Prevention is the best option

Back pain

Mal d'esquena

Back pain is a very common and complex complaint that also encompasses many concepts: neck pain, herniated discs, sciatica, etc. It can stem from a multitude of causes, show different symptoms and there are also risk factors that can lead to its onset. To alleviate, prevent and be more informed about back pain, Dr Judith Sanchez, the doctor in charge of the Traumatology, Rehabilitation and Burns Hospital, answers the following questions.


What are the main causes of back pain, or which are the most common complaints?

Most cases of back pain are caused by muscle pain due to mechanical overloading of the spine, static positions, physical exertion and bad movements that cause a muscle spasm and pain. A bio-mechanical alteration of the small posterior joints of the vertebrae that cause nerve irritation with a spasm of the surrounding paravertebral muscles. 

The most frequent types are mechanical lumbar pain, where you can find spasms of the lumbar region or the pyramidal muscles, with the pain radiating towards the gluteal region. 

You can observe phenomena such as wear, osteoarthritis of these joints, protrusion of the discs or disc herniation can make these spasms be more or less frequent. The next, in terms of frequency, is neck pain, which can cause pain towards the shoulders, or even tension-related headaches. These are more directly related to bad posture and spasms of the trapezoid and sternocleidomastoid muscles.


Do some people have a predisposition to back pain?

Yes, and most of the time it is multi-factor. People with the following issues can suffer it:

  • Those with a specific anatomical spinal constitution
  • Those with important lumbar or cervical lordosis
  • Those with a weak muscular constitution
  • Those that perform mechanical tasks with poor ergo-dynamic adaptation
  • Those that do not exercise and have a sedentary lifestyle
  • Those with hereditary genetic factors, etc.


As well as lower back pain and neck pain, there are other very common ailments that affect the back, such as sciatica. What is sciatica and how does it manifest?

Sciatica is an irritation of the sciatic nerve, which starts at the lower lumbar area and radiates throughout the gluteus, all the way to the posterior part of the leg. This irritation can be caused by a herniated disc, foraminal stenosis, or a pyramidal muscle spasm, which all present a similar clinical picture, pseudo-sciatica.


What is a herniated disc and what causes it? 

Hernias are caused by a rupture of the inter-vertebral disc that causes the extrusion (it moves outwards) of its contents, which can come in contact with the root of the nerve that runs alongside it and produce a painful irritation that will radiate along the nerve's whole trajectory. 


Can having muscle spasms on a regular basis be indicative of a more severe back problem?

Not necessarily. It depends on many factors. It is best to see a specialist so they can orient a proper diagnosis for muscle spasms.


If your back hurts, is it better to rest or exercise?

It is best to combine both, though it depends. You should never do any exercises that cause pain while you are doing them or afterwards. You can stretch, for example, which can help relax muscles and ease the pain. Total bed rest is not beneficial either.


Are orthopaedic elements, such as girdles, back braces, etc, really of any use for back pain?

It depends on the diagnosis. They are not recommended in general terms, though they can alleviate pain during a certain period of the day, depending on the type of activity being performed and the pathology in question. We always recommend that they only be used when prescribed by a doctor.


When should an anti-inflammatory be taken to deal with back pain? Can they have side effects that are bad for our health?

They must always be prescribed by a doctor. The best thing to do is decrease the intensity of your daily activity, rest a bit, apply gentle heat locally for 15 minutes at a time and take a conventional analgesic, and if the pain does not improve, you can take an anti-inflammatory, assuming it has been recommended by a doctor and has been effective in the past. 


How can we alleviate back pain while sleeping? Is it true that there are some postures that help, and others that hinder, back pain?

The quality of your rest at night is important for improving back pain. If pain is interfering with your sleep patterns, you’ll wake up feeling worse, with more spasms and pain. Sleeping in postures that cause pain, such as flat on your back or flat on your stomach, is not recommended. Sleeping on your side, or in a foetal position can help with the pain. You can place pillows or cushions between your legs if you are on your side, or under your stomach if you are lying face-down, to try to alleviate the pain and be able to rest. 


To what extent do our shoes influence back pain?

They can make it worse if you don't use adequate footwear. You should use comfortable shoes, with a snug fit, least a 2 cm sole, and a wedge heel. Shoes should never be totally flat.


As well as regular physical activity and good posture, are there any other things we can do to prevent back pain?

The most important things would be to keep a correct height/weight ratio, eating well and also another recommendation would be to work in an adapted environment.


Is there a specific exercise to prevent back pain?

Yes, there are specific exercises. In general, any that strengthen the abdominal area. It is best if these are prescribed by a professional in that field, since they really do need to be adapted to each person’s morphology. As a general recommendation, you can find exercises, for example, on the website for the Sociedad Española de Rehabilitación y Medicina Física (Spanish Society for Rehabilitation and Physical Medicine), under the “Exercises” header.


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