Talking back

The back is a complex structure consisting of a column of vertebral bodies, arches and intervertebral discs through which the spinal cord and nerve roots pass, supported by an array of muscles, ligaments and tendons. The complexity of the structure means the back is extremely vulnerable to injury through normal daily activities. Any impairment to the back is also likely to restrict an individual's lifestyle.

In the majority of cases, back pain will not impact on life or critical illness (CI) cover, however it can result in disability which may require time off work. This year alone, UK industry is expected to lose an estimated £5bn due to absence from work with back pain. Based on this fact it is not surprising to learn that back pain is the number one cause of sickness absence in the UK. Life companies, therefore, need to carefully underwrite a potential policyholder with a history of back pain for sickness-related benefits, such as income protection (IP), total and permanent disability (TPD) or waiver of premium. There are several different types of back pain.

Non-specific low back pain

This is diagnosed when a GP can find no underlying cause to identify the source of the pain. It is thought that most back pain fits into this category. The pain is usually the result of muscle or ligament damage brought on by bending, lifting or twisting. Some pain can be the result of poor posture, standing or sitting for long periods, or being overweight.

Slipped disc (intervertebral disc prolapse)

A slipped disc is when the soft part of the disc bulges through the circle of connective tissue. This prolapse may push on the spinal cord or on the nerve roots. The term 'slipped disc' does not really describe the process properly ' the disc does not actually slip out of place, but bulges out towards the spinal cord. It may occur in any part of the spinal column, but is most likely to develop in the lower parts of the cervical (neck) or lumbar (lower) spine. A slipped disc in the lower back is most often seen between the ages of 30 and 50. In the neck vertebrae, slipped discs are most often seen between the ages of 40 and 60.

Symptoms include pain, sciatica, numbness or tingling (pins and needles), weakness of movement and some muscle wasting corresponding to the involved nerve roots. In more severe cases, bowel and bladder impairment can also occur. Signs include reflex and sensory loss, muscle weakness and signs of nerve root irritation (positive straight leg raising test), as well as limitation of back movement.

Other mechanical back pain

There are many other mechanical causes of back pain including degenerative diseases of the spine, which can give rise to similar symptoms to the above as they can result in pressure on the spinal cord and nerve roots. Spondylolisthesis involves a partial dislocation of one of the joints of the spine. Spondylosis is the degeneration and narrowing of the discs. The natural curve in the spine may be deformed, known as spinal curvature, scoliosis or kyphosis. Although back pain is not always a feature with spinal curvature, it can lead to restriction as the condition develops and perhaps an increase of breathlessness on exertion.

The treatment for the above conditions is usually conservative involving simple pain killers, physiotherapy, traction, stress management and exercise programmes. In some circumstances surgery is required, although frequently back pain may recur in adjacent areas of the spine in those who have had successful surgery.

Non-mechanical back pain

Less than 10% of back disorders are non-mechanical. These include:

• Spinal fractures, which may or may not include damage to spinal cord or nerve roots.

• Spinal infections.

• Spondyloarthritism, for example, ankylosing spondylitis, reactive arthritis.

• Spinal tumour, whether benign or malignant, although malignancies in the spine are usually secondary tumours.

Naturally these types of back disorders would need careful underwriting, not only for the sickness-related benefits, but also for life and CI cover.

It is thought that the increasingly sedentary lives that we now lead contributes greatly to the back pain epidemic we are currently experiencing. An office worker can spend anything from 25 to 40 hours a week in a static position working at a computer. Travelling to and from work also usually involves sitting in a car or on a bus for long periods as well as the travelling done in our recreation time. Many people relax in the evening by sprawling in a comfortable chair in front of the TV. It follows that there are many campaigns to improve back care, particularly in the working environment.

Debbie Bolton is a life and disability underwriter at Scottish Equitable Protect