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By Dr David Delvin
Have you got back ache?
Well, I really do feel for you! I had awful back pain myself for about 15 years, so I know how truly miserable it can be.
This is a really common problem. Each day of the week, you could fill the Millennium Stadium in Cardiff with all the people who are 'off sick' because of backache. This strongly suggests that the human race is doing something badly wrong with respect to it's spine!
Today, I'd like to show you how to deal with back pain - and also how to avoid it - if possible.
Don't go to the Doctor
First things first. If you get an attack of back pain, what should you do about it?
Well, my answer may surprise you. It's this: don't bother to go to the doctor!
Why not? Well, there's very little that us medics can do for a person with back pain. Frankly, our most important function is usually to offer a medical certificate.
So if you don't need a certificate for your work, and you don't need prescription only pain killers, then there's very little point in going along to see your GP.
There's far more point in going to an expert on back pain - like an osteopath or chiropractor or maybe a physio. They are really the only people who stand any chance of actually curing your back pain. Sadly, no family doctor is going to be able to do that, I assure you.
People often imagine that the pills we give them for back pain are intended to cure them. But if you think about it, you can see that this is quite impossible. No pill can make a 'slipped disc' go back, or heal a torn muscle. All that our pills can do is to ease pain, and perhaps reduce inflammation.
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Causes
Now what are the causes of back pain? There are quite a lot of them, but they're mostly 'mechanical' things, in other words, something getting torn or pushed out of place.
Very often, the episode of back ache is 'triggered off' by something which you did yourself; for instance, lifting unwisely, or bending over too sharply (and too far) in the garden or sitting in a totally unsuitable chair.
Sometimes you actually feel something 'go' in your back at the most of the injury. But more often the pain comes on gradually over a few hours.
If you've only torn or strained some soft tissue, such as a muscle, or ligament, then you can reasonably expect that it will get better over the course of a week or 10 days, provided you take care of yourself!
But there are one or two more significant causes of back pain, and these may drag on a lot longer.
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Sacro-iliac strain
Firstly, there's a back injury called 'Sacro-Iliac Strain'.
I'm always amazed that most of the British public have never heard of this. Most Americans seem to know about it - and quite reasonably so, as it's very, very common.
It's a strain of one of the pair of joints which lie on either side of your lower spine, just a the top of your buttock. The pain it produces can be agonising, particularly when you try to stand up!
Sacro-Iliac strain isn't easy to diagnose in yourself. But a doctor or osteopath can diagnose it instantly by simply pressing on the joint and finding that it is extremely tender.
The initial treatment is rest and warmth (a hot water bottle on the buttock is very good). There is a way of manipulating the joint, but few people, other than physios, osteopaths and chiropractors know about it.
Fortunately, most sacro-iliac strains do get better within two or three weeks.
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'Slipped Disc'
Now a so-called 'slipped disc' is the thing that really does mean big trouble. It can cause months of pain and stiffness, and in the old days lots of sufferers had to give up work altogether and give up activities like gardening and driving and golf.
What is it? Well, it's not really a 'slip' of the disc. What happens is, a disc (which is a circular shock-absorber, made of gristle) gets pushed around by stresses and strains, until it bulges backwards. The bulge then presses on a nerve. And then you areally are 'in the soup' because that pressure causes intense pain.
The commonest place for a disc to bulge is in the lowest part (that is the lumbar part) of the spine.
Usually, it presses on the nerves which run down into your leg. And that produces a very characteristic pain running down the back of your thigh. This is known as 'sciatica'.
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Treatment of Discs
If you have a disc problem, you must take it very seriously indeed, unless you want to end up as a cripple. Please follow your doctor's, or osteopath's advice about:
· Avoiding lifting;
· Avoiding bending.
If you don't, things may get very much worse. You don't usually have to go in for the absolute bed rest that medics used to recommend a generation ago. But please stick to the amount of activity that your health professional recommends.
Sadly, no drug is going to make your disc 'pop' back into place. However, there are several things which may induce the disc to stop pressing on the nerve. These are:
· Manipulation - by a skilled practitioner, of course.
· Traction - a therapy (usually given by physiotherapists) in which the bones of the spine are stretched apart.
· Epidural injections - these are 'jabs' given into the area at the base of the spine.
Unfortunately, many people who have 'disc lesions' do not respond to these techniques. They mostly end up having to have 'the operation'. The object of this is simply to remove the disc which is causing all the trouble.
The 'op' is a pretty major business. But in the hands of a good surgeon, it can be highly successful. I know, because I've had it!
