Take Care of your Back
The 6 – 12 September 2010 is the National Back and Physiotherapy awareness week.
The KwaZulu-Natal Department of Health and the South African Society of
Physiotherapists dedicate this week to educate and make aware health workers and
members of public in the Province on the problems of back pain, common causes
/risks, complications, management and prevention of common causes /risks of low
back pain. Physiotherapists from both public and private sectors will be at hand
to offer advice and necessary intervention
What is Back Pain?
Pain in the lower back or low back pain is a common concern, affecting up to 30
– 40 % of South Africans at some point in their lifetime. Low back pain is not a
specific disease but rather, a symptom that may occur from a variety of
different processes. In some cases, people with low back pain despite a thorough
medical examination, no specific cause of the pain can be identified.
- Low back pain is second only to the common cold as a cause of lost days at
work. It is also one of the most common reasons to visit a doctor's office or a
hospital's emergency department.
- For 90% of people, even those with nerve root irritation, their symptoms will
improve within 2 months, no matter what treatment is used-even if no treatment
- Doctors usually refer to back pain as acute if it has been present for less
than a month and chronic if it lasts for a longer period of time.
What Causes Back Pain?
Back pain is only a symptom of an actual problem. Pain arising from other organs
may be felt in the back. This is called referred pain. Many intra-abdominal
disorders-such as appendicitis, aneurysms, kidney diseases, bladder infections,
pelvic infections, and ovarian disorders, etc. can cause pain referred to the
back. Your doctor will have this in mind when evaluating your pain.
Back pain may be caused by injury, mechanical or inflammatory conditions of the
spine. The mechanical or inflammatory problem must be fixed before the pain will
go away for good.
Nerve root syndromes are those that produce symptoms of nerve impingement (a
nerve is touched/compressed), often due to a hernia (or bulging) of the disc
between the spinal bones. Sciatica is an example of nerve root impingement.
Impingement pain tends to be sharp, in one spot, and associated with numbness in
the area of the leg that the affected nerve supplies.
Musculoskeletal pain syndromes that produce low back pain include myofascial
pain syndromes and fibromyalgia.
Other skeletal causes of low back pain include osteomyelitis or sacroiliitis
(infections of the bones of the spine). This pain is usually worse at night and
is worse when sitting or standing for a long time.
Tumors, possibly cancerous, can be a source of skeletal pain
What are the Common Symptoms of Back Pain?
- Pain in the lumbosacral area (lower part of the back) is the primary symptom of low back pain.
- The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back.
- The pain may become worse with activity or change of posture.
- Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip.
- You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.
Back Pain Treatment
Self-Care at HomeGeneral recommendations are to resume normal, or near normal, activity as soon
as possible. The best immediate care of a back injury is rest in order to allow
the back to heal. However bed rest must be limited to a few days only to allow
for the injury and inflammation enough time to heal. Two/three days of bed rest
can be effective but can also produce severe weakness, stiffness and poor
circulation to back structures. Muscles become weak and lose flexibility. Joints
get stiff and become over-sensitive. Discs become starved of oxygen and
nutrients. Prolonged bed rest can also produce emotional problems. These changes
can prevent recovery. However, stretching or activities that place additional
strain on the back are discouraged.
- Sleeping with a pillow between the knees while lying on one side may increase
comfort. Some physiotherapists and doctors recommend lying on your back with a
pillow under your knees.
- No specific back exercises were found that improved pain or increased
functional ability in people with acute back pain. Exercise, however, may be
useful for people with chronic back pain to help them return to normal
activities and work.
- Topical agents such as "deep heating rubs" have not been shown to be
- Some people seem to benefit from the use of ice or heat. These modalities are
not considered to be harmful. However one needs to take care that he /she does
not use a heating pad on "high" or place ice directly on the skin, or when using
on a person with poor skin sensation
- Most experts agree that prolonged bed rest is associated with a longer
recovery period. Further, people on bed rest are more likely to develop
depreesion, blood clot in the leg, and decreased muscle tone. Very few experts
recommend more than a 48-hour period of decreased activity or bed rest. In other
words, get up and get moving to the extent you can
MedicationMedication can reduce pain, inflammation and muscle spasm. They can speed
recovery and help you tolerate return to activities. Like bed rest, medication
reduces symptoms only. They do not restore spinal function.
Physical ModalitiesHeat, ice, ultrasound and electrical stimulation can improve circulation and
reduce pain. These modalities stimulate nerves that assist in decreasing pain,
open blood vessels and relax muscle tension. However, they do not restore spinal
Massage can be very healthy for muscles and connective tissue. It can reduce
spasm and improve circulation but, does not restore strength.
Mobilization is when a physiotherapist moves the joints of the spine with their
hands. This is usually a gentle procedure.
