Doctor in the House: How to manage back pain
Nearly 10 million working days are lost each year for adults aged 25-64 due to back pain - and around 80% of us will suffer from back pain at some point in our lives.
The financial cost to the UK economy is estimated to be around £12bn per year, plus there are huge personal and emotional costs.
In BBC One's Doctor in the House I help 42-year-old Mark, who works in retail. A former athlete, Mark has suffered from back pain for over 20 years and this has caused him significant problems.
Most cases of back pain are self-limiting and probably go within a few weeks. Mark was different.
He had chronic back pain and this had lasted for years. He has had to take time off from work, which has impacted his family's financial situation, and he's even had to stay in hospital because his pain has been so severe.
So what causes back pain?
It is always important to rule out specific causes such as cancer, infections and fractures, so seek advice from a medical professional if you're concerned.
Thankfully, the vast majority of back pain cases have no sinister cause and are called non-specific, and there are a wide variety of therapies that can be useful.
The National Institute for health and Care Excellence (NICE) guidelines encourage sufferers to continue with normal activities as much as possible. Unfortunately for Mark, this was not possible.
He used to do mixed martial arts classes every week with his son, Kiki, but had to give this up because of his pain. This was upsetting for them both.
After spending time with Mark, I identified some key areas that I felt were playing a role in his back pain - mechanical, psychological and biochemical. My treatment plan involved tackling them all.
I first examined Mark's feet and noticed they were not symmetrical - this is like a building with a wonky foundation. I knew that this was likely to be a contributing factor to Mark's back pain so I took him to see a movement specialist.
He looked at Mark's full history. Mark had an injury to his right knee and had broken his leg when he was five years old. Both these factors may have contributed to Mark's back pain.
The therapist assessed Mark's movement patterns and identified muscles that were not working as efficiently as they should. He also assessed Mark's stability and flexibility. He identified a reduced range of motion in his right leg and overuse of his left.
He recommended a series of movements for Mark to perform several times per week. These were personalised for Mark.
He said: "Just by speaking to a movement specialist and them looking at the way I walked, they could tell that it was my left side that was overcompensating for my right.
"Doctors and specialists I'd seen in the past hadn't recognised this, and it was only Dr Chatterjee's completely different approach that flagged this as one of the possible reasons for my back pain.
"Seeing the movement specialist has definitely helped and what I've realised from this process is that there are other ways of improving your health and any conditions you have, if you know how."
In addition, Mark suffered from huge amounts of stress. Financial worries, concerns over employment and resultant insomnia meant that Mark was carrying a lot of stress around with him. Stress can modify our perception of pain through its action on the brain.
To combat Mark's stress, I taught him various ways in which he could actively de-stress, such as making time for himself, listening to music and meditation.
In addition, I sent him to try Tai Chi. Mark already had a love of martial arts so I felt it would be an activity he'd enjoy. Tai Chi is a low impact form of exercise known as a "moving meditation" and combines slow, purposeful movements with controlled breathing.
Mark had very low levels of Vitamin D, which is an important nutrient for bone health. Our main source is from the action of sunlight on our skin although we can get some from foods such as oily fish and eggs. Many of us struggle to get enough from food and require supplementation.
People with dark skin are at higher risk of being low in Vitamin D. Mark felt a reduction in pain once I corrected his Vitamin D levels. I have many patients who have seen similar improvements.
A combination approach
The 2016 NICE guidance on the management of back pain recognises that a combination of approaches may be necessary to treat back pain - exercise, psychological therapies as well as manipulative therapy.
In my 15 years of clinical experience, I have found that different patients have different triggers. Therefore, it stands to reason that the success of a treatment regime may vary from person to person.
I used a combination of approaches with Mark. Within a few weeks he was back doing mixed martial arts classes with his son. Two months later, he was riding his bike and using a cross trainer for 30-minutes every day.
The bane of back pain
The key to managing back pain is to understand what the causes are for you. I suffered with back pain for 10 years and tried many different therapies that would give me short term relief.
It was only when I saw movement specialist, Gary Ward (who featured in Doctor in the House series 1), that my pain went away for good. He helped me to re-train my movement patterns.
Here are some simple tips that may help you with your back pain.
1. Get up regularly from your desk
Set an alarm once every hour to remind you to get up and move around. Perhaps try a standing desk, a different chair or even a Swiss ball.
2. Prioritise active relaxation
This could be meditation, yoga, or simply going for a walk.
3. Find a regular form of activity that you enjoy
You are much more likely to engage with an activity long term if you enjoy it. I suggested Tai Chi to Mark because he loved martial arts.
4. Try and be as active as possible
Don't underestimate the benefits of regular walking.
Watch the full episode of Doctor in the House
Monday, 21:00 BST on BBC One.