Frequent Asking Questions (FAQ)
1. What are the causes of back pain?
- In over 90% of patients, pain is due to complaints in the back
itself. These are known as "mechanical complaints" and are the
subject of this Web Site.
- They are recognized because pain varies according to posture,
movement and effort, and is not accompanied by any sign of
general disease, such as fever or weight loss.
- Most of the "mechanical" complaints are caused by the deficient
performance of the back musculature. On other occasions, these
may be due to structural
lesions of the components
of the spine, such as fractures,
protrusions or hernias of the intervertebral disc or wear
and tear in the facetary
joint. In some cases, it is impossible to determine the
origin of the pain with accuracy.
- The pain caused by mechanical complaints is due to the
activation of pain-transmitting nerves, and may go hand in
hand with muscular contracture and swelling. If you are interested
in learning how such mechanisms are triggered, click
here.
- In other cases, which are much less frequent, pain is not due
to a back complaint, but rather to a general disease manifested
therein, such as cancer or an infection.
- In these cases, signs of general disease may be present,
such as problems in joints or bodily organs, fever or weight
loss. The influence of posture, movement and effort is often
less evident. Back pain due to general disease requires specific
treatment for the cause, and pain does not improve with treatments
indicated for mechanical complaints.
- Within their rarity, the most frequent causes are inflammatory
diseases (such as ankylosing spondylitis, or Bechterew's disease),
certain types of cancer or infections of the intervertebral
disc, the vertebra or nearby
organs - such as the kidney - and vascular diseases - such
as aortic aneurysm.
2. How is back pain treated?
Many treatments have been suggested, but few have been evaluated
in a rigorous manner and fewer still have shown to be effective.
The treatments
section of this Web site includes a detailed description of
the basis, effectiveness - or ineffectiveness- tests and indications
of all treatments for back pain.
The section "recommended
treatment" includes a description of the strategy combining
those procedures of proven efficacy recommended by current scientific
evidence.
3. How can back pain be prevented?
The section on "How
to avoid pain" in this Web site includes a detailed description
of how to prevent back pain. Namely:
- Always keep yourself physically
active within your possibilities.
- Follow the rules
of postural hygiene when adopting postures, making efforts
and performing various types of activities.
- Exercise
so as to maintain the musculature involved in the working order
of the back in good condition.
4. Is it advisible to consult a physician for
back pain? In which cases?
It is necessary to consult a physician in the event of any of
the following:
- If it is the first time that you suffer from back pain, in order
to discover the origin of the pain and confirm that this is a
"mechanical" complaint, that is, a back complaint not related
to general disease manifesting therein, or
- If the characteristics of the pain vary with regard to previous
episodes, in order to confirm that it continues to be a mechanical
complaint, or
- If the pain should spread toward your arm or your leg, or is
accompanied by loss of sensitivity or strength, in order to determine
whether it is caused by compression of the nerve, or
- If a painful episode is particularly intense, or should persist
for a week, in order to indicate suitable treatment.
- It is necessary to urgently consult the physician, in
the event of any one of the following:
- Pain is accompanied by a loss of sphincter control of loss
or sensitivity in "saddle" area - genital area and inner side
of the upper part of the thigh-, or
- Loss of strength in arms of legs, with or without pain, or
- Onset of fever of other signs of general disease
In principle, it is not necessary to consult a physician if it
is a renewed pain episode with simultaneous appearance of all the
following circumstances:
- Its location and characteriscs are identical to previously
diagnosed episodes and are being treated by a physician, and
- Its onset is due to a clear and habitual trigger, and
- It is not intense and improves or disappears within a few days
with usual treatment previously indicated by a physician.
Nevertheless, if in doubt, it is always better to consult, even
when not necessary, than to assume the risk of not consulting when
it should be necessary.
5. How do frequently used postures influence back
pain?
Essentially, these may force the musculature to overexert itself,
or increase the load borne by the spine to the point of erosion
or lesion. In both cases, the stronger, the more symmetrical and
the better trained the musculature, the lesser the risk of suffering
from back pain.
For instance, spending much time seated, as well as the adoption
of incorrect postures, are some of the factors which increase the
risk of suffering from back pain.
A detailed description of the methods applied to reduce the risk
of back pain by performing differents kinds of activity is included
in the subsection "Postural
hygiene" in the section "How
to avoid back pain", and analysis of the factors which affect
some specific groups may be found under the sections "Sedentary
people", "Expectant
mothers", "Workers"
and "Computer
addicts".
6. Which are the correct steps to be taken when
working with a computer?
It is important to watch the position of the screen, the keyboard
and the mouse, the height of the chair and its back, and advisable
to change position, to get up, to stretch and walk a few steps approximately
every 45 minutes.
In the subsection "Working
with computers" in the "Postural
hygiene" section in this Web site, details are included on the
steps to be taken in order to reduce the risk of suffering from
back pain when carrying out this activity.
