CHRONIC BACK PAIN: CAUSES AND EFFECTS

What are the causes of Back Pains?

Back pain is most commonly felt as soreness, tension or stiffness in the lower back (the area between the bottom of the ribs and the top of the legs) but it can also be felt in the neck, shoulders, buttocks and thighs.
The pain sometimes develops suddenly after lifting something heavy or twisting your back awkwardly, or it can develop gradually as a result of years of poor posture.

Sometimes the pain develops for no apparent reason. Some people just wake up one day with a sore back. Typically, the pain eases when you lie down flat, whereas moving, coughing or sneezing makes it worse.



When to get medical help

Most cases of back pain usually improve without you having to get medical help, but if your condition does not get any better within three days see your GP. You should also see your GP if you suffer regular episodes of back pain for more than six weeks.

There are several warning signs, known as red flag signs, that may indicate that your back pain is caused by a more serious condition that requires immediate medical help. These include:

• unexplained weight loss
• a fever of 38ºC (100.4ºF) or above
• swelling of the back
• constant back pain that does not ease after lying down
• pain in your chest or high up in your back
• pain down your legs and below the knees
• pain caused by a recent trauma or injury to your back
• loss of bladder control
• inability to pass urine
• loss of bowel control
• numbness around your genitals, buttocks or back passage
• pain that is worse at night

Other types of back pain

Pain in the upper back, legs, neck and shoulders can also be felt as back pain but it may be caused by another condition:

• pain in the lower back that moves down the buttocks into one or both of the legs may be a symptom of sciatica
• soreness in the lower back, muscle weakness, tight muscles and loss of bladder control may be the result of a slipped disc
• back pain, buttock pain, swollen joints and tendons and extreme tiredness are common symptoms of ankylosing spondylitis
• pain in the joints (including the back) when walking and stiffness first thing in the morning are symptoms of arthritis
• painful stiffness of the shoulder, which makes it very difficult to dress, drive or sleep, may be a sign of frozen shoulder
• neck pain and stiffness, headaches and lower back pain following an accident are common symptoms of whiplash

Almost everyone has back pain at some point in their lives. According to the National Institutes of Health, back pain is the second most common neurological disorder in the United States -- only headache is more common.

If you have back pain, the first step is to be properly assessed by your primary care provider. Back pain has many causes, from muscle strain to more serious conditions such as a herniated disc, spinal stenosis, spondylosisthesis, osteoporosis, or a tumor, so it's important to find out what is causing the back pain.

1) Acupuncture

A study conducted at Sheffield University in the United Kingdom looked at the long-term symptom reduction and economic benefits of acupuncture for persistent low back pain. An average of 8 acupuncture treatments were given to 159 people, while 80 people received usual care instead.

After one year, people receiving acupuncture had reduced pain and reported a significant reduction in worry about their pain compared to the usual care group. After two years, the acupuncture group was significantly more likely to report that the past year had been pain-free. They were less likely to use medication for pain relief.

How does acupuncture work? According to traditional Chinese medicine, pain results from blocked energy along energy pathways of the body, which are unblocked when acupuncture needles are inserted along these invisible pathways.

A scientific explanation is that acupuncture releases natural pain-relieving opioids, sends signals that calm the sympathetic nervous system, and releases neurochemicals and hormones.

An acupuncture treatment generally costs between $60 and $120. Acupuncture is tax-deductible (it's considered a medical expense) and some insurance plans pay for acupuncture.

If you want to try acupuncture, plan on going one to three times a week for several weeks initially.

2) Capsaicin Cream

Although you may not have heard of capsaicin (pronounced cap-SAY-sin) before, if you've ever eaten a chili pepper and felt your mouth burn, you know exactly what capsaicin does. Capsaicin is the active ingredient in chili peppers.

When it is applied to the skin, capsaicin has been found to deplete substance P--a neurochemical that transmits pain--causing an analgesic effect.

In one double-blind study, 160 people were treated with capsaicin for 3 weeks, while another 160 people used a placebo. After 3 weeks, pain was reduced by 42% in the capsaicin group compared to 31% in the placebo group. Investigators rated capsaicin significantly more effective than placebo.

Capsaicin cream, also called capsicum cream, is available in drug stores, health food stores, and online. A typical dosage is 0.025% capsaicin cream applied four times a day. The most common side effect is a stinging or burning sensation in the area.

