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Lower & Upper Back Pain

Male smiling after being pain free from headache

Lower and Upper Back Pain

What is lower back pain?

Back pain is an incredibly common condition. It is estimated to affect 1.8 million Australians (9.2% of the population) with an estimated 70-90% of these people suffering from lower back pain (which can also be identified with sore lower back) at some point in their life.1 Lower back pain can be significantly detrimental to an individual’s quality of life and those who care for them.2

The best way to understand back pain is to have a comprehensive idea of how the spine works. The spine is structured such that movement and flexibility are emphasised without compromising bone structure.3 Vertebrae (spinal bones) are connected by pairs of small joints that help guide our movement. There are also ligaments that assist in holding the spine together and the layers of muscles surrounding the spine provide structural support and allow movement.4

Lower back pain refers to the problems associated in the lumbar region (lower back) of the spine affecting the complex, interconnected network of muscles, nerves, bones, discs or tendons.5 Lower back pain affects people of all ages. It can cause sore lower back pain for days, weeks and sometimes it can be ongoing.6

What is upper back pain?

Upper and middle back pain (which is similar to upper back muscle pain) is not as common as lower back pain because the range of movement in the upper part of the spine is significantly limited compared to the lower part of the spine.7 Pain in the upper back can effect anywhere from the base of the neck to the bottom of the rib cage.8 The upper and middle back (thoracic spine) contains:9

  • 12 vertebrae that attach to the rib cage
  • Discs that separate each vertebra and help absorb shock
  • Muscles and ligaments that help hold the spine together

The upper spine and ribs help stabilise the back whilst protecting vital organs such as the heart and lungs.10

What are the symptoms of lower back pain?

Lower back pain symptoms can last for several weeks, but the severity, longevity and frequency is dependent on the individual.11 The signs and symptoms of lower back pain may include:12,13

  • Difficulty moving, preventing individuals from walking or standing
  • Limited movement of torso
  • Pain that moves around the groin, buttock, upper thigh but does not radiate down to the knee
  • Pain that is achy and dull
  • Muscle spasms
  • Tenderness upon touch
  • Reduction of reflexes
  • Nerve compression

What are the symptoms of upper back pain?

Similarly, to lower back pain, upper back pain can cause a range of symptoms that can impact daily life. Common symptoms of upper and middle back pain include:14

  • Dull, burning or sharp pain
  • Muscle tightness or stiffness

What are common lower back pain causes?

Often, back pain is caused by a strain on the soft tissues (muscles, ligaments or tendons) rather than serious damage to the spine.15 However, lower back pain is often defined as a ‘non-specific’ problem, meaning the lower back pain cause unknown or certain.16 Below are a few causes for specific lower back pain and potential causes for non-specific lower back pain.

Non- Specific Lower Back Pain Causes17,18

  • Poor posture
  • Manual handling (due to heavy lifting)
  • Sedentary lifestyle
  • Sprains and strains
  • Traumatic injury

Other lower back pain causes can include:19

  • Irritation of large nerve roots between the lower back and the legs
  • Irritation of smaller nerves that supply to the lower back
  • Strained lower back muscles
  • Damaged bones, ligaments or joints

What are the common upper back pain causes?

Common upper back pain is usually due to either de-conditioning (lack of strength), and possibly even overuse injuries (such as repetitive motions using the upper back). Upper back pain may also be caused by joint dysfunction (such as an injury to the upper disc in the back).20

There are also a range of triggers that cause upper back pain. Upper back pain may be caused by: 21

  • Muscle strain, injury or overuse of spinal muscles, ligaments or discs
  • Sports injuries that affect the upper back
  • Poor posture
  • Spinal nerve pressure (i.e. herniated disc)
  • Fractured vertebrae
  • Osteoarthritis (breakdown of cartilage that helps cushion small joints in the spine)
  • Myofascial pain (affects the connective tissue of a muscle)

How is back pain diagnosed?

