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THE BACK BOOKThe best and most up-to-dateadvice on how toDeal with your backache yourselfRecover quickly and keepmovingStay active andavoid disabilityHelp yourselfto lead a normal lifeBased on the latestmedical evidence
The Stationery Office LtdApplications for reproduction should be made to The Stationery Office Ltd,THE BACK BOOKSt Crispins, Duke Street, Norwich NR3 1PDThe New Approach to Back PainThe Publisher is not responsible for any statement made in this publication. Adviceis offered by the authors for information only, and is not intended for usewithout independent substantiating investigation on the part of the potential users.The help and advice from colleagues too numerous tomention is gratefully acknowledged.To order copies of this or any other titles from The Stationery Officeplease call 0870 600 5522.Back pain has always been very common and wehave learned a great deal about it. There has beena revolution in thinking about back care, and wenow approach it in a different way.Most people can and do deal with back painthemselves most of the time. This booklet givesyou the best and most up-to-date advice on howto deal with it, avoid disability and recoverquickly. It is based on the latest research.There are lots ofthings you can do tohelp yourselfThe Stationery OfficePO Box 29, NorwichNR3 1GNSingle copies ISBN 0 11 322312 9Price 1.25Packs of 10 copies ISBN 0 11 702078 8 Price 12.50Discounts apply for larger quantitiesWe can now send you updates on your specific areas of interest by email.To register, visit www.thestationeryoffice.com1
B A C K FA C T S Back pain or ache is usually not due to anyserious disease. Most back pain settles quickly, at least enoughto get on with your normal life.Back pain need notcripple you unlessyou let it! About half the people who get backache willhave it again within a couple of years. Butthat still does not mean that it is serious.Between attacks most people returnto normal activities with few if anysymptoms. Your back is designed for movement. Thesooner you get back to normal activity thesooner your back will feel better. The people who cope best are those who stayactive and get on with their life despite thepain.C A U S E S O F B A C K PA I NYour spine is one of the strongest parts of yourbody. It is made of solid bony blocks joined bydiscs to give it strength and flexibility. It isreinforced by strong ligaments. It is surroundedby large and powerful muscles which protect it.It is surprisingly difficult to damage your spine.People often have it wrong about back pain.In fact:It is surprisingly difficult to It can be very painful and you may need toreduce some activities for a time. But restfor more than a day or two usually doesnot help and may do more harm thangood. So keep moving.2damage your spine Most people with back pain or backache do nothave any damage in their spine.3
Very few people with backache have a slippeddisc or a trapped nerve. Even then a slippeddisc usually gets better by itself. Most x-ray findings in your back are normalchanges with age. That is not arthritis – it isnormal, just like grey hair.Back pain is usuallynot due to anythingseriousIn most people we cannot pinpoint the exactsource of the trouble. It can be frustrating not toknow exactly what is wrong. But in another wayit is good news – you do not have any seriousdisease or any serious damage in your back.Most back pain comes from the muscles,ligaments and joints in your back. They aresimply not moving and working as they should.You can think of your back as ‘out of condition’.So what you need to do is get your back workingproperly again.4Stress can increase the amount of pain you feel.Tension can cause muscle spasm and the musclesthemselves can become painful.People who are physically fitgenerally get less back pain,and recover faster if they doget it.So the answer tobackache is to getyour back movingand working properlyagain. Get back intocondition andphysically fit.It’s your back - getgoing!5
REST OR ACTIVE EXERCISE ?The old fashioned treatment for back pain wasprolonged rest. But bed rest for more than a dayor two is not good, because:Bed rest is badfor backs Your bones get weaker.Your muscles get weaker.You get stiff.You lose physical fitness.You get depressed.The pain feels worse.It is harder and harder to get going again.No wonder it didn’t work! We no longer use bedrest to treat any other common condition. It istime to stop bed rest for backache. The message isclear: bed rest is bad for backs.Of course, you might need to do a bit less whenthe pain is bad. You might be forced to have aday or two in bed at the start. But the mostimportant thing is to get moving again assoon as you can.6EXERCISE IS GOOD FOR YOUUse it or lose itYour body must stay active to stay healthy. Itthrives on use.Regular exercise: Gives you stronger bones. Develops fit active muscles. Keeps you supple. Makes you fit. Makes you feel good. Releases naturalchemicals whichreduce pain.Even when your back issore, you can make astart without puttingtoo much stress onyour back: Walking. Exercise bike. Swimming.7
