Your back and how to look after it
This leaflet is based on the latest research and aims to help you deal with your back pain and speed up your recovery. It is aimed at people who are receiving conservative treatment only.
• Most people experience some back pain at some time
• It usually gets better quickly with minimal rest and continued activity
• Stay active
• Stay at work or return to work as soon as possible
• Do not be afraid of the pain it is unusual for it to indicate serious damage
Your back is strong and stable. The bones or vertebrae are held together by discs and the whole spine is strengthened both front and back by strong ligaments. It is surrounded by powerful muscles which help to protect it. It is surprisingly difficult to damage your back.
Causes of back pain
Most people with back pain do not have any damage in their spine and so it is not always possible to pinpoint the exact source of the pain. It is a fact that very few people with back pain have a slipped disc or a trapped nerve. Serious causes are very rare.
If you have back pain and suddenly develop any of these symptoms you should see a doctor immediately:
• Difficulty passing or controlling urine or bowel motions
• Numbness around your back passage or genitals
• Numbness, pins and needles or weakness in both legs
• Unsteadiness on your feet
• High fever
• A sudden change in the shape of your spine
• Most X-ray findings in your back are normal changes with age just as we get grey hair at different times as we get older, our backs age at different times too
• You may find it frustrating not to know exactly what is wrong but this is good news because it means there is nothing serious.
You can also try some of the following:
- Lie on your front with or without a pillow under your tummy
- Lie on your side with a pillow between your knees and, if comfortable, a small pillow or towel under your waist.
- Lie on your back with your hips and knees bent and your legs supported on a stool.
Good ideas to help you stay active
• Ice – Try putting a bag of frozen peas wrapped in a damp towel on the painful area for 20 minutes
• Heat – This can help reduce the pain of muscle spasm. Try using a hot water bottle wrapped in a towel over the painful area for 20 minutes
• Ice and heat do have a risk of causing burns unless you are cautious in their application
• During the first few days it is important to start gentle activity
• You may feel a temporary increase in pain during or after the activity but this is normal and does not mean that you are causing harm
• Exercises such as walking, cycling and swimming can help to ease pain and improve fitness
• Find a comfortable bed for you and avoid one that sags or is too hard
• If your bed is too soft put your mattress on the floor or a piece of hardboard between the mattress and the base
• If your bed is too hard put a thick duvet or sleeping bag between the mattress and the sheet
• You do not need to worry – sex will not damage your back although you may need to try different positions
• Stress, tension and worry can tighten the muscles and cause more pain
• Try to do things that make you feel calm like focusing on relaxed breathing, going for a walk, listening to music or having a warm bath
• Try to avoid feeling low. Be positive!
• Choose a chair that supports your lower back to avoid slouching.
• Do not sit for too long get up regularly, stretch and walk about. This includes driving.
• Stay relaxed whilst driving and take regular breaks.
• Try to keep your posture upright and avoid remaining in one position for too long.
• When you bend down, try to bend your knees and hips to make your position more powerful. Think before you lift.
• When reaching, pushing or carrying, keep items close to your body and use work surfaces at a comfortable height. If items are heavy get some help and do not rush
Although a physiotherapist may help you to manage your pain what you do is the most important thing.
• Carrying out your normal everyday activities and daily responsibilities will help your back recover. Remember not using your back does more harm than good
• Try to do a little more each day aiming for a steady return to work and domestic tasks
It is normal to have good and bad days. Keep doing your normal activities little and often throughout the day and break down big jobs into smaller, more manageable tasks. This will keep your joints moving and your muscles strong and help speed up your recovery.
Pain killers and anti inflammatories can help you control the pain. Easing the pain helps to make you more comfortable as you gradually get back to your usual activities.
Expect to get better! Remember back pain is very common and rarely serious. Talk about any fears you may have with your doctor or physiotherapist.
Improve or keep fit
Activities like the gym, cycling, swimming and walking are very useful ways of managing back pain problems. Other activities that may help include tai chi, yoga, pilates.
As well as being active some people find they also get relief from activities such as massage or acupuncture.
What if it happens again?
If you do get back pain again remember it will go away it did last time, and just because it comes back it is still not serious. Remember in the early days it is important to keep active. The most important steps are the things you do to help yourself. You have a better chance of having a healthy back if you get a bit fitter. Being fitter will help you to look after your back.
Back pain is common but is rarely due to any serious disease. Staying active will help you get better quicker. Resting in bed for more than a day or two is usually bad for your back. The sooner you get going, the sooner you will get better! Hurt does not mean harm.
The following exercises should be started gently and increased gradually, and you should not try to push hard to get rid of pain. A little discomfort is common when starting a new activity or exercise, especially if you have not been active for some time, as your joints and muscles get used to working again.
Try each exercise in turn and find out how many times you can repeat it without feeling extra discomfort the following day. If you are not sure, try each one 5-10 times to start with. As your back gets used to the new exercise, you should gradually increase the number of times you do the exercise.
If you are lucky, you may find a particular exercise eases your pain. If so, you should do more of this exercise and can use it as ‘first aid’.
Sometimes you may experience a `flare-up’ or marked increase in pain. This can happen whether you exercise or not. For a couple of days you may be happier reducing the amount you exercise, but try not to stop completely. As the pain eases, try and build back up to the previous level quite quickly.
1. Hugging knees to chest Lying on your back with bent knees, lift one leg and hold on to it with one hand and then lift and hold the other leg. Pull both knees gently closer to your chest, hold for a count of 5, then relax your arms but don’t let go completely. Repeat the hug and relax. Some people prefer to hug one knee at a time.
2. Leg stretches Lying on your back with your knees bent, lift one knee and hold your thigh with both hands behind the knee. Gently straighten the knee that you are holding and hold for a count of 5. Repeat with the opposite leg.
3. Half push-ups Lie on your front on a firm surface, with your hands under your shoulders, palms down. Look up and push up, lifting your head and shoulders up with your arms. Keep your hips on the floor. Hold for a count of 5 and then gently lower yourself back down. To start with, you may not be able to lift your shoulders far. As you become more flexible, work towards trying to straighten your arms, still keeping your hips on the floor.
4. Half push-ups Lie on your front on a firm surface, with your hands under your shoulders, palms down. Look up and push up, lifting your head and shoulders up with your arms. Keep your hips on the floor. Hold for a count of 5 and then gently lower yourself back down. To start with, you may not be able to lift your shoulders far. As you become more flexible, work towards trying to straighten your arms, still keeping your hips on the floor.
5. Arching and hollowing Start on all fours, hands under shoulders, knees under hips. Arch your back upwards, letting your head drop, and hold for a count of 5. Then reverse this posture: lifting your head and looking up, relax your tummy and stick your behind out, holding for a count of 5.
This leaflet was produced from collaborative work by the Bristol, North Somerset and South Gloucestershire Physiotherapy Working Group.
The Back Booklet ISBN 0117029491 National guidelines and current evidence (numerous) UBHT leaflet Your Back Pain and How to Look After It Acute Low Back Pain Management ACC526, 1998
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