Your teeth are clenched, your face is etched with pain and it's impossible to carry out your normal daily activities. You have back pain and you're not even sure what caused it. Close to 80 per cent of us will experience back pain at some point in our lives, and it's one of the most common reasons we end up at the doctor. Yet there are many things about back pain that are poorly understood. Here are some facts about back pain that will probably surprise you.
1. Back pain is not always caused by injury
Up to 50 per cent of us develop back pain without an injury.
Yes, stress to the back and accidents can result in soft-tissue injuries like strains and tears, as well as fractures and disc problems. And in the workplace, one in five serious compensation claims relate to an injury to the back.
But less obvious causes are when the spine's structures become sensitised due to other factors such as stress, low mood, anxiety and lack of sleep.
Getting enough sleep, regular exercise and taking steps to reduce and manage stress can help reduce the risk of back pain (and a host of other health problems too).
2. Back pain usually gets better by itself
The notion you might never recover and be pain-free again is understandably frightening.
But fortunately, almost all cases of acute back pain (back pain that comes on suddenly) will recover fully by themselves in weeks or months, even if your pain was severe to start with, musculoskeletal expert and back pain researcher Dr Chris Maher says.
You should see a doctor if:
The pain radiates down your leg
You have numbness, pins and needles or muscle weakness
It leads to abnormal bladder or bowel symptoms, is associated with unexplained weight changes, loss of appetite, fever or feeling unwell
You have chronic illness such as osteoporosis
You experience severe pain that doesn't improve within a week
3. Paracetamol is unlikely to help
For years, guidelines around the world have advised GPs to tell patients with back pain they should take simple paracetamol for pain relief.
But when this idea was put to the test for the first time in a large study, the results showed paracetamol actually didn't seem to help. It didn't speed time to recovery; it didn't improve pain; and it didn't improve the range of activities people could do.
There's also little evidence other popular over-the-counter painkillers known as anti-inflammatories (for example. ibuprofen) help back pain much either.
Manual pain-relieving therapy such as "pushing and prodding of the back" offered by physiotherapists, chiropractors, osteopaths and some doctors may offer some benefit though.
These professionals can also teach you how to modify everyday movements to help reduce pain.
4. Don't take back pain lying down
Many of us head to bed when back pain strikes, perhaps believing damaged tissues will heal faster if they're given a chance to rest.
But rest isn't as helpful to healing as we might think, Dr Maher says. In fact, studies have shown not only is complete or extensive bed rest unhelpful for back pain, it may actually delay your recovery.
"What we've learned is that most tissues recover more quickly from injury or trauma if they're gently loaded [used]," Dr Maher says.
"For all sorts of tissue injuries, we've discovered that complete rest is a bad thing."
Instead it's recommended you try to stay as active as possible.
"If you've got severe back pain you may find you have to split up your normal activities and take a break between them. That's fine. But don't rest more than an hour or two a day," Dr Maher says.
5. Back pain can be brought on by sustained stress
One of the side effects of stress is increased muscle tension. This can lead to fatigue, stiffness and localised pain. Constantly tight muscles can create imbalances in a person's posture that may cause misalignment of the spine.
Stress may also increase the risk of inflammatory diseases, which in turn can result in back pain (and other health conditions).
6. Back pain is more common in smokers
Smoking causes a number of problems that may potentially lead to back pain.
These are reduced blood flow to the spinal region (making it more vulnerable to injury), reduced bone mineral content, upset repair processes (leading to inflammation and back pain) and jarring from increased coughing caused by smoking.
It's yet another reason to quit.
7. Scans are unlikely to help
Getting an x-ray, CT scan or MRI to try to find out what's causing your pain might seem like a good idea.
But evidence shows such scans are often a waste of money as they don't help you get better faster and may pose risks by exposing you to radiation which can increase cancer risk.
They can also highlight abnormalities that could be completely unrelated to the pain, but which set off another spiral of investigations.
One study of 1,800 people with back pain found those who had imaging tests after reporting the problem fared no better, and sometimes did worse, than people who took simple steps like applying heat and staying active.
If there are 'red flags' or things get worse, imaging might then be appropriate. These include a history of cancer, unexplained weight loss, fever and a loss of feeling in the legs.