Walking, using an exercise bike, or swimming alluse your muscles and get your joints moving.They make your heart and lungs work andare a start to physical fitness.When you start to exercise you mayneed to build up gradually over a fewdays or weeks. You should then exerciseregularly and keep it up – fitnesstakes time.Different exercises suit differentpeople. Find out what suits yourback best. Rearrange your life to getsome exercise every day. Try walkinginstead of going by car or bus. Someof the easiest activities to get backto are walking, swimming, cyclingand smooth rhythmic exercises. Theimportant thing is general exerciseand physical fitness.Athletes know that when they starttraining, their muscles can ache.That does not mean that they aredoing any damage. The same appliesto you and your back.8No-one pretends exercising is easy. Pain killersand other treatments can help to control the painto let you get started. It often does hurt at first,but one thing is sure: the longer you put offexercise the harder and more painful it will be.There is no other way. You have a straight choice:rest, or work through your pain and recovery.S TAY I N G A C T I V EDealing with an acute attackWhat you do depends on how bad your backfeels.Remember, your back isn’t badly damaged.You can usually: Use something to control the pain. Modify your activities. Stay active and at work.You may have gooddays & bad days that’s normal9
If your pain is more severe you may have to restfor a few days. You might need stronger painkillers from your doctor, and you might evenhave to lie down for a day or two. But only for aday or two; don’t think of rest as treatment. Toomuch rest is bad for your back. The faster you getgoing the sooner your back will feel better.You should build up your activities and yourexercise tolerance over several days or a fewweeks. But the faster you get back to normalactivities and back to work the better, evenif you still have some pain andsome restrictions. Ifyou have aheavy job,you may needsome help fromyour workmates. Simplechanges canmake your job easier. Talk toyour foreman or boss if youneed to.10Control of painThere are many treatments which can help backpain. They may not remove the paincompletely, but they shouldcontrol it enough for you to getactive. These treatments help tocontrol the pain, but they do not cureyour back. It is up to you to get going andget your back working again.Pain killersParacetamol or soluble Aspirin are thesimplest and safest pain killers. It maysurprise you, but they are still oftenthe most effective. Take two tabletsevery 4-6 hours. Or you can useanti-inflammatory tablets likeIbuprofen.You should usually take the painkillers for a day or two but you may need to takethem for a few weeks. Take them regularly and donot wait till your pain is out of control. Do nottake Aspirin or Ibuprofen if you have indigestionor an ulcer problem.11
Heat or coldIn the first 48 hours you can try a cold pack onyour back for 5-10 minutes at a time – a bag offrozen peas wrapped in a towel. Other peopleprefer heat – a hot water bottle, a bath or ashower.Spinal manipulationMost doctors now agree that manipulation canhelp. It is best within the first 6 weeks.Manipulation is carried out by osteopaths,chiropractors, some physiotherapists and a fewdoctors with special training. It is safe if it is doneby a qualified professional.Other treatmentsMany other treatments are used and some peoplefeel that they help. It is up to you to find outwhat helps you.12Stress and muscle tensionIf stress is a problem you need to recognise it atan early stage and try to do something about it. Itis not always possible to remove the cause ofstress, but it is quite easy to learn to reduce itseffects by breathing control, muscle relaxationand mental calming techniques.H O W T O S TAY A C T I V EYou can do most daily activities if you thinkabout them first.The basic idea is not to stay in oneposition or do any one thing for morethan 20-30 minuteswithout a break.Then try tomove alittle further andfaster every day.13
