Back pain is one of the UK’s most common disabling health conditions. But according to physiotherapist Nick Sinfield, overcoming the problem is a mental, as well as physical, challenge. Lisa Salmon reports

IF you’ve never had a bad back, consider yourself lucky. However, chances are you’ll experience it to some degree in the future, as four out of five UK adults, including celebrities such as Victoria Beckham and the former Dr Who, David Tennant, have back pain at some stage in their lives.

It’s a huge problem, costing the NHS £1.3m a day, and the UK economy £37m a day, with about one per cent of the working population off sick due to back pain every day.

The charity BackCare says: “Back pain doesn’t kill, it tortures.”

This won’t be the case for everybody, of course.

For many people, the pain will only be mild or will improve or disappear quickly. For others, though, it is a debilitating, chronic condition which can have a huge impact on quality of life.

However, physiotherapist Nick Sinfield is eager to point out that relief could be out there – providing people look after both their backs and their mindsets. In his new book, Now I Can Bend My Back!, Sinfield says that much of the problem is tension related pain (TRP).

“If people feel some back pain and it doesn’t subside and they aren’t given an answer to its cause, they may become worried, confused, and anxious about it,” he says. “This, in turn, may cause more tightness in the soft tissues around the back and neck, especially as people concentrate on the pain, which is commonly TRP.

“This soft tissue tightness to the muscles and connective tissue can cause lingering pain or chronic back pain.”

Sinfield says TRP will affect people differently, and the level of pain will vary from individual to individual. But if sufferers acknowledge and deal with TRP, and look after their backs by doing regular stretches and core strength exercises, the torture of back pain can be avoided by many.

Most back pain is mechanical – connected to muscles and joints, rather than discs or nerves – says Sinfield, and he advises: “People need to get to know their bodies so they can self-manage their back pain. They need to learn about their back and manage the confusion and anxiety about it so that they’re in control.”

While TRP is very common, he acknowledges that it’s not the only cause of back pain. However, while injury and structural issues such as disc problems or a simple strained muscle can cause acute symptoms, in the vast majority of cases this should settle in time.

According to BackCare, 90 per cent of people with acute pain will recover within six weeks.

But Sinfield believes that often after a medical diagnosis, people become stressed and frightened that they will hurt their back further.

“This accumulation of anxiety and stress causes the arrangement of your muscles, nerves, tendons and ligaments to tighten and change,” he says, “and it’s these changes that cause your back pain to flare up and recur again and again.”

He believes that even structural abnormalities such as herniated discs, low back and shoulder pain can be linked to TRP, and advises sufferers to identify stress and tension in their lives, which might be anything from financial and work pressures to family conflict.

Accepting that the pain has an emotional root and changing behaviour and thought patterns, together with exercising to stimulate blood flow and oxygen to areas of pain, can help, he says.

SINFIELD suggests exercises ranging from postural awareness tasks and breathing exercises, to stretches and low back and neck strengthening activities, which can be slotted into an existing exercise programme, or perhaps done for ten to 15 minutes every other day.

“Muscles can get imbalanced, some become tight and others become weak,” he says. “With core stability exercises you’re aiming to rebalance them.

“I think huge numbers of people, particularly in the construction industry, just put up with bad backs and soldier on. But if they do a few stretches and some core stability, self-manage their backs and change their mindset, they can avoid these problems.

“I want to change the way people look at the situation and give them more confidence to start exercising.”

Dr Adam Al-Kashi, BackCare’s head of research, agrees that tension and worry can have a big impact.

The charity has funded research into negative thinking and back pain that showed people prone to worrying were less likely to recover.

“Acute pain is an important indicator of tissue damage,” he says, “but once the pain becomes chronic, while it feels identical it’s actually driven in a completely different way by the central nervous system, via the mind.”

He would like to see body strength exercises “become the new jogging” and advises people to try calisthenic exercise such as yoga or pilates.

  • For more information about back pain, visit BackCare at backcare.org.uk, or call the helpline on 0845-130-2704
  • Now I Can Bend My Back! (Back Pain Company, £12.95).