If possible, wear disposable gloves (available at drugstores) before applying the cream. Be careful not to touch the eye area or open skin. A tube or jar of capsaicin cream typically costs between $8 and $25.

3) Vitamin D

Chronic muscle pain can be a symptom of vitamin D deficiency. Vitamin D is found in fish with small bones, fortified milk and cereal, and exposure to sunlight.

Risk factors for vitamin D deficiency are:

darker pigmented skin (e.g. Hispanic, African American, Asian) does not convert UV rays efficiently to vitamin D digestive disorders, such as celiac disease use of glucocorticoid medications for conditions such as lung diseases and allergies minimal sun exposure (elderly, institutionalized, homebound, veiled or heavily-clothed individuals) latitude and season - for example, people in Boston do not produce vitamin D from sun exposure between November and February.  A study by the University of Minnesota looked at the prevalence of vitamin D deficiency in 150 people with chronic musculoskeletal pain. Researchers found that 93% of patients had vitamin D deficiency. All people with darker pigmented skin (African American, East African, Hispanic, and Native American origin) had vitamin D deficiency.

Another interesting finding was that the majority of people with severe vitamin D deficiency were under 30 years of age. Season was not a significant factor.

The researchers concluded that all people with persistent, non-specific musculoskeletal pain should be screened for vitamin D deficiency.

4) Music Therapy

Music therapy is a low-cost natural therapy that has been found to reduce the disability, anxiety, and depression associated with chronic pain.

A study evaluated the influence of music therapy in hospitalized patients with chronic back pain. Researchers randomized 65 patients to receive, on alternate months, physical therapy plus 4 music therapy sessions or physical therapy alone.

Music therapy significantly reduced disability, anxiety, and depression. Music had an immediate effect on reducing pain, although the results were not statistically significant.

5) Vitamin B12

Vitamin B12 has been found to relieve low back pain. A double-blind Italian study examined the safety and effectiveness of vitamin B12 for low back pain. People who received vitamin B12 showed a statistically significant reduction in pain and disability. They also used less pain medication than the placebo group.

Besides pain, other symptoms of vitamin B12 deficiency are numbness and tingling, irritability, mild memory impairment, and depression.

Risk factors for vitamin B12 deficiency are :

• pernicious anemia
• medications (stomach acid-blocking medications)
• inadequate intake of meat or dairy products
• infection (small intestine bacterial overgrowth, parasites)
• Digestive diseases (stomach removal surgery, celiac disease, Crohn's disease
• Vitamin B12 muscle injections are the standard treatment for vitamin B12 deficiency. Studies have found vitamin B12 sublingual tablets (placed under the tongue for absorption) and nasal gel are also effective.

6) Magnesium

Magnesium is the fourth most abundant mineral in the body. It's involved in over 300 biochemical reactions in the body.

Magnesium helps maintain normal muscle and nerve function, keeps heart rhythm steady, supports a healthy immune system, and keeps bones strong. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis.

Symptoms of magnesium deficiency include muscle spasms and pain, premenstrual syndrome, irritability, depression, insulin resistance, high blood pressure, irregular heart rhythms, and heart disease.

A German study found that mineral supplements increased intracellular magnesium levels by 11% and was associated with a reduction in pain symptoms in 76 out of 82 people with chronic low back pain.

7) Willow Bark

The bark of the white willow tree (Salix alba) has pain-relieving properties similar to aspirin. An ingredient in white willow bark, called salicin, is converted in the body to salicylic acid (aspirin is also converted to salicylic acid once in the body). Salicylic acid is believed to be the active compound that relieves pain and inflammtion.

A number of studies have compared white willow to medication or placebo:

A University of Sydney study compared the effects of willow bark extract to refecoxib, a Cox-2 inhibitor pain medication. In the study, 114 patients received a herbal extract containing 240 mg of salicin and 114 received 12.5 mg of refecoxib every day. After four weeks, both groups had a comparable reduction in pain.

A study in the American Journal of Medicine examined 191 patients with an exacerbation of chronic low back pain. They were randomly assigned to receive a willow bark extract with either 120 mg (low-dose) or 240 mg (high-dose) of salicin, or placebo. In the fourth week of treatment, 39% of people receiving the high-dose extract were pain-free, 21% receiving the low-dose were pain-free, and 6% of people receiving the placebo were pain-free. People in the high-dose group improved after the first week. Significantly more people in the placebo group required pain medication.