A thorough examination by your doctor will determine whether further investigation needs to be conducted or whether appropriate treatment and management regimes need to be put in place to manage the lower back pain or upper back pain.22 In most circumstances, the doctor will:23

  • Ask about your back (causes or triggers for the pain, prior back pain, what makes the pain worse and what makes it better)
  • Conduct a thorough physical exam
  • Refer you for further testing, if required

It is important to note that in most back pain cases, imaging (x-rays, CT or MRI scans) are not useful or recommended.24

What different options available for lower back pain treatment?

There are a range of treatment options available to provide lower back pain relief for sufferers. For non-specific lower back pain, the current treatment recommendations include:25,26

  • Wait out the pain – most lower back pain is not serious and will get better with time
  • Move early and avoid prolonged bed rest
  • Space your activities
  • Stay active
  • Use hot or cold packs
  • Use NSAIDs to help relieve pain and inflammation (e.g. ibuprofen)

For more persistent lower back pain, below are a few treatments that can help provide lower back pain relief: 27

  • Supervised exercise therapy (e.g. physiotherapist or exercise physiologist)
  • Cognitive behaviour therapy (Working with a health professional to help change unhealthy habits)
  • Multidisciplinary pain management (Specialist pain physicians, physiotherapists, occupational therapists and psychologists)
  • Some medications (e.g. ibuprofen)

Surgery is rarely used as an appropriate method to treating back pain.28

What different options available for upper back pain treatment?

Because of the nature of the upper back pain causes (upper back muscle pain causes), upper back pain treatment options would usually include strengthening exercises and stretching exercises for the upper back muscles. The upper back pain is usually linked to muscles of the shoulders which is why strengthening these will help manage the pain longer term.29

Specialists such as a chiropractor or a osteopathic physician may be consulted to seek the appropriate treatment of upper back pain.

Upper back pain may also be caused by specific trigger points. These areas are usually very tender. These trigger points are usually located in a skeletal muscle and can be worked on by either one or a combination of the following upper back pain treatments:

  • Massage therapy
  • Acupuncture
  • Pain medications can also be helpful. Muscular irritation usually includes some form of inflammation, so non-steroidal anti-inflammatory medications or NSAIDs (such as ibuprofen) can be helpful to reduce the inflammation.

. How can I manage my back pain?

With majority of people suffering lower back pain at some stage in their life, it is important to know how to self-manage and protect your back’s lumbar region from further damage.30

The most effective treatments to manage lower back pain comprises of things you can do yourself, such as:31

  • Staying active
  • Remain positive about recovery
  • Learn more about your back pain (i.e. what makes it better or what makes it worse)
  • Consult a physiotherapist or exercise physiologist if you need specific advice
  • Manage stress levels
  • Staying involved (i.e. leisure and social activities)
  • Aiming to stay at work
  • Be aware of posture

Having an ongoing discussion with your GP or pharmacist can also help when trying to manage lower or upper back pain.

What are the dangers of having lower back pain?

It is rare for lower back pain to cause serious medical problems and for most people, the back pain settles down quickly.32 Nine out of 10 people will recover from lower back pain after two months and between attacks, those suffering will have little symptoms.33

However, people suffering from consistent back pain can develop a fear of movement assuming it’ll increase their pain.34 Those living with persistent lower back pain can experience mood issues such as anxiety, irritability, and frustration.35

Lower back pain is manageable and it is important to learn how to prevent them from reoccurring.

When should I see a doctor?

Visiting a doctor is recommended when the pain does not improve or subside over time or if you have any other unusual symptoms, for example: 36,37

    • Fever
    • Difficulty passing urine
    • Losing weight
    • Problems controlling your bladder
    • Weakness
    • Numbness or pins and needles in legs

    Some important questions you can ask your doctor about your back pain include:38

    • What are my treatment and management options?
    • What are the benefits and risk associated with the treatment options that exist?
    • How can I relieve my pain?
    • If I need a pain reliever medicine, which one is the best for me?
    • What should I do if the pain is ongoing and I get other symptoms?

