. A variety of treatments can help to lessen pain and stiffness and to make movement easier. Your active involvement in developing your prescribed treatment plan is essential.

Medicine

For mild to moderate back pain doctors often recommend acetaminophen (Tylenol®, Panadol®, Exdol®, etc.). Acetaminophen is a pain reliever, but has no anti-inflammatory properties. For this reason it can usually be safely taken along with most prescription medications, should these also be needed. However, there are daily limits of acetaminophen that can be taken, so caution should be exercised, particularly if other medications that contain acetaminophen (for example, it’s found in many cold remedies) are being used. A serious overdose of acetaminophen can cause liver damage.

NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin®, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).

Exercise

Muscles and the other tissues that hold joints together weaken when they aren't moved enough, so the joint loses its shape and function. Moderate stretching exercises will help relieve the pain and keep the muscles and tendons around the affected joint more flexible and strong. Low-impact exercises like swimming, walking, water aerobics and stationary bicycling can all reduce pain while maintaining strength and flexibility. Always consult a doctor before beginning an exercise program.

Heat/Cold

Heat or cold application can provide temporary relief of pain. Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area. There is some concern that heat may worsen the symptoms in an already inflamed joint. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint. Applying ice or cold packs appears to decrease inflammation and therefore is the method of choice when joints are inflamed.

Protect Your Joints

Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. There are several techniques to protect your joints

Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest. Avoid any activity that increases the pain.

Position your joints wisely so you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.

When you lift a heavy item be sure to keep it as close to your body as possible. Keep your back straight and use your legs to do the lifting. The leg muscles are strong and designed for heavy work, unlike the back, which is designed for flexibility. Make sure that your feet are apart and firmly placed so that you do not slip. If the object is too heavy for you to lift, get help.

Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.

Staying at your recommended weight or losing weight helps lessen pain and prevent back injury by reducing stress on the joints. If you plan to lose a lot of weight, discuss the best program for you with your doctor and a dietician.

Be aware of your posture and be sure to stand straight. To have good posture when standing, your head should be lifted (not leaning forward) and your chin pulled back, and your buttocks should be ‘tucked in’ so that your stomach is flat. To ensure good posture when you are sitting, use a chair that allows you to have both feet on the floor with your knees higher than your hips. Sit firmly with your back against the chair. If necessary, use a lower back support cushion to allow your back to maintain its natural curve.

If you suffer from back pain you should wear proper walking shoes that support your feet and help keep your posture properly aligned. Many back and lower limb injuries arise from poor walking techniques. With each step you take, your body absorbs a shock that is about three times your body weight – this can place excess pressure on your lumbar spine.

Sleep on a firm mattress that gives your back support. If you sleep on your back make sure your pillow supports your neck and head, but does not lift your head and shoulders too high. If you sleep on your side make sure that your pillow supports your neck and head so that your spine is in a straight line. Sleeping on your stomach forces your neck into an awkward position and is not recommended if you have chronic back or neck pain.

Relaxation

Developing good relaxation and coping skills can give you a greater feeling of control over your arthritis and a more positive outlook.

Surgery

If no other treatments provide relief your doctor or rheumatologist may recommend surgery. However, surgery is rarely required for chronic back injury. 

Seventy percent of people with back pain recover within a month. Back pain that persists for more than six months occurs in only 1% to 5% of the chronic back injury cases. About half of the people with long-term back injury return to work.

Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

• The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis.
• The Open Forum within this Web site is an opportunity to discuss and share information with other visitors - people who, through their own experiences, may be able to offer some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.