8) Yoga for Back Pain

Yoga creates balance in the body through various poses that develop flexibility and strength. A study of people with chronic mild low back pain compared Iyengar yoga to back education. After 16 weeks, there was a significant reduction in pain intensity, disability, and reliance on pain medication in the yoga group. Benefits were also seen at three month follow up assessments.

Another study compared yoga, conventional exercise, and a self care book for people with chronic low back pain. Back function in the yoga group was superior to the book and exercise groups at 12 weeks. Although there was no difference in symptoms at 12 weeks, at 26 weeks, the yoga group was superior to the book group.

9) Bowen Therapy

Bowen therapy is a type of gentle bodywork that was developed in Australia by osteopath Tom Bowen (1916-1982). Bowen therapy is more widely used in Australia and Europe, but it has been growing in popularity in North America.

Bowen therapists use a series of specialized "moves" using their fingers and thumbs. The moves typically involve the therapist pulling the skin slack away from the muscle, applying pressure, and then quickly releasing the tension.

These moves are performed on precise areas of muscles where special receptors are located. Nerve impulses are sent to the brain, resulting in muscle relaxation and reduction of pain.

The moves are not continuous - the therapist allows the client to rest for a few minutes between each move. A typical treatment is between 30 to 40 minutes.

10) Breathing Techniques

Breathing techniques that make use of the mind-body connection have been found to reduce pain. These techniques integrate body awareness, breathing, movement, and meditation. What's great about breathing techniques is that you can do them yourself at home at no cost.

One study compared 6-8 weeks (12 sessions) of breath therapy to physical therapy. Patients improved significantly with breath therapy. Changes in standard low back pain measures of pain and disability were comparable to those resulting from high quality, extended physical therapy. Breath therapy was found to be safe. Other benefits of breath therapy were improved coping skills and new insight into the effect of stress on the body.

11) Massage Therapy

When many people have back aches and pain, the first thing they think of is massage. Studies have found that massage may be effective for subacute and chronic pain. It has also been found to reduce anxiety and depression associated with chronic pain. Massage therapy is the most popular therapy for low back pain during pregnancy.

12) Chiropractic

Back pain is one of most common reasons people see a chiropractor. Doctors of chiropractic use chiropractic spinal manipulation to restore joint mobility. They manually apply a controlled force to joints that have become restricted by muscle injury, strain, inflammation, and pain. Manipulation is believed to relieve pain and muscle tightness and encourage healing.

A study published in the Spine Journal examined manipulations compared to simulated manipulations in 102 people with back pain and/or radiating pain. The researchers found that active manipulations were more effective at reducing acute back pain and sciatica with disc protrusion.

13) Alexander Technique

Alexander technique teaches people to improve their posture and eliminate bad habits such as slouching, which can lead to pain, muscle tension, and decreased mobility. This technique was created by Frederick Matthias Alexander (1869-1955), an Australian actor who learned how to correct hoarseness in his voice by improving his posture.

You can learn Alexander technique in private sessions or group classes. A typical session lasts about 45 minutes. During that time, the instructor notes the way you carry yourself and coaches you with verbal instruction and gentle touch.

14) Prolotherapy

Prolotherapy addresses damaged ligaments (bands of connective tissue that help keep bones attached to each other) to relieve chronic musculoskeletal pain.

How does it work? Tendons and ligaments in the back often do not heal completely after injury. Bones of the spine become less stable, which can lead to chronic pain.

Prolotherapy involves the injection of a liquid solution into soft tissues such as ligaments and tendons. This triggers local inflammation and triggers the body's natural healing response which repairs the weakened soft tissues and relieves pain. Unlike drugs, prolotherapy is thought to address the underlying problem. 

After locating the areas that require treatment, the doctor inserts a thin needle with the solution into the area. There is often mild pain, but it can be reduced by using a local anaesthetic. A typical course of treatment is 10 to 25 sessions for back pain. Since it is believed to repair the joint, no other treatment is necessary. 

Preliminary studies have found that back pain, which often involves ligament injury, responds particularly well to prolotherapy. It is the position of the American Association of Orthopaedic Medicine that prolotherapy is a safe and effective therapy for the treatment of selected cases of low back pain and other chronic myofascial pain syndromes. Prolotherapy injections must be administered by a medical doctor (M.D.), osteopath (D.O.) or by a state-licensed naturopathic doctor (N.D.) in certain states.

