How to Manage Low Back Pain
NHS England reports back pain to be “the largest single cause of disability in the UK”, so knowing what to do if you are experiencing back pain is really important. I am frequently asked “how long will it take to settle down”, “if it hurts should I stop moving” and “should I rest in bed”?
So what should you do?
Most low back pain is what we call Mechanical Low Back Pain, which means it stems from the muscles, joints and soft tissue around the spine. It is often centred in the lower back and doesn’t go into the legs. Mechanical Low Back Pain usually settles down within a few weeks or so and resting for more than a few days can actually make the situation worse. As you rest the muscles around your spine can start to get weaker and the joints in the spine a bit stiffer. This can make movement more difficult and in turn have an adverse effect on the pain. Research has shown that for the majority of cases the best way to manage Mechanical Low Back Pain is through exercise. Doing gentle exercises, as far as you are able, and gradually building up. It is fine to continue with your normal activities but do so within your limits of pain and build back up to your regular exercise levels. Some people may find heat helpful to reduce muscle spasm and ease pain. For example, a wheat pack that is warm, not too hot, applied for 10 minutes can help to relax the muscles around the back*.
What happens if I have pain into my leg, often referred to as Sciatica?
I would always advise that you seek advice from a health professional such as a Physiotherapist or your GP if you are experiencing pain into your leg. Especially if there is any weakness in the muscles, pins and needles, numbness or the pain goes into both legs. They will be able to assess what is causing the pain and give you more specialist advice. Even with leg symptoms we encourage people to keep as mobile as possible, moving as pain allows and not rest in bed. Local application of heat or cold may help to reduce pain.* If you are uncomfortable at night placing a