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Low back pain

What is it?  

Most people suffer from lower back problems (low back pain or lower back related leg pain) at some point in their lives. They are very common. The majority of the time it doesn’t mean actual damage to your back.

It is so common it should be seen as an annoying but normal part of life. It is likely to settle within a couple of weeks but can take up to 6-12 weeks.

80% of the adult population in this country will have a significant episode of back pain in their life. Around 10% of the population have back pain at any one time.

It can come on quite suddenly, or over time, and can be caused by lifting something awkwardly, which can be extremely distressing and can sometimes stop you carrying out your everyday activities. However, more often than not, back pain comes on without any specific injury to your back.

You will often hear that the best thing you can do for back pain is to lie down and rest. However, inactivity will prolong the episode of back pain.

Most people with low back pain just need to keep moving and the pain will improve with time.

Exercises

Try these simple exercises to keep the back moving. Do these little and often through the day

Back stretch

Lie on you back, either on a mat or your bed. Bend your knees, keep the back relaxed. Roll your knees from side to side.

Hold the stretch for 10 seconds and repeat 3 times on each side.

Pelvic tilt

Lie down with your knee bent. Tighten your stomach muscles, flattening your back against the floor (or bed)

Hold for 5 seconds and repeat 5 times.

Deep lunge

Kneel on one knee, the other foot in front. Facing forwards, lift the back knee up off the floor.

Hold for 5 seconds and repeat 3 times.

support if needed, bend one leg up behind you. Feel a stretch in the front of the thigh.

Hold for 5 seconds and repeat 3 times on each side.

Knee to chest

Lie on your back, knees bent. Bring one knee up and pull it gently to your chest for 5 seconds.

Repeat up to 5 times.

If these exercise are too painful. You could use diaphragmatic (abdominal) breathing in this positions or in sitting to help relax and reduce your pain.

For a description and video on abdominal breathing follow this link 

 

Keeping active

Regular exercise is vital in reducing back pain by toning your muscles and allowing your body to carry out daily tasks more easily. Government guidelines encourage us to perform at least 150 minutes of moderate intensity cardiovascular exercise (or 75 minutes vigorous i.e.: running, spinning) per week over a few sessions. As well as 2 days including some form of strength training and balance training (remember many exercises combine these i.e.: spinning is cardio and strength, yoga can be balance and strength).

People with good fitness levels tend to experience less back pain, so get out of the house and go walking, swimming or cycling for half an hour a day. Exercise classes such as yoga, pilates or going to the gym are also great for your back. Find something you can enjoy and stick with! Cardiovascular exercise is shown to decrease the pain you feel by 20% as well as improving your overall health and mental well-being.

We would also recommend some online exercise videos found on the NHS website (If you are new to the exercises build up gradually).

Keeping active is also good for you if you already have back pain. Even if exercising feels painful, it will not harm your back and keeping active is one of the best ways to allow your back to recover.

However, it is also important to gradually build yourself up from your starting point, working on strength and flexibility as well as cardiovascular (getting hot and sweaty) fitness.

Posture

Despite common posture beliefs, there is no strong evidence that one optimal posture exists or that avoiding ‘incorrect’ postures will prevent low back pain. Please see this information developed with help from South Tees Hospitals

Posture ‘Sit up Straight’ – Time to Re-evaluate!

Advice for at work

You are better continuing with activity, including work, even if you are still in some pain. People who remain active have far better outcomes than those who don’t.

If you are struggling with back pain:

  • Inform your manager
  • Keep mobile
  • Stay at work as long as possible, this helps with your rehabilitation and recovery
  • Use pain killers to help you carry on – it’s the movement that will get you better, and the pain killers will allow you to move better by reducing your pain not masking it..
  • Seek professional advice if you are unable to manage

If you have to go off work sick, use that time to get your back better – this might mean going out for walks, to the shops, etc. Don’t feel that just because you are off work you should not keep active – you must!

Stay in touch with your workplace. Hopefully your employer will be trying to keep in touch with you as well. Be open-minded about getting back to work as soon as possible. This can be facilitated by changes to your normal job role, hours and even where you work.

The longer you remain off work the more difficult it becomes to get back to work.

Useful tips for the work place

Many people spend at least eight hours a day at work and there is a lot that you can do to reduce the likelihood of developing or help manage back pain better.

  • If you have to lift things at work plan the lift first, does it need to be done? Can you make it easier by dividing the load? Ensure you are strong enough for the task (by doing regular strength exercise)
  • If you work in a static job, seated or standing make sure your work set-up is correct for you.
  • Avoid prolonged static postures, for example sitting at a telephone station or a screen – take regular movement breaks.
  • Use equipment provided

At your desk

Working at a desk all day can be uncomfortable for your body as it was not designed to be still for prolonged periods of time.

  • Try to have your computer screen at eye level in front of you and your chair facing it.
  • Have your mouse and keyboard within easy reaching distance.
  • Take regular breaks and get up and move regularly
  • If you are getting stressed or tense, take a break to relax your body and mind. Doing some abdominal breathing can help this relaxation.
  • Be active when you are out of work to compensate for the time you spend inactive at work.

Lifting and handling 

When lifting and handling heavy goods you have to be fit/strong enough for the task.

  • Whether it is a heavy stacks of paper in an office or machinery – power through your legs and arms to lift – it is safe to lift without bracing your back or keeping it overly straight
  • If possible, use lifting and moving equipment such as a trolley to aid you.
  • Test the weight of an unknown item you are about to lift if able by pushing it with your foot. This way you know what to expect.
  • Always plan ahead to ensure that where you are moving the item to is clear and uncluttered – this avoids having to hold the item for longer than needed.
  • Most importantly do regular exercise that keeps you strong enough for activities such as lifting.