15) Balneotherapy

Balneotherapy is one of the oldest therapies for pain relief. The term "balneo" comes from the Latin word, balneum, meaning bath. Balneotherapy is a form of hydrotherapy that involves bathing in mineral water or warm water.

A study compared bathing in mineral water to plain tap water in 60 people with low back pain. They found that mineral water containing sulphur was superior in reducing pain and improving mobility compared with tap water.

A systematic review and meta-analysis published in the journal Rheumatology assessed spa therapy and balneotherapy for low back pain. The researchers found that the data suggest beneficial effects compared to control groups. They concluded that the results were encouraging and that large-scale trials were warranted.

Dead Sea salts and other sulphur-containing bath salts can be found in spas, health food stores, and online.

People with heart conditions should not use balneotherapy unless under the supervision of their primary care provider.

BACK PAIN SYMPTOMS AND MANAGEMENT

Why occur back pain at work?

Back Pain & the Workplace
After the common cold, back pain is the leading reason adults under 45 years of age stay home from work, according to the American Academy of Orthopaedic Surgeons. All told, back pain results in about 83 million lost work days each year. It’s one of the most common work-related injuries, especially among those working in physically demanding jobs, and the leading cause of job-related disability and work limitations in those under 45 years of age.

According to experts at the Mayo Clinic, there are four work-related factors that are associated with increased risk of back pain and injury:


Applying too much force to your back by lifting or moving heavy objects
Repetitive tasks, which can lead to muscle fatigue or injury, particularly if they involve stretching to the limit of your range of motion or awkward body positioning
Poor posture, especially if you stay in the same position for an extended period of time; according to experts your body can remain in one position for an average of 20 minutes before you need to adjust
Too much stress at work or at home can result in pain or injury by leading to muscle tension and tightness, which can result in back pain.

Many jobs place stress and strain on the back, making you more prone to getting back pain.

Episodes of acute and chronic back pain are more likely for people working in nursing, construction, factory work and truck driving because of the demands placed on the spine. Nurses, for example, put a great amount of strain on the lower back every time they help transfer patients from bed to bed, lift them from a chair or change positions. Nursing aides, orderlies and attendants had more back injuries and other musculoskeletal disorders than any other occupation in 1999, according to the United States Bureau of Labor Statistics.

Some jobs that increase the risk of back pain include:

Nursing
Construction
Truck driving
Service jobs, including police officers and firefighters
Janitors and cleaners
Factory and farm work
Sedentary office work
Teaching, especially in nursery schools
Even routine office work can worsen back pain, especially if you have bad workplace habits (for example, slouching over your desk, not taking regular breaks, using a chair that doesn’t give enough support) or your workspace isn’t well designed.


You are more likely to experience back pain if your job involves:

Physical labor, particularly heavy lifting and forceful movements; this is true for nurses, factory workers and those in other manual labor jobs
Bending or twisting, especially in awkward postures; for example, early childhood educators who are often reaching down to talk to or pick up a small child
Whole body vibrations; construction workers who use machinery and tools that vibrate their entire body or truck drivers whose vehicle’s vibration can cause back pain
Spending hours on end in the same position; for example, spending your days at a desk typing


Fortunately, there are steps employees and employers can take to help protect their backs and prevent or reduce further injury and pain.

Steps to protect your back at work

If your job is physical in nature, be aware of the way you move your body. When lifting or carrying a load, never bend and lift with your back only. Instead, bend your knees and let your legs do the work. Hold the object close to your body and engage other muscles - especially your core - to lift. Always consider asking for help. If you find that you are on your feet all day at work, make sure you wear supportive footwear.

Look at how your work area is setup. If you work in an office, the best way to protect your back from unnecessary stress is to make your workplace more ergonomically friendly. Ergonomics is the science of making sure that workplace conditions and equipment - such as desks, lighting and uniforms - fit the worker. These principles can help prevent work-related back strains and injury by identifying and controlling the risk factors that might strain workers' bodies.