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Prevention of Back Pain
As I said at the start, there's so much back pain around that the human race must be doing something wrong! Too right, we strain our backs by:
· Excessive lifting;
· Lifting in a wildly dangerous way, with straight knees;
· Bending over to an extent that our spines can't cope with;
· Twisting our spines;
· Sitting in diabolically uncomfortable chairs;
· Riding in cars with truly terrible seats!
· Finally, putting enormous strains on our spines by simply being overweight. People who are carrying too much poundage are far more liable to serious back trouble than those who are slim.
Having been through a heck of a lot of back pain myself in my 30s and 40s, I just wish I'd known then what I know now about prevention.
I'd recommend that everyone who is reading this, whether you've got back pain or not, should take great care in future to avoid straining that delicate structure called the human spine.
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Q. I often have to bend forward to pick up my little granddaughter, and I know this is putting a strain on my spine. I get back ache every time she has visited us!So what can I do to avoid it?
A. Really, grandparents (and parents) who are in this situation should try to be very firm, and say: I'm sorry, dear: I just can't lift you any more'.
But in practice, very few people can bring themselves to do this. So if you have to life your little granddaughter, then do it correctly.
Basically, what this means is that you should keep your back straight, and start with your knees bent. Then lift by straightening the knees. Also, make sure that you hold the child close to you as you life. Holding a heavy weight away from you while lifting is inviting disaster.
The same principles apply to anyone lifting any heavy object. Diagrams of how to lift are in the books mentioned below.
Q. Our dining room chairs are intensely uncomfortable, and I always get low back pain after dinner. What can I do?
A. Ditch these chairs - before they damage your back permanently. You'll find diagrams of good chairs (which support the lumbar spine) in the books I've mentioned below.
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Q. Is it true that there's some way of sitting which is good for your back and another way that is bad?
A. Yes. Basically one should always sit with one's bottom pushed well to the back of the chair-seat, so that the lower part of the chair's back-rest supports your lumbar spine. That isn't easy to describe in words!
So, you may find it preferable to look at the pictures in a small book I wrote some years ago for the National Back Pain Association. It's called 'Back Pain and You'. It's not available in the shops, but you can find it in many public libraries. And if it's not in your local library, they'll certainly have other 'back pain books', which contain the same sort of pictures.
Q. My doctor has been treating me for that disease called 'lumbago' for many years. Will it ever get better?
A. Lumbago isn't actually a disease. It's just a general word meaning 'pain in the lower spinal area'. You need to ask your doctor what this pain is caused by. For instance, have you got a disc problem?
Q. I'm out in the sunshine a lot - on holidays abroad and gardening. Now I've got a funny little 'raw' place on the side of my nose. Could this have been caused by the sun?
A. Yes, indeed. My concern is that this might be an early skin cancer, since these are so very common among people who've spent a lot of their lives in the sun. Please ask your doctor to check it, as soon as possible.
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Q. I have suddenly become diabetic, at the age of 65. Fortunately, I don't have to take insulin injections. But do I really have to stick to a diet?
A. Absolutely. I'm afraid that if diabetes isn't controlled properly, you can run into all sorts of complications. So everyone who has diabetes really does need to stick to a strict diet, as laid down by the hospital or clinic.
Q. My husband, age 68, has suddenly found that he can't manage to make love to me. I do sympathise with him, and would like to get him right again. What treatments are available?
A. Well, he needs to have a check-up from a doctor, to make sure that there's no serious underlying cause - and whether there's any emotional problem.
If there isn't, then the main lines of treatment these days include:
* Viagra;
* The new oral drug Uprima;
* Muse - a pellet which you insert into the male organ.
* Injections into the penis;
* Vacuum cylinders, which in effect 'suck' the man into erection.
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Q. I am an ex-soldier and a smoker, age 71. I have noticed that there seems to be something 'beating' inside my tum, rather like a football, beating time with my heart. What could it be?
A. This sounds like an Aneurysm. That's a swelling in the main artery of your body, the aorta. This condition is common in over-50 males who smoke. Please see your doctor today and have this examined. If it is an aneurysm, I'm afraid you will need an operation.
Q. I am a retired actress, age 67. I am really pleased with the HRT which I use, since it makes me feel young! But is it true that it increases the risks of breast cancer?
A. Yes, hormone replacement therapy (HRT) has many benefits. But it does increase the risk of breast cancer a little. So you should take great care to check your breasts regularly, say, once a month.
Also, have the regular mammograms (breast x-rays) that the NHS offers.
When you're examining your breasts, if you ever feel you've found anything wrong (and particularly a lump) then see a doctor within 48
hours.
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