A more intense, sudden force referred to as a manipulation can also be used. The
purpose of manipulation is to restore mobility to the joints and to stimulate
their nerves in ways that can reduce pain and spasm. Manipulation is usually
accompanied by exercises that build strength and flexibility.
SurgerySurgery does not fix a “bad” back. It may help some people with certain severe
back problems and it should be viewed as an option of last resort.
One of the most important parts of surgery is the rehabilitation post
Physiotherapy Physiotherapy is a physical, mechanical and educational approach to correcting
the causes of back problem. Specially trained medical professionals i.e.
physiotherapists use a combination of treatment strategies including:
Exercise is a key to recovery. Movement must be started as soon as pain will
allow some activity. Movement, strength and flexibility are necessary to restore
circulation; healing and back function for long - term recovery. Certain
exercise may also help damaged discs improve their circulation and reduce disc
- Physical modalities to control pain and inflammation
- Massage to reduce pain and restore tissue mobility
- Traction and joint mobilization
- Exercises to build flexibility, strength and endurance
- Education to make people aware of their back problem, to stay in shape and avoid re-injury.
Taking care of your back problemFor a new/ new re-injury:
Stop, rest and apply ice. Immediately rest your injured back. A good rest
position is to lie on your back on a hard surface such as the floor. Place your
legs on a chair, so that your hips and knees are bent at right angles. Support
your lower back with a rolled towel.
Place ice rather than heat for 10-15 min at a time. Pain should improve
significantly in a day or two. You should start activity as soon as you can
tolerate it e.g. walking, back exercises etc. Do not quit exercises when the
pain goes away. You need to do preventative exercises for life, to avoid
Back protection and recovery exercises:
Long- term recovery and protection come only from restoring strength,
flexibility and endurance. These are restored only through exercises.
Flexibility is vital to the working spine. You must be able to comfortably
maintain postures, move freely within those postures and move out of the
postures. You also need adequate strength to stabilize and protect your spine
during work activity.
Exercises start with gentle movement and stretches, progressing to more vigorous
strengthening. One should not do any back exercises that cause pain. The very
best overall exercise is walking. Walking brings rhythmic movements of the spine
in its proper patterns of motion. This increases circulation, mobility, strength
and endurance of all the structures of the spine working together.
Stages of exercises:
- Gentle stretching
- Gaining full mobility
- Back strength and protection
Ergonomics“Ergonomics” is designing your job to reduce work effort. This means avoiding
bad postures and stressful movements to reduce fatigue, discomfort and damage.
Two things determine how much work your back does on the job: THE DESIGN of your
job and your WORK HABITS. Following the rules of proper lifting is vital to
protecting your back from fatigue and injury. The design of your job, however,
is also important. Job design factors include the following:
- How much weight you lift
- How often you lift
- How low you bend to lift the load
- How high you lift the load
- How far you carry the load
- How far you twist with the load
- How far you reach with the load
- How you use the your body to move the load
- How long you sit at your job
- Design of seating for sitting jobs
- Sustained or repeated bending, twisting or reaching
- The physical environment of your job
Proper LiftingUsing your back properly is essential to a happy and healthy life. There are
simple rules to safe lifting.
1. Stand with your feet apart, one foot slightly ahead with the other. A wide
stance helps your balance during lifting. If you plan to move the load to the
left, position the foot slightly back and turned out toward the left.
2. ARCH YOUR BACK INWARD and lock it with muscle power: tuck your chin in as in
military attention and stick out your chest to arch your back. Then squat down
to the load. Grasp the load securely. Curl it to your body. Keep your chin
tucked and lift smoothly. Do not lift with a sudden, quick pull.
3. Keep the load close. Holding the load close to your body greatly reduces the
stress to your back. Holding the load away from you at arms length can increase
the load on your spine by ten times. Remember to maintain your locked back
position as you put the load down.
Repeated lifting puts forward- bending loads on your lower back, stressing discs
and back muscles. Do frequent standing back- bending stretches to help reverse
some of these stresses. Frequent back – bending stretches may reduce disc
degeneration and may help prevent disc rupture.
Pushing is safer than pulling, if you have a choice. Whether you push / pull ,
you must follow safe back work rules:
Wide stance, tuck chin and arch back slightly, push/pull close to body, do not
use sudden high – speed efforts.
CarryingHold the load close to your body. Keep your chin tucked and lower back slightly
arched. Try to stand an inch taller than usual as you carry the load.
Think before you liftAnalyse the work task to decide how best to do it. Lift properly. Do not try to
lift too heavy a load. Get help. Use equipment. DO not do something unsafe to
Healthy or hurt, it’s your back for life!
For more information on back care, contact a physiotherapist at any nearest
public hospital or the Disability and Rehabilitation Programme on tel. 033 846
7247 or email: Daniel.email@example.com
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Copyright © KwaZulu-Natal Department of Health, 2001