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By Dr Dulcy Rakumakoe

Chief Executive Officer

Back pain has many causes

Surgery is rarely needed to treat back pain but one can see a doctor if self-help does not work.

Back pain is one of the most common reasons people go to the doctor or miss work and is a leading cause of disability worldwide. Most people have back pain at least once.

You can fortunately take measures to prevent or relieve most back pain episodes. If prevention fails, simple home treatment and proper body mechanics often will heal your back within a few weeks and keep it functional for a long period. Surgery is rarely needed to treat back pain. If self-care does not help within two weeks, see your doctor.

In rare cases, back pain can signal a serious medical problem. Seek immediate care if your back pain:

-Causes new bowel or bladder problems.

-Is accompanied by fever.

-Follows a fall, blow to your back or other injury.

-Is severe and doesn’t improve with rest.

-Spreads down one or both legs, especially if the pain extends below the knee.

-Causes weakness, numbness or tingling in one or both legs.

-Is accompanied by unexplained weight loss.

-Or if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use, or drug or alcohol abuse.


Back pain can come on suddenly and last less than six weeks (acute), which may be caused by a fall or heavy lifting. Back pain that lasts more than three months (chronic) is less common than acute pain. It often develops without a specific cause that your doctor can identify with a test or imaging study.

Conditions commonly linked to back pain include: Muscle or ligament strain:

Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms:

-Bulging or ruptured disks: Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you undergo spine X-rays for some other reason.

-Arthritis: Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.

-Skeletal irregularities: Back pain can occur if your spine curves abnormally. Scoliosis, a condition in which your spine curves to the side, also may lead to back pain, but generally only if the scoliosis is severe.

-Osteoporosis: Your spine’s vertebrae can develop compression fractures if your bones become porous and brittle.


Anyone can develop back pain, even children and teens. Research has yet to prove what contributes to back pain. However, these factors might put you at greater risk of developing back pain:

-Age: Back pain is more common as you get older.

-Lack of exercise: Weak, unused muscles in your back might lead to back pain.

-Excess weight. Carrying too much weight puts extra stress on your back.

-Diseases: Some types of arthritis and cancer can contribute to back pain.

-Improper lifting: Using your back instead of your legs can lead to back pain.

-Psychological conditions: People prone to depression and anxiety appear to have a greater risk of back pain.

-Smoking. This can keep your body from delivering enough nutrients to the disks in your back.


-Muscle ache

-Shooting or stabbing pain

-Pain that radiates down your leg

-Limited flexibility


-History and examination:

The doctor will ask questions and examine your back and assess your ability to sit, stand, walk and lift your legs. This helps determine where the pain comes from, how much you can move before pain forces you to stop and whether you have muscle spasms. They will also help rule out more serious causes of back pain.

-X-ray: These images show the alignment of your bones and whether you have arthritis or broken bones.

-MRI or CT scans: These scans can generate images that may reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

-Blood tests: These can help determine whether you have an infection or other condition that might be causing your pain.

-Bone scan: In rare cases, your doctor may use a bone scan to look for bone tumours or compression fractures caused by osteoporosis.

-Nerve studies (electromyography, or EMG): This measures the electrical impulses produced by the nerves and the responses of your muscles. It can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).


Most acute back pain gets better with a few weeks of home treatment. Over-the-counter pain relievers and the use of heat or ice might be all you need. Bed rest isn’t recommended. Continue your activities as much as you can. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don’t avoid activity out of fear of pain. Medications.

-Nonsteroidal anti-inflammatory drugs (NSAIDs) that you can get over the counter might relieve acute back pain: Take these medications as directed by your doctor, because overuse can cause serious side effects. If these pain relievers don’t work, your doctor might suggest prescription NSAIDs.

-Muscle relaxants: If mild to moderate back pain doesn’t improve with pain relievers, your doctor may also prescribe a muscle relaxant. Muscle relaxants can make you dizzy and sleepy.

-Topical pain relievers: These are creams, salves or ointments you rub into your skin at the site of your pain.

-Narcotics: Certain drugs, such as codeine or hydrocodone, may be used for a short time with close supervision by your doctor.

-Antidepressants: Low doses of certain types of antidepressants – particularly tricyclic antidepressants, such as amitriptyline – have been shown to relieve some types of chronic back pain, independent of their effect on depression.

-Injections: If other measures don’t relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone – an anti-inflammatory medication – or numbing medication into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than a few months.


Education might involve a class, a talk with your doctor, written material or a video. Education emphasises the importance of staying active, reducing stress and worry, and teaching ways to avoid future injury.


Physiotherapy is the cornerstone of back pain treatment. The therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you a range of exercises that can increase your flexibility, strengthen your back and abdominal muscles, and improve your posture.

Regular use of these techniques can help prevent pain from returning.


Few people need surgery for back pain. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you may benefit from it. Otherwise, surgery is reserved for pain related to structural problems, such as:

Chiropractic care: A chiropractor hand-manipulates your spine to ease your pain.

-Acupuncture: A practitioner of acupuncture inserts sterilised stainless steel needles into the skin at specific points on the body. Some people with low back pain report that acupuncture helps relieve their symptoms.

-Massage: If your back pain is caused by tense or overworked muscles, massage might help.

-Yoga: There are several types of yoga, a broad discipline that involves practising specific postures or poses, breathing exercises, and relaxation techniques. Yoga can stretch and strengthen muscles and improve posture, although you might need to modify some poses if they aggravate your symptoms.


You may be able to avoid back pain or prevent its recurrence by improving your physical condition and learning and practising proper body mechanics. The best prevention is to keep your back healthy and strong by:

-Exercise. Regular low-impact aerobic activities: Those that don’t strain or jolt your back – can increase strength and endurance in your back and allow your muscles to function better. Walking and swimming are good choices.

-Build muscle strength and flexibility: Abdominal and back muscle exercises (core-strengthening exercises) help condition these muscles so that they work together like a natural corset for your back. Flexibility in your hips and upper legs aligns your pelvic bones to improve how your back feels.

-Maintain a healthy weight: Being overweight strains back muscles. If you’re overweight, trimming down can prevent back pain. Use proper body mechanics. Stand smart, sit smart and lift smart!!!

-Stand smart: Maintain a neutral pelvic position. If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back. Alternate feet. Good posture can reduce the stress on back muscles.

-Sit smart: Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level. Change your position frequently, at least every half-hour.

-Lift smart: Avoid heavy lifting, if possible, but if you must lift something heavy, let your legs do the work. Keep your back straight – no twisting – and bend only at the knees. Hold the load close to your body. Find a lifting partner if the object is heavy or awkward.

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

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