    References:

    1. 10Cavanagh & Weinstein. “Low back pain: Epidemiology, Anatomy and Neurophysiology.” In: textbook of Pain, Wall D. & Melzack R. (eds) Churchhill Livingstone, 10994

    References:

    1. 1Health Direct, Back Pain, [Accessed 18 January 2017] https://www.healthdirect.gov.au/back-pain
    2. 2Department of Health WA, Low back pain, [Accessed 18 January 2017] http://healthywa.wa.gov.au/Articles/J_M/Low-back-pain
    3. 3 Better Health, Back Pain, [Accessed 18 January 2017]https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    4. 4 Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    5. 5 Spine-Health, Lower Back Pain Symptoms, Diagnosis and Treatment, [Accessed 18 January 2017] http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment
    6. 6Health Direct, Back Pain, [Accessed 18 January 2017] https://www.healthdirect.gov.au/back-pain
    7. 7WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017] http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    8. 8WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017] http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    9. 9WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017] http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    10. 10WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017] http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    11. 11 Arthritis Australia, Back pain, [Accessed 18 January 2017] http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2012/Back_pain.pdf
    12. 12 Better Health, Back Pain, [Accessed 18 January 2017]https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    13. 13Spine-Health, Lower Back Pain Symptoms, Diagnosis and Treatment, [Accessed 18 January 2017]http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment
    14. 14WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017] http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    15. 15 Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    16. 16NPS Australia, What is acute low back pain?, [Accessed 18 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/low-back-pain/for-individuals/pain_back_acute_low
    17. 17 Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    18. 18WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017] http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    19. 9National Institute of Neurological Disorders and Stroke, Low Back Pain Fact Sheet, [Accessed 18 January 2017] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet#3102_3
    20. 19 Spine-Health, Lower Back Pain Symptoms, Diagnosis and Treatment, [Accessed 18 January 2017] http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-diagnosis-and-treatment
    21. 20 Spine Health, All about upper back pain [Accessed 24 April 2017] http://www.spine-health.com/conditions/upper-back-pain/all-about-upper-back-pain
    22. 21 WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017]http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    23. 22Department of Health WA, Low back pain, [Accessed 18 January 2017]http://healthywa.wa.gov.au/Articles/J_M/Low-back-pain
    24. 23Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    25. 24Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    26. 25Department of Health WA, Low back pain, [Accessed 18 January 2017] http://healthywa.wa.gov.au/Articles/J_M/Low-back-pain
    27. 26National Institute of Neurological Disorders and Stroke, Low Back Pain Fact Sheet, [Accessed 18 January 2017] https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet#3102_3
    28. 27 Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    29. 28WebMD, Upper and Middle Back Pain, [Accessed 02 February 2017]http://www.webmd.com/back-pain/tc/upper-and-middle-back-pain-overview
    30. 29Spine Health, All about upper back pain [Accessed 24 April 2017] http://www.spine-health.com/conditions/upper-back-pain/all-about-upper-back-pain
    31. 30 Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    32. 31Better Health, Back Pain, [Accessed 18 January 2017]https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    33. 32 Arthritis Australia, Back pain, [Accessed 18 January 2017] http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2012/Back_pain.pdf
    34. 33Arthritis Australia, Back pain, [Accessed 18 January 2017] http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2012/Back_pain.pdf
    35. 34Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    36. 35 Better Health, Back Pain, [Accessed 18 January 2017] https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/Back%20pain
    37. 36NPS Australia, What is acute low back pain?, [Accessed 18 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/low-back-pain/for-individuals/pain_back_acute_low
    38. 37Arthritis Australia, Back pain, [Accessed 18 January 2017] http://www.arthritisaustralia.com.au/images/stories/documents/info_sheets/2012/Back_pain.pdf
    39. 38NPS Australia, What is acute low back pain?, [Accessed 18 January 2017] http://www.nps.org.au/conditions/nervous-system-problems/pain/for-individuals/pain-conditions/low-back-pain/for-individuals/pain_back_acute_low