Back pain in Canada
by Dr. Brian S. Seaman, DC, FRCCSS(C), FICC

Back pain?

Did you know that 80% of people have at least one significant episode of back pain during their life time??  That’s right!

And back pain affects the time spent with their families and friends – that means you miss out on some quality time with your children and grandchildren.

So what do you do for back pain?  The most frequent comment I hear is “I thought it would goaway”.   But when you realize that back pain can persist for more than a few days, and affect your daily activities, it is time to do something about it.

Admittedly, you may be unsure as to when you should pick up the phone and call your health care professional.  When asked by patients, I will often suggest a “three day rule”.

Day 1

  • Take charge of your back pain.
  • Do not try to work through it – you may only be making it worse.  Take a break from any physical or strenuous activity which you may be doing.
  • If you are at work, sitting or driving, take a break; move around or go for a short walk.
  • Use ice or a cold pack on the area of the back pain, for periods of 15-20 minutes several times a day.  This will help to reduce any irritation or inflammation of the joints and muscles as well as to help ease your pain.

Day 2

  • Continue with the advice from day one.  If the pain is getting worse, take more frequent breaks from sitting (which increases the pressure on the discs in your back) and increase the frequency of using ice therapy.
  • Depending upon severity of the back pain, give serious consideration to contacting your health care professional for an appointment.

Day 3

Okay, by now you may be realizing that the back pain is not going away.  It may be getting worse and if it is causing pain, tingling or numbness down your legs, these are not good signs.  It is definitely time to call your health care professional for an appointment.  Delaying the decision to make an appointment can result in more pain and limitations in your activity level.  Plus, at the very least you will not have to be one of those patients who says “I thought it would go away”.

By the way, remember that exercise program that your health care professional gave you after the last episode of back pain?  The one that you have not been doing?  Be cautious about starting it once the back pain has reoccurred – it may aggravate your condition.  Human nature is such, that it is estimated that only 20% of patients continue with their prescribed exercise programs beyond a period of six months.

Heat versus ice?

A common question which I am asked, is whether you should use heat or ice for back pain.  For the vast majority of my patients, I have found that ice therapy is more beneficial.  Ice will help to reduce the irritation and inflammation often associated with causes of back pain which can include disc injuries, muscle strains, ligamentous sprains or joint problems (also referred to as mechanical type back pain).  By decreasing the inflammation, you will help to ease the pain and assist in your recovery.

While heat will undoubtedly make you feel more comfortable and is soothing, it can also cause a reactive inflammation of the tissues which in turn can prolong your episode of back pain or make it worse.  I have come across some literature which was done on ankle sprains which concluded that ice was superior to heat even with an ankle injury that was several weeks old.

When thinking about heat versus ice, one analogy which I often use with patients is think back to the last sunburn that you had.  When you go to get in the shower the next morning, how does your back feel if you put hot water on it?  It is not very comfortable is it?  Generally, a cold or cool shower will help to sooth the pain of a sunburn.  It is no different than burning your finger in the kitchen – you quickly put the finger under the tap of cold water; not hot.

The other problem with using heat is you may not realize it is aggravating your condition until it is too late.  I have examined many patients over the years with chronic back problems who use heat on a consistent basis; heating pads are especially troublesome.  There is a tendency to gradually increase the intensity of the heat as you get used to it.  Think again of being in the shower and gradually increasing the amount of hot water as you get used to the increased temperature.  I have actually seen second degree burns on patients’ backs, resulting from inappropriate use of electric heating pads.

With the small number of cases in which ice aggravates back pain, the patient can generally identify this within one or two applications of the ice.  In this case, the individual should consult with their health care professional as to whether heat would be indicated, or to not use either heat or ice.

I have seen cases where simply advising a patient to stop applying heat and switching to ice has made considerable difference in their pain levels.  This can make a significant difference in your day – decreased pain, you feel better, and you are able to resume some of your usual activities.

Treatment – What to do?

An  Environics survey in 2003,found that the most common health care professional consulted regarding back pain was a chiropractor (14%).  Physiotherapy was next (9%) followed by massage therapy (8%), family physician (6%), acupuncture (1%) and pain clinic (1%).

This is not surprising as research has shown chiropractic care to be effective and cost effective for back pain.  Back and spine disorders cost Canada an estimated 8 billion dollars annually in direct and indirect cost (Coyte et al. 1998). 

Preventing Back Pain

Always warm up your muscles before any strenuous or physical activity. 

  • Do strengthening exercises for your lower back, hips and abdominals on a regular basis (especially those prescribed by your health care professional).
  • Reduce and/or maintain a reasonable body weight.  Rule of thumb is that every extra pound of abdominal body weight is 15 lbs extra strain on your lower back!
  • Depending upon your previous history of back pain, periodic check-ups with your health care professional may be well advised to assess for any developing problems, and if your exercise program is still doing the job it was designed to.
  • Check with your health care professional about any foot or knee problems you may be having.  Changes in your gait mechanics (in other words, how you walk) can cause back pain.  Customized orthotics to correct any alignment problems in the feet may be indicated.

So as you can see, back pain can have a significant impact on your overall health can lifestyle.  Look after your back – it has to last you a lifetime.

Reprinted with permission of
The Seniors' Advocate. P.O. Box 5005, Waverly, Nova Scotia, B2R 1S2

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