Back pain can be very distressing and disabling but is also very common and rarely dangerous. Statistics suggest that 84% of people worldwide experience back pain at some point in their lives and it is equally common across age groups. Before we discuss some easy things that you can try to help manage your back pain, it is useful to understand a little more about it.
Types of back pain
Acute back pain: Most back pain is acute (short term) and lasts from a few days to a few weeks. It commonly ours without any injury or with simple, everyday movements. Acute back pain can also occur after an accident, fall or lifting too heavy, however, in most cases the pain is not caused by anything serious and will usually get better over time.
Chronic back pain: Sometimes back pain can last for longer than three months and can become chronic although this is far less common. After an injury, tissue healing should occur within a period of three months. If your pain has not resolved by then it usually means there are other contributing factors other than just the anatomical (e.g. muscle, ligament or disc injury) and physical (e.g. posture or bending/lifting movements). The scientific evidence is clear that these factors only explain a small proportion of back pain that is not getting better.
Other important factors include lifestyle (e.g. sleep, activity, stress, diet), social (e.g. relationships, financial stress, work dissatisfaction), cognitive (what the person thinks is wrong with their back) and psychological (e.g. mood, fear). The combination of these factors is important to consider when addressing back pain and can vary greatly between individuals.
There are some circumstances where your back pain may be more serious and would require review by a medical professional before proceeding with the 10 steps.
Visit your GP if you have:
- Constant or intense pain, particularly at night
- Radiating pain down one or both of your legs, particularly if it goes below the knee
- Tingling, numbness or weakness in one or both legs
- Back pain in combination with unintended weight loss or swelling/redness
Visit hospital emergency if you have:
- Back pain after a high-impact fall, sports injury or motor vehicle accident
- The recent development of bowel or bladder control problems
- Back pain in combination with a fever
The 8 steps to help you manage your back pain:
Step 1 – Stay Active and Avoid Bed Rest
Staying active is one of the most important things that you can do and you don’t need to wait until you’re completely pain-free. It is a common myth that back pain requires bed rest to aid recovery. Research now suggests that prolonged rest and avoidance of activity leads to higher pain levels, greater disability, poorer recovery and longer absence from work. So, you should try not to rest for more than 1-2 days before returning to your normal activities as soon as possible.
Step 2 – Exercise
As stated above, gradually progressing into exercise is helpful for back pain. The best exercise that you can do is the one that you enjoy and can do regularly. Doing general exercise (e.g. walking, swimming or cycling) for the recommended 30 minutes per day is best but any amount you can tolerate initially will help. Exercise will help increase movement confidence, reduce the fear that aids recovery and also helps to prevent recurrence of pain and injury when performed long term. It is important to be aware that not all back pain is the same. If you have tried one type of exercise which is not helping then it is best to consult a physiotherapist who can provide you with some specific exercises to help to address your back pain.
Step 3 – Reduce Fear and Stress
Trying to relax is crucial to easing pain as activity avoidance and muscle tension/guarding caused by the fear can make your pain worse. There is a common belief that the back needs to be protected more than other body areas, which is not true. Scientific evidence has shown that structures in the back do not ‘slip’ or ‘move out of place’ at all. The spine is much stronger and robust than most people think and can certainly move and load safely in a variety of postures. So, although it can be difficult when in pain, it is important to stay positive and recognise that your pain will settle.
Step 4 – Posture
Despite the common myths, there are no correct or incorrect postures. Evidence suggests that there are many natural variations in spinal curves between people with no specific spinal positions strongly associated with pain.
Finding ‘comfortable’ postures can be different for everyone. Frequently changing and adopting different postures during the day (including those considered ‘incorrect’) as well as changing persistent ‘habitual’ postures may provide some symptom relief. Furthermore, prolonged sitting for more than 30mins in one posture is not dangerous but moving and changing position regularly is often helpful.
Step 5 – Sleep
Sleep is an essential survival function. When you have poor sleep the body will react by creating an inflammatory response which can cause you to feel sick, tired and irritable. Poor sleep can increase the risk of developing pain, can cause your current pain to become worse and can also delay recovery increasing the risk that your acute pain will become persistent. Unfortunately, it can be a vision cycle because sleeping well when you have back pain can be difficult which may then make your back pain feel worse.
A poor sleeping position may aggravate your pain. Try lying on your side with a pillow between your knees which will help to relieve strain on your back. If you have to sleep on your back try putting pillows under your knees which can also help to ease the pain.
Step 6 – Healthy Diet/Weight management
Maintaining a healthy diet is important for all aspects of health. Some diets can be highly inflammatory particularly those high in trans fats, refined sugars and processed foods. It would be a good idea to ask your doctor to see if your diet could be a contributing factor to your persistent back pain.
Being overweight can place a greater strain on your back and can make your pain worse. Consulting your doctor to find out how you can appropriately lose weight through a healthy diet and exercise will help with your pain.
Step 7 – Lifestyle modification
If you have persistent/chronic back pain it can be important to look at all aspects of your lifestyle to see what may be contributing to your pain.
Take note of activities that aggravate your back pain. It can help to recognise your limitations and adapt by modifying them or taking more frequent breaks during these activities e.g. make multiple trips while carrying the groceries.
Improper heavy and repetitive lifting can contribute to back pain. Whether it’s part of your job or when carrying a suitcase, bag or groceries where possible modify your activities in the short term to reduce load. This can be done by addressing lifting technique, carrying less, distributing the weight evenly on both sides or shifting weight from side to side more frequently. It would be beneficial to consult a Physiotherapist or Exercise Physiologist to determine if there is a lifting technique issue and provide you with specific strengthening exercises so that your back adapts to handle greater loads which may help with your pain long term.
Smoking is also known to increase the risk of back pain. Evidence suggests that nicotine restricts blood flow to the discs in the spine which can lead to increased degenerative changes. Smoking also reduces oxygen levels in the blood which will impair the nourishment of muscles and tendons in the body.
Step 8 – Don’t Rely on Pain Medications
Prescription medications are the most common form of treatment used by Doctors for back pain. Over the counter, non-steroidal anti-inflammatory drugs can provide some relief but are not suitable for everyone. Recent scientific evidence suggests that paracetamol (Panadol) is not very effective in helping to ease persistent back pain. This should not necessarily mean that stronger prescription medications are the answer either as research also suggests that they often do not provide greater relief of pain compared to simpler options and have increased potential for harm due to several side effects. If you do have to take stronger painkillers it is recommended that you only take them in short term, as they do not address the underlying cause of your pain and the risk of addiction increases the longer they are used.
Finding other ways to manage your pain before turning to medication is always recommended. Using hot or cold packs can help with temporary relief of pain. Most importantly, utilising all of the steps above will help ease your pain.
If your pain persists or you would like some assistance with managing your back pain then make a booking to see one of our Physiotherapists HERE.