There are many small changes that can help make a desktop office space more ergonomically friendly, says Karen Jacobs, EdD, OTR/L, CPE, FAOTA, occupational therapist, board certified professional ergonomist and occupational therapy professor at Boston University. She suggests:

Adjusting your computer monitor so that it’s directly in front of you. This will prevent straining the neck and upper back muscles, a common complaint of many computer-users.
Making sure your chair fits your weight and height. Often, chairs are not adjusted appropriately and may not provide enough support.
Using a foot rest. A small foot rest - even a thick phone book - placed under your feet may help support legs and reduce strain on the lower back, especially if your feet don’t comfortably rest on the floor. When you sit in your chair, your feet should rest flat on the floor, and your thighs should be parallel to the floor.
Keeping your elbows close to your body and at a 90 degree angle when typing. Adjustable keyboard trays with extra space for a mouse are best because they reduce excessive and repetitive reaching.
Checking that the lighting in your office has minimal glare. When lighting is poor, workers often have to compensate by putting their bodies in awkward positions, causing back strain.
Making sure you move your body properly at work. For example, while sitting at the computer, instead of twisting to reach something, swivel your chair to avoid unnecessary strain on your back muscles. If you have to slide a heavy object, push rather than pull.
It’s also important to build in time to stretch before, during and after work. Take a few moments to deep breathe during periods of stress.

For people who want a deeper stretch, workplace yoga is increasing in popularity. Dedicating 10-15 minutes per day to workplace yoga not only provides physical benefits including relaxed muscles and improved circulation, but mental renewal as well. Some people may also benefit from progressive muscle relaxation exercises.

Other advice for employees

Talk to your supervisor. Although it might seem daunting to approach your boss, remember that as an employee you have a right to be safe of all known harm at work. If you have chronic back pain or are returning to work after an injury, talk with your employer about your work conditions and limitations. Make sure you both have the same expectations about the work you will be doing and any modifications that are needed to your workspace or tasks.

Plan ahead. When dealing with back pain at work, try to anticipate what might lead to or aggravate back pain. Plan out your moves to prevent problems or flare ups. For example, limit the time you spend carrying and moving heavy objects by knowing exactly where you’re going and the shortest route.

Listen to your body. Pace yourself to avoid feeling overloaded at work and excessive activities while at home. If you feel a flare up of back pain beginning, stop any activities that may aggravate it. Take frequent breaks and rest your back (set a timer as a reminder if you need to). If you’ve worked with a PT, use the stretches or exercises he or she has taught you. Consider creating a comfort kit that is well stocked and easily accessible. You might want to include a heating pad, ice pack, counterirritants, medication, and soothing music. Some people find it helpful to keep an exercise ball at the office to sit on during meetings or when they need a break from their chair. Make sure to drink plenty of water to stay hydrated - dehydration can cause more discomfort.

Advice for employers

Employers have a responsibility under health and safety laws to provide a safe workplace for their employees. Back pain is the sixth most costly condition in the U.S. Together, health care and other indirect costs due to back pain are over $12 billion per year, according to research. In addition, surgery for low back pain is one of the top five claim costs each year. As an employer, take steps to minimize employees’ risk of injury that may cause episodes of back pain.

Communication is key. Talk and listen to employees. Let them know it’s okay to share workplace concerns.

Provide education and training. If employees are among those at higher risk for back pain or injury, it’s important to provide information and training on ways to keep their backs healthy. APF and other organizations have resources that can help.

Adopt a philosophy of health and wellness. Promote this philosophy to employees, and stress the importance of proper exercise and taking small breaks throughout the day. Investigate the benefits of offering health club memberships as an incentive bonus or a means to reduce health insurance premium costs to your employees. Plan health fairs on-site. Encourage group walks before or after work or during lunch hour. It’s a great way to boost morale too.

Invest in proper equipment and technologies to create a safer workplace. If a job requires employees to stand for the majority of the day, invest in anti-fatigue mats to help support their backs. Use ergonomically friendly office equipment for those whose spines may be affected from sitting in the same positions for a long time each day. Make sure conference rooms and other meeting places are also included.

Consider inviting safety representatives or occupational therapists to assess current work conditions and provide ideas to improve health and safety. Occupational therapists can perform job site analysis and make recommendations on improvements. They are able to work with OSHA, employees and employers regarding the workplace and concerns.

As an employer, it is important to identify and reduce employees’ exposure to hazards in the workplace. By training and engaging employees in their own safety, you can reduce the occurrence of workplace injuries, increase employee productivity and morale and lowers workers’ compensation costs.