Some ways to help your painLiftingKnow your own strength: lift what you can handle.Some things may make your pain worseLifting without thinkingAlways lift and carry close to your body.Bend your knees and make your legs do the work.Don’t twist your back – turn with your feet.SittingUse an upright chair.A low, soft chair.Try a folded towel in the small ofLack of back support.your back.Sitting for a long time.Get up and stretch every 20-30 minutes.StandingTry putting one foot on a low box or stool.Long periods in one position.Have your working surface at a comfortable height.DrivingAdjust your seat from time to time.Long drives without a break.Try a folded towel in the small of your back.ActivitySleeping20-30 minutes walking, cycling or swimming every day.Sitting around all day.Gradually increase physical activity.Not exercising: being unfit.Some people prefer a firm mattress –Staying in bed too long.or try boards beneath your mattress.RelaxLearn how to reduce stress.Worry: being tense.Use relaxation techniques.1415
WHEN TO SEE YOUR DOCTORWhat do you find helps you?You can deal with most back pain yourself, butthere are times when you should see your doctor.1What doctors can and can’t do2345What do you find makes your pain worse?1234516Doctors can diagnose and treat the few seriousspinal diseases. But they have no quick fix forsimple back pain. You must be realistic aboutwhat you can expect from your doctor andtherapist. They can reassure you that you do not have anyserious disease. They can try various treatments to help controlyour pain. They can advise you on how you can best dealwith the pain and get on with your life.It is natural to worry that back pain might be dueto something serious. Usually it isn’t. But youmay still feel the need to check. That is one ofthe most important things that your doctor cando for you.Doctors can support andhelp you but it’s yourback and it is up to youto get it going!17
IT’S YOUR BACKWarning signsIf you have severe pain which gets worse overseveral weeks instead of better, or if you areunwell with back pain, you should see yourdoctor.Here are a few symptoms which are all very rarebut if you do have back pain and suddenlydevelop any of these symptoms you should see adoctor straight away. Difficulty passing or controlling urine. Numbness around your back passage orgenitals. Numbness, pins and needles or weakness inboth legs. Unsteadiness on your feet.Don’t let that list worry you too much.Remember that back painis rarely due to anyserious disease18Backache is not a serious disease and it shouldnot cripple you unless you let it. We have tried toshow you the best way to deal with it. Theimportant thing now is for you to get on withyour life. How your backache affects you dependson how you react to the pain and what you doabout it yourself.There is no instant answer. You will have yourups and downs for a while – that is normal. Butthis is what you can do for yourself.There are two types of suffererOne who avoids activity,and one who copes.The avoider gets frightened by the pain andworries about the future. The avoider is afraid that hurting always meansfurther damage – it doesn’t. The avoider rests a lot, and waits for the pain toget better.The coper knows that the pain will get betterand does not fear the future. The coper carries on as normally as possible. The coper deals with the pain by being positive,staying active or staying at work.19
Who suffers most?Avoiders suffer the most. They have pain forlonger, they have more time off work and theycan become disabled.Copers suffer less at the time and theyare healthier in the long run.So how do I become a Coper andprevent unnecessary suffering? Try to stay fit – walking, cycling or swimmingwill exercise your back and should make youfeel better. And continue even after your backfeels better. Start gradually and do a little more each day soyou can see the progress you are making. Either stay at work or go back to work as soonas possible. If necessary, ask if you can getlighter duties for a week or two. Be patient. It is normal to get aches ortwinges for a time.Follow these guidelines –you really can helpyourself. Live life as normally aspossible. This is muchbetter than staying inbed. Keep up daily activities – theywill not causedamage. Justavoid reallyheavy things.20 Don’t just rely on pain killers. Stay positive andtake control of the pain yourself.Don’t stay at home or give up doing things youenjoy.Don’t worry. It does not mean you are going tobecome an invalid.Don’t listen to other people’s horror stories –they’re usually nonsense.Don’t get gloomy on the down days.Be positive and stay active,you will get better quickerand have less troublelater.21
Remember:
THE BACK BOOK There are lots of things you can do to help yourself. 2 3 Back pain or ache is usually not due to any serious disease. Most back pain settles quickly, at least enough to get on with your normal life. About half the people who get backache will have it again within a couple of years. But that still does not mean that it is serious. Between attacks most people return to .