On your feet

If your job requires you to be on your feet all day, then it’s likely you will at some point have suffered from aches and pains, it is important to try and keep moving and walking around and to sit every so often.

  • As with all jobs, getting regular exercise and keeping fit outside of work will greatly improve the strength of your body and reduce your chances of getting back pain.
  • Take regular breaks to stretch your muscles – this will prevent stiffness and keep your circulation going

Advice for at home

Whether you’re out in the garden or cleaning the house you may benefit from following the simple tips and advice:

Gardening & DIY 

For many people, gardening is an enjoyable hobby.

Some general tips when gardening:

  • Take a moment to warm up
  • Digging – take a wide stance and let your leg muscles do the work. If necessary, lever the spade using your foot if the soil is dense and heavy.
  • Moving tubs – roll them onto their outer rims to avoid lifting as they are often very heavy and more than you would normally lift.

If carrying, the following tips should help:

  • Ensure you’re wearing loose, casual clothing and sensible shoes
  • Lift close to the body and pick up and set down using the powerful leg and arm muscles.
  • Plan movements of compost bags/soil/chippings using wheels wherever possible
  • Wheelbarrows – don’t overload as these can be awkward to move

When bending:

  • Loosen with some repeated bends first.
  • Combine with bending the knees into a squat if easier, or bend your knees as far as possible with one foot in front of the other (lunge)
  • Otherwise go down on one knee or both
  • Take regular breaks changing position going for a short walk or stretching (time can fly when you are having fun in the garden!)
  • If you are tired, STOP for a break instead of pressing on (there’s always tomorrow, pace yourself)

Around the house

Back pain affects around 8 out of 10 of us at some time. During an acute flare of back pain you may have to pace your activities better and reduce the amount that you do, but it is important to keep moving and not stop completely. Activities around the house such as cleaning and hovering require good range of movement and strength in our bodies. It is important that we use exercise to enable us to have the required range of movement and strength, so that we can carry out these activities and remain independent. Using the tips above for gardening can also make activities within the house easier.

Simple painkillers

Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.

Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions

However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.

Up to date guidelines can be found on the NHS website:

Ibuprofen

Paracetamol

Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.

If you are unsure and concerned about your symptoms, please see our ‘when to seek medical advice’ section on the back pain home page

Persistent Back pain

Persistent back pain can refer to recurrent back pain or pain that has lasted for several weeks and it can have a big impact on your day-to-day life.

Persistent back pain can range from a mild pain or ache, to a more severe pain. This can depend on a variety of things, such as general health and fitness, whether you have had back pain before and how happy you are at home or work.

Persistent back pain may require treatment such as medication or physiotherapy. In most cases though, your back will settle to a manageable level itself. It is important that you keep active and continue as normal.

How to manage back pain

When you have back pain it is crucial for you to keep moving. It will not do any harm – remember, the spine is a strong structure designed to move.

Management of long standing low back problems:

10 do’s and don’ts for managing long-lasting low back problems

Movement, little and often at first, is something you can do to contributes to your back getting better. Part of that process is allowing time for the body’s natural healing to occur and this will be much better if you continue to move, even if this causes some discomfort. During an acute flare of back pain you may have to pace your activities better and reduce the amount that you do, but it is important to keep moving and not stop completely.

Significant evidence-based changes have been made to the way back pain is managed in the NHS.

Better understanding of back pain through research has highlighted other factors that can influence any episode of back pain. These include stress, anxiety, poor sleep and poor general health. It is important to recognise how these factors could be influencing you and look at how you may need to make changes.

For those who really struggle to self-manage their back pain long term and it remains severe and significantly effecting function you may be referred on to a spinal service. If it is felt appropriate you may then be referred on to a pain service who can consider multidisciplinary pain management strategies to help improve your long term management.

In line with NICE guidelines spinal surgery is not recommended for the management of back pain alone.

Understanding the complexity of pain and other influencing factors

What we have learnt through research is that pain, especially persistent pain is more complex than just what is going on locally to where you feel the pain. It can be affected by many things including poor sleep, poor general health, reduced fitness, stress, past experience of pain and our beliefs about pain and our physical structure.  The links below provide some insight into understanding pain, understanding your own beliefs around your pain and then looking at positive changes you can make that can in turn have a positive effect on your pain and levels of function.

Understanding pain in less than 5 minutes

Separating fact from fiction

Facts about back pain and exercise

Sleep and pain

10 things you need to know about your back

Why things hurt

Tame the Beast

Pain Tool Kit

Pain-ed

Abdominal breathing, relaxation and sleep

Stress and tension are common with persistent pain. For some it may be part of the underlying cause for many it’s a consequence as pain itself causes more stress and anxiety. What we know is that if we can use tools to help reduce our muscle tension and stress this can help with pain, sleep and function. Below are links you may find useful

Abdominal breathing

Online video describing abdominal breathing

Headspace

Breathe2relax. This is an APP specifically for abdominal/diaphragmatic breathing – go onto your smart phones APP store for more details

Sleep well with pain

Below are links to local services that can help with aspects of physical and mental health that you feel may be impacting your pain and general health.

Live well Dorset – Weight management, stop smoking, exercise advice, lifestyle change 0800 8401628/ 01305 233105

Steps to wellbeing – for help with feelings of anxiety, depression, bereavement and trauma/PTSD

Welcome to the moodzone – for help with self-management of stress, anxiety and depression

Dorset Pain Management Service website – This website contains a lot of further information and links about pain and also gives you the opportunity to see if you feel a referral to the Pain Service may be beneficial for you.

Understanding persistent pain – this booklet is commonly used by the Dorset Pain Management Service.

Physiotherapy  

If you find that you are not improving after following the above self management information, some advice from a physiotherapist can be helpful in managing low back pain.

Click here to self-refer to a physiotherapist.

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