Making sure a workplace is fit (and safe) for its workers has many benefits including:

Greater productivity
Reduced risk of illness, injury and recurrence
Increased satisfaction among the workers
Be in the know

You may be able to avoid back pain and injuries if you understand what might cause it or trigger a flare up. For more information, check out other articles in APF’s Spotlight on Back Pain.

The information on this website is provided to help users find answers and support. Readers may wish to print the information and discuss it with their doctor. Always consult with health care providers before starting or changing any treatment.

Back pains diagnosed: Tips to get rid of back pains in instant

Back pain

With no definitive treatment for back pain, many people turn to complementary therapies such as yoga.

It can happen walking up a hill, lifting a suitcase or even watching TV. There is a feeling of something going 'click' in the lower part of the spine. It may start as a little twinge, but it's likely to get worse over the next 24 hours.

What does it feel like?

At first there will be a lack of flexibility in the back, then some pain on walking or bending with gradual stiffness spreading throughout the body.

Back pain can progress so virtually every movement is painful. Lying down may give some relief, but turning over can be difficult.

Getting out of bed may involve rolling onto the floor and raising yourself to a crawling position before teasing your body to its feet.

How long does it last?

Back pain can last up to six weeks and in 90 per cent of cases is likely to come back again within a year.

Who gets back pain?

A survey by the Department of Health found that 40 per cent of UK adults had back pain in the previous year, with 15 per cent in continuous pain. A conservative estimate is that 11 million working days are lost each year as a result of back pain.

It strikes men and women equally. Young people tend to have short episodes of back pain that resolve quickly. With older people, the pain is more likely to be long term (chronic).

Some people are more at risk because of their jobs. Back pain is more common in manual jobs and unskilled workers. You are at higher risk if you drive more than 25,000 miles a year.

People who work on the telephone for more than two hours a day without a headset and supermarket cashiers are also likely to be hit by back pain.

How is back pain diagnosed?

Dr Jeremy Sager, GP, says: 'First, it's important to make sure that your problem is back pain and not something more serious.'

• The pain should be in the lower back, be related to movement and be present all the time.
• It shouldn't involve the legs.
• It should have begun suddenly and not have come on over time.
• You should feel well, apart from the back pain.
• There should be no sudden loss of weight.

What else could it be?

• Back pain can be confused with sciatica, which is caused by the degeneration of an intervertebral disc. In sciatica leg pains accompany the back pain.
• Kidney problems and pelvic and abdominal diseases can also cause back pain.
• Although very rare, tumours can occur in the spine or lungs and cause back pain.

Always visit your GP so they can diagnose your symptoms.

What causes back pain?

Dr Loic Burn, a GP and author of books on back pain, says: 'There is no known single cause for back pain, which makes it difficult to name a specific treatment or method of prevention.

'Heavy lifting, for instance, can be a cause of back pain, but it is in a minority of cases. Basically we don't know what causes back pain.'

How is back pain treated?

Doctors used to advise complete bed rest for backache. Now this advice has changed: evidence shows the more active you can remain, the quicker your recovery.

Dr Burn says: 'The best medical advice is to take painkillers at once at the full dosage.'

Dr Sager agrees: 'You should take paracetamol or ibuprofen at the maximum dose. There is no use in pussyfooting about, you have to really attack the pain.

'Being as active as you can and taking painkillers cannot do you any harm and you will be back to living a normal life more quickly.'

Evidence also shows that manipulation techniques work for back pain, particularly if given in the first two weeks of pain.

Dr Burn says it doesn't matter who does the manipulation, as long as they have been trained. This means the person is a registered chiropractor, osteopath, physiotherapist or doctor.

'There are also medical treatments that involve epidural or spinal injections, but they don't always work.

'Spine-fusing surgery [where vertebrae are joined] is a last resort and only given to one in 10,000 patients. It is a very radical step considering we don't understand the causes of back pain and the results aren't always wonderful.'

What about alternative therapies?

Dr Burn is happy for his patients to try complementary therapies such as the Alexander Technique, yoga, shiatsu, acupuncture and massage. There is limited evidence that these therapies work, but some people find they help.

'Since we don't know the cause of back pain, we have to be open-minded on methods of treatment and look at every case on its merits.'

While it's fine to try different therapies, Dr Burn says 'if it doesn't work, move on to other things. The best approach is to stay active and be proactive in looking for something that stops the pain.'

A cure for back pain may be years away, but the fact to remember, he says, is the more active you are, the more likely you are to beat that pain in your back.