7. Does pain in the hip have anything to do with
the back?
They may sometimes be related:
- Some forms of back pain may be referred to the hip area. In
this case, the patient feels pain in this area despite the origin
being in the back.
- Other times back pain may spread toward the buttocks or hips.
In these cases, the patient feels pain in the back and in the
hip area.
- On the other hand, and although not proven, many physicians
believe that some chronic hip complaints, such as osteoarthritis
in the hip, may cause postural defects and imbalances in the load
distribution when standing and walking which, in the long term,
may increase the risk or suffering from back pain.
Nevertheless, back complaintss and hip alterations which cause
pain are intrinsically different complaints. They may be present
separately, or coincide in one same patient although not mutually
related.
8. Does the weather affect back pain?
Some patients with back pain state that they feel more pain when
the weather changes. One explanation may be the variation in atmospheric
pressure. Within the joints, including the facetary
joint there is a vacuum (zero pressure). This vacuum helps the
bones to stay together. The fall in atmospheric pressure may produce
a suction effect which aggravates the inflammation in the area.
This would explain the onset or aggravation of pain when atmospheric
pressure is reduced, that is, a few hours before the weather changes.
On the other hand, in those cases in which pain is due to an organic
alteration of the spine, weather variations may help to increase
the pain felt by the patient, but do not aggravate the alteration
which causes such pain.
9. Which are the correct postures when sleeping?
The characteristics of the resting surface may be as important
as the postures.
The subsection "Back care while lying down" in the section
"Postural
hygiene" in this Web site includes a detailed description and
illustrations on the most suitable sleeping postures and the criteria
to be met by the resting surface in accordance with the consensus
of specialists in this field, although no reliable studies exist
as yet in this regard.
10. Which are the correct postures when studying?
The subsection "Back care while sitting" in the section
"Postural
hygiene" in this Web site includes a detailed description and
illustrations on the most suitable postures when seated and the
criteria to be met by the chair in accordance with the consensus
of specialists in this field, although no reliable studies exist
as yet in this regard.
11. Do legs influence back pain? In what way?
They may influenceit in several ways:
- The different length of the legs (known as "heterometry of lower
limbs) may cause scoliosis
postures -lateral deviation of the spine-. In the past, heterometry
and scoliosis were believed to always cause back pain, but today
we know that scoliosis neither causes nor increases the risk of
suffering from back pain unless it is significant -above 60º-.
Likewise, heterometry does not cause back pain when the difference
between the length of either leg is less than 1 cm. It is acknowledged
that, if the difference exceeds 2 cms., the risk may be increased,
and it is doubtful whether this is the case in differences falling
between 1 and 2 cms. Although the studies carried out have not
proven that back pain is reduced by placing a raised insole in
the shoe of the shorter leg, this is usuallly recommended for
those heterometries which exceed 1 cm., to be removed if this
should have no effect or prove counterproductive.
- On the other hand, the lack of a strong, resistant, trained
and flexible musculature in the legs may increase the risk of
suffering from back pain. The ischiotibial
muscles -muscles in the back part of the thigh, which allow
the knee to be bent -and the glutea
-muscles in the buttocks which allow the thigh to move backward
and straighten the back upon the pelvis- are involved in the correct
performance of the back. Furthermore, if the quadriceps is underdeveloped
or under-trained -muscle in the front of the thigh which allows
the knee to stretch-, it is easy to adopt incorrect postures when
bending or standing, thus forcing the back musculature to exert
more effort than is necessary, therefore increasing the risk of
suffering from back pain.
12. Which preventive steps may be taken when
additional weight is frequently carried?
Load handling has proven to be one of the risk
increasing factors in suffering from back pain.
In order to reduce such a risk, it is effective to:
- Keep back musculature strong and trained. This increases the
strength of the back, its structural resistance to the load and
the musculature coordination which allows weight to be supported.
- Handle the load with correct strategies and postures, which
aim to reduce the pressure on the spine and the effort to be made
by the back musculature. In the subsection "Back care when
lifting weight" under the "Postural
hygiene" section in this Web site, the most suitable ways
to handle loads are described in detail with illustrations.
13. Is it bad to carry a back pack every day?
Depends on the amount of weight carried and existing alternatives:
- The weight carried in the back pack should not exceed 10% of
subject's weight. Schoolchildren who carry their textbooks to
school usually exceed this limit. In this case, the method of
transport is not as damaging as the excessive weight.
- Whenever possible, it is best to avoid carrying the load. For
instance, school lockers would be a good solution.
- If weight must be carried, it is best to keep the back from
carrying the load. A satchel on wheels, allowing the load to be
pulled rather than carried, is the best option, particularly if
its design allows adjustment to the subject's height and to be
pulled in an ergonomic and comfortable manner.
- Should a satchel on wheels not be possible, carry the backpack
in the centre of the back, hanging from both shoulders, as close
as possible to the body and fixed to the back; this is better
than carrying the weight on one shoulder or from one arm.
