 Don’t panic – most people suffer with back pain at some point in their lives and nearly all get better

Exercise, exercise, exercise – be sure to include specific back exercises and general exercise

Keep going with everyday activities and stay in work where possible

Too much rest is not good for back pain
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Posture – improve your posture in all your daily activities
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Avoid lifting anything too heavy and practise good lifting techniques
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Try to keep your stress and anxiety levels to a minimum
 Get a good night’s sleep
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Stop smoking

Back pain is an extremely common condition with over 80% of people experiencing at least one episode at some point in their lives. For many people recovery from spinal pain begins within a few days, especially if they keep as active as possible, as soon as possible. However for some (very few) people spinal pain can last for months or even years.
It is important to note that back pain caused by more serious conditions is very rare.
Your GP or physiotherapist will ask you questions to rule these out.
Causes and Types of Back Pain
The exact cause of low back pain is often difficult to find. Most people (over 85%) have ‘ nonspecific back pain’ , which means your back pain is not caused by any specific damage or disease. Tension, soreness and stiffness are common. Joints, muscles, ligaments and discs can all contribute to the symptoms. With the right information, support and treatment, most people find they can manage their back pain.
Back pain can also be described as ‘ acute ’, ‘ subacute’ or ‘persistent’ depending on how long you have had the pain. You may have:

acute back pain – lasting less than 6 weeks

sub-acute back pain – lasting 6 weeks to 3 months

persistent back pain – lasting longer than 3 months

Structure of the Spine
The spine strong structure which helps us to stand and to bend. It is made up of the following:

24 small bones called vertebrae
 the ‘tailbone’ or sacrum and coccyx
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shock absorbing discs which allow the spine to bend
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ligaments that reinforce the vertebrae and discs

tendons that connect muscles to vertebrae

the spinal cord, which carries nerve signals from the brain to the rest of the body

nerves

muscles
Warning Signs
If you have any of the following symptoms you should see your GP immediately:

loss of control of your bowel and/or bladder

inability to pass urine

constant pain, especially at night

numbness or weakness in one or both legs or around the buttocks, genitals or back passage

unexplained weight loss
Sciatica
Back pain can be localised to the back but you can sometimes have pain in your legs. This is known as Sciatica. Sciatica usually only lasts for a short time, however, if it persists, you should be reviewed by a GP or Physiotherapist.
Factors that increase the risk of Back Pain
Check for everyday things that may be aggravating your back pain such as

smoking

obesity

pregnancy

lack of exercise

stress

depression

poor posture

poor lifting

previous history of back pain
Simple Home Treatments for Back Pain

Simple painkillers such as paracetamol or ibuprofen can be used for a short time to relieve back pain. Both of these painkillers are available without prescription


Regular painkillers will allow you to remain active- don’t wait until the pain gets too much. Painkillers will not mask your body’s warning signals or increase the risk of damaging your back

You can also apply hot and cold packs to the affected area of your back. Hot and cold packs should be wrapped in a towel to avoid damaging your skin).
Specially designed hot and cold packs are also available from most pharmacies.

Keep active and exercise (see below)
EXERCISE IS THE MOST IMPORTANT WAY TO EASE AND PREVENT BACK
PAIN.
Remaining active is a key part of managing your back pain. But be realistic -if your back pain is severe you may need to pace your activity and incorporate short periods of rest.
Simple, everyday activities like walking and gentle gardening can ease some of the pain by causing the release of your body’s natural painkilling hormones. Activity also helps to stretch stiff and tense muscles, ligaments and joints, which can lessen pain. Specific back exercises can also help.
It’s natural to be hesitant if exercise is painful and if you’re worried about doing more damage. If you become more active gradually, it's very unlikely you will cause any damage or harm. The pain you feel when you start gentle exercise is because your back is getting fitter.
In central Manchester your GP may refer you to the P hysical A ctivity R eferral
S cheme (PARS) who can help you to become more active and support you with healthy lifestyle choices such as weight management.
This leaflet is not intended to replace professional advice from your GP, physiotherapist or another health professional. If you feel that any exercise is making your pain worse, stop and talk to your GP or physiotherapist.

Other Treatment Options
Scans and X-rays for Back Pain
The most up-to-date research shows that x-rays, MRI (magnetic resonance imaging) and CT (computed tomography) scans are only recommended for a very small number of people with spinal pain.
Physiotherapy
The vast majority of people will recover from back pain within 4-6 weeks.
If your back pain persists your GP may refer you for a course of physiotherapy.
In Central Manchester a course of physiotherapy will usually last between 4 and 12 weeks. It may be that you only require a small number of sessions. Physiotherapy may be a combination of individual sessions or we may refer to you into our Back to
Fitness Rehabilitation service.
Acupuncture
Acupuncture originates from ancient Chinese medicine and is where very fine, sterile needles are inserted into your skin at certain points of your body. In Central
Manchester you may be offered acupuncture as part of your physiotherapy treatment.

Pain Management Programme
Persistent pain can be difficult to understand and manage on an everyday basis.
Some people’s back pain can last for many months and may not respond to standard treatment. Persistent low back pain can affect your work, hobbies and also your relationships with family and friends.
This can leave you feeling very frustrated and over time less confident to keep active. It’s easy to get into a cycle of increased pain and inactivity. This is called the persistent pain cycle.
Image printed with the kind permission of www.paintoolkit.org
In these circumstances a pain management programme may be of benefit. A pain management programme aims to help you to understand your pain and gives you different tools to help you cope.
Spinal Surgery
Only a very small number of patients with back pain will require surgery, probably less than 1%. Surgery is not recommended if you have non-specific back pain.
Back Corsets
Back corsets are not recommended. It is better to strengthen the back through exercise.

Driving and Sitting
People who sit or stand in the same position for a long time should change position frequently and take short breaks when possible. Maintaining a good posture whilst sitting is also beneficial.

Further information and advice
Arthritis Research Campaign www.arc.org.uk
Backcare www.backcare.org.uk
Low back pain: patient information ( NICE working with Back Care leaflet) http://www.nice.org.uk/nicemedia/pdf/CG88PatientInformationLeaflet.pdf
British Pain Society www.britishpainsociety.org
The British Association of Spine Surgeons www.spinesurgeons.ac.uk
The Pain Toolkit www.paintoolkit.org
Arthritis Research Campaign http://www.arthritisresearchuk.org/arthritis_information/arthritis_types_and_sympto ms/back_pain.aspx
Sheffield Back Pain website http://www.sheffieldbackpain.com/
NHS Choices http://www.nhs.uk/Conditions/Back-pain/Pages/Introduction.aspx
Getting Manchester Moving www.gettingmanchestermoving.org
Manchester Active Lifestyles www.manchester.gov.uk/activelifestyles
Manchester Psychological wellbeing services http://www.selfhelpservices.org.uk/shs_service/manchester-psychologicalwellbeing-services/
Physical Activity Referral Scheme www.mhsc.nhs.uk/services/wellbeing-services/physical-activity-referralscheme.aspx
Walking for Health www.walkingforhealth.org.uk

References
1 Arthritis Research Campaign (n.d.) Back Pain, An Information Leaflet Arthritis
Research Campaign, Derbyshire, UK
2 Backcare (n.d.) available at http://www.backcare.org.uk/
3 BUPA Information (2010) About back pain available at www.BUPA.co.uk/individuals/health-information/directory/b/backpain (accessed
18/01/2011)
4 Chou, R. Altlas, S. J. and Eamranond, P. (2010) Low back pain in adults, available at www.uptodate.com/home.store.do
5 NHS Choices (n.d.) available at http://www.nhs.uk/Conditions/Backpain/Pages/Introduction.aspx
6 NHS Clinical Knowledge Summaries (n.d.) Back Pain available at http://www.cks.nhs.uk/home
7 NICE (2009) Early Management of non-specific back pain, NICE available at http://www.nice.org.uk/nicemedia/pdf/CG88NICEGuideline.pdf
8 Pain Toolkit (n.d.) available at http://www.paintoolkit.com