Goodbye Pain in the back: Proper tips to watch out for

There are a million ways to hurt your back. When you do the pain can range from a mild ache to years of agony. Prevention, however, is always better than cure. So, here's how you can stop the problem before it starts.

Heavy lifting

Lifting objects incorrectly is the number one way to damage your back. Common mistakes include:

• allowing your back to curve forwards, while you pick up an object
• holding a heavy object away from the body
• lifting an object above shoulder level
• underestimating the weight or awkwardness of an object.

Combat this by using your legs, not your back when lifting. 'If the object is on the ground, squat down and get close,' says Patricia Watber, Research and Information Officer from the national back charity, Back Care. 'Then lift it up by straightening your legs (push upwards on your legs), all the while keeping your back straight. Above all avoid twisting.'

Watching TV

Most of us think nothing of how we sit down when watching TV and as a result we damage our backs, without even realising it. Help yourself, advises Patricia Watber, by:

• sitting with both buttocks firmly on the seat and not slouching to one side
• placing a wooden board under your sofa cushions if it's too soft
• avoiding resting your neck on the sofa arm, and instead use a cushion to support your head
• shifting positions every 20 minutes to maintain flexibility.

Wearing high heels

Heels may help women feel sexy, but the price for looking good is likely to be back pain because as you walk, your centre of gravity is thrust forwards.

Help yourself by varying the height of your heels and improving your core stability by exercising the muscles that run round your back and body like a corset. The stronger these muscles, the more internal support you will have as you totter and the better your postural alignment will be.

Pilates and yoga can help strengthen your core - as can sucking in your stomach as you walk, sitting at a computer or waiting at the bus stop. Simply imagine pulling your belly button to your spine, release and repeat regularly.

Gardening and housework

Gardening and housework often involve lifting, moving and unnatural hunched postures, so it's important not to overdo it. If you're particularly stiff, post gardening or housework, stretch your body the opposite way from how you've been holding it.

'Be aware that the spine moves in six directions: forwards, backwards, to the left side, the right side and rotates left and right. So, always stretch your back regularly in all six directions to maintain flexibility.' says Garry Trainer, osteopath and author of 'BackChat: The Ultimate Guide to Healing and preventing back pain'.

Sleeping

If back pain is affecting your sleep consider your position, mattress and pillow. Your mattress should be firm and supportive, and it should give slightly when you lie down. Your pillow should be firm and not too high, allowing your neck to fall in line with the rest of your spine.

'Lying face down is the worst position to keep your back healthy because it can lead to locking and tension within the back joints themselves,' warns Dave Gibson, osteopath and back expert at bed specialists, Warren Evans (www.warrenevans.com). 'Lying on your side in an embryo position is the best position to limit back pain and keep you feeling fine.'

Working

To keep your back healthy at work:

• ensure your chair height allows you have both feet flat on the floor
• make sure the height of your desk is below your elbows when seated
• ensure the top of your computer screen is at eye level and at arm's length distance away.

'You don't have to invest in an expensive ergonomic chair to keep back pain away,' says Garry Trainer. 'A cheaper option is to buy a little back wedge or wobble cushion (available from www.bodyopathy.com). A wedge gives you the proper curve in your spine - while a wobble cushion keeps you on an unstable surface, which prevents your back from becoming stiff.'

Driving

People who spend their working life behind a steering wheel, such as taxi or lorry drivers, are highly susceptible to back problems and the same applies to your when you are driving. Bad driving habits can be bad for your back.

Help yourself, advises Danny Williams, osteopath at Third Space Medicine www.thirdspace.com/medicine, by:

• sitting with your back placed into the back of the seat and well supported
• ensuring your seat is in an upright position and that you sit straight in relation to the steering wheel
• taking breaks on long drives and putting a small pillow or rolled towel behind your lower back for extra support
• ensuring your legs are kept straight to the wheel because the left leg has a tendency to fall outwards when driving.

Carrying a child

'Lifting and carrying children can also be a constant source of back pain for mothers,' acknowledges Patricia Watber. The best technique for carrying a child is to:

• keep your back straight and bend your knees so that you are the child's level
• use both arms to hold the child, while placing your feet shoulder width apart
• lift the child using your legs to push upwards and hold the child with both arms while carrying them.

Above all, avoid multitasking with a child and carrying one on a hip because this causes an imbalance of your posture and can cause chronic back pain.