14. What is the Kovacs Foundation?
The Kovacs Foundation is the promoter and coordinator of the Web
of the Back. It is a Spanish non-profit organization, devoted to
scientific research, health care and promotion of public health.
It specializes in back complaints and 297 physicians from 12 countries
participate in its projects.
Its institutional web site (www.kovacs.org) includes detailed
and updated information on its members and activities.
15. Why do they maintain this page if there is
no commercial objective and it is free of charge?
Because this is one of the public health promotion programmes
of the Kovacs Foundation, as a Spanish non-profit organization.
The aim of this page is to:
- Provide physicians with updates via its scientific
area.
- Provide and disseminate to the non-medical population the widest,
most reliable and most current information on the back and its
complaints, with the aim of teaching how to prevent and handle
them.
This page has no commercial objectives because the Kovacs Foundation
is a non-profit organization. It is free of charge:
16. Why is advertising included in the page?
The objective of advertising is to allow the maintenance of the
Web keeping it free of charge for its users, and the aim of this
zero-cost policy is:
- To stimulate the widest dissemination of information provided
in the Web of the Back, and
- To allow the contents on the Web of the Back to be accessible to all
those who may need them with no financial limitation. Its universal
accessibility and bilingual nature (Spanish/English), render it
particularly important in updating physicians' knowledge and that
of the population at large in developing countries.
As a result, the Kovacs
Foundation and other institutions which co-sponsor the Web of the Back -Spanish Red Cross, ONCE
and Flex- prefer to support the
costs of maintaining the page as well as the work of the 84 staff
involved in the page via advertising and sponsorship, instead of
charging users for the information.
17. Who are the specific experts in charge of
evaluating the studies published on the page?
In the section on credits in the scientific
area you will find the names of the experts who participate
in each of the phases of detection, selection, evaluation, summary
and translation to which each study referring to back complaints
is subjected, as well as that of the members of the Editorial Committee
in charge of the supervision and control of the process and quality
control mechanisms.
These are mainly experts in medical documentation and research
methodology.
In the section on credits in the
scientific area you will find the names of the experts who participate
in the preparation and supervision of the contents in the information
area, as well as the sources on which this is based.
These are mainly experts in the clinical handling of back complaints
who, using non-technical language, compile and summarize the results
of the studies selected in the scientific area.
18. What is your opinion on acupuncture?
In the subsection "acupuncture",
under the "Treatments
suggested for back pain" section you shall find the most reliable
and current information on acupuncture and its application in back
complaints.
To summarize, scientific studies carried out preclude us from
stating the effectiveness of acupuncture in the treatment of back
complaints.
19. What is your opinion on reik?
No scientific studies have been found which evaluate the effectiveness
of reik in the treatment of back complaints, and thus we lack the
information to respond.
20. Is back surgery dangerous?
In the subsection "Surgery
of the spine" in the "Treatments"
section you will find the most reliable and current information
on the risks and indications of surgery of the spine.
Generally, back surgery carries the inherent risk of all surgery.
The risk of complications, such as infections of hemmorrhages is
below 2%, with risk of death being even lower. The main risk is
that the operation is ineffective, and the way to prevent this is
to perform surgery only on those patients who present signs which
suggest its suitability thereof.
The section "organic
alterations of the spine column" includes the criteria which
advise surgical intervention in the smaller percentage of cases
of disc
herniation, spinal
stenosis, spondylolisthesis
or scoliosis.
Generally, surgery is indicated in less than 1% of patients with
back complaints.
21. Which are the best drugs available for back
pain?
In the subsection "Pharmacological
therapy" under the "Treatments"
section you will find the most reliable and current information
on the effects, risks and indications of the drugs used for back
pain, and in the section "Treatment
recommended guidelines" you will find the subsequent guidelines
that are suggested.
By and large, analgesics and non-steroid anti-inflammatory medication
or muscle relaxants are used for back pain.
Nevertheless, in many countries it is legally required and, in
any case, this is always best for your health, that it be a physician,
and only a physician, who should evaluate the indication of a drug,
should prescribe it and should assess its effects. He/she is the
only expert on your health who has the necessary training to do
so and lacks any financial motives influencing his/her advice.
22. When should one take medication?
In the subsection "Pharmacological
therapy" under the "Treatments"
section you will find the most reliable and current information
on the indications for the different types of drugs used for back
pain, and in the section "Treatment
recommended guidelines" you will find the subsequent guidelines
that are suggested.
Medication is generally indicated in acute episodes of pain, when
it is sufficiently intense or limiting so as to justify the side
effects and risks, or during periods when chronic back pain is exacerbated.
The use of drugs should be as brief as possible, since scientific
studies prove that their lesser use thereof is associated with a
greater effect when used, a reduction in the risk of side effects
and a lower risk of chronification of the complaints.
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