The importance of posture

Lower back pain is an extremely common consequence of poor posture.

How you stand and hold yourself, not only makes a difference to the way you look – but more importantly, the way your body feels.

Poor posture can lead to a wide variety of problems – such as chronic backache, headache and evenrepetitive strain injury (RSI).

Lower back pain is a common consequence of poor posture.

In fact, it's estimated that in the United Kingdom, up to 4 out of every 5 adults aged 16 or over will experience back pain at some point in their lifetime. Each year, backache accounts for seven million trips to a GP.

We look at different exercise regimes you can do that focus on improving posture, and we share some tips on how to keep your body in perfect alignment at your desk.

Pilates

Pilates helps strengthen the core abdominal muscles, improve posture and ease back problems.

Pilates is all about training people to use their core, specifically the muscles of the stomach, back and pelvic floor – so that they can hold themselves correctly.

Classes consist of a series of controlled movements and exercises that train the body to move more efficiently. This relieves pain caused by poor posture.

Years of slouching, hunching and rounding can leave us using weak or superficial muscles to hold ourselves up. As such, it’s often recommended to sufferers of lower back pain.

Pilates also reduces the stress we place on the legs, hips and feet from standing or moving incorrectly.

Good posture creates space in the body, taking pressure off the organs. It improves muscle function, range of motion in the joints and allows the shoulders to relax and the head to move more freely.

Yoga

Beginners to yoga should try to practise at least once or twice a week.

There are many different types of yoga, but all help to relieve tension from the body and restore flexibility to the muscles and joints.

Regular yoga practice develops body awareness, which allows you to break habits and patterns of bad posture.

All types of yoga involve poses that stretch the muscles and ease out tension.

Yoga classes also involve dedicated time for relaxation, which helps you to form a new tension-free body position.

Classical yoga postures, such as those found in Hatha yoga, are fantastic for addressing muscular imbalances and restoring balance and flexibility.

Iyengar yoga focuses on proper alignment – while dynamic yoga styles, like Ashtanga and Rasa Vinyasa, help to develop core, back and upper body strength.

Alexander technique

It re-teaches everyday movements, such as walking, to consciously change your bad posture habits.

The Alexander technique teaches us that we each create our own patterns of posture and movement.

Over time these postures and movements become so deeply ingrained, we often can't see that they cause us to move inefficiently.

Alexander technique sessions adopt a common sense approach to good posture and teach new ways of sitting, standing, breathing and moving.

Students learn how to perform daily activities, with greater ease and efficiency, and reduce the pressure they put on their bodies.

The technique is designed to free you of subconscious habits – so that you can use your body more effectively and see improvements in posture, breathing, performance and health.

The Technique is not a quick fix. The ‘retraining’ process takes some time. But with patience, you can learn new habits for life.

Feldenkrais

Feldenkrais teaches awareness of movement through gentle prompting and guided touch.

Through gentle prompting and guided touch, the Feldenkrais method helps you to develop an awareness of body positioning and movement, retraining yourself to move more flexibly and fluidly.

Students of Feldenkrais are taught that constantly adjusting body position, with hard work and effort, is not the most effective way to improve posture.

According to the Feldenkrais method: our muscles aren't meant to directly support our weight and hold our posture. But they should to align the skeleton to support the body.

Feldenkrais teaches that a relaxed, aware body will align itself easily and naturally – so that body mass balances lightly on the skeleton with a minimum of muscular effort.

Feldenkrais aims to take the hard work out of achieving proper posture, by using gentle movements to develop a self-awareness that in time allows you to regain the fluid movement and balance you were born with. This state is referred to as natural balance.

Flexibility is thought to improve after just one session, as well as increased levels of energy and vitality.

How to sit perfectly at your desk in 5 easy steps

1. Start standing. Place your thumbs on the bony protrusions of your hip bones and your forefingers on your pubic bone. Tilt your pelvis, so both bones are level.
2. Now sit down. Try to maintain this position, ensuring you keep a small curve at the base of the spine.
3. Next, place your feet flat on the floor, shoulder width apart, pointing directly forwards. Your hips and knees should be bent at 90 degrees.
4. Now, roll your shoulders back and down. Feel your chest broadening and your shoulder blades moving down your back.
5. Finally, ensure that your head can move freely and that there's a slight curve at the top of the spine, with the ears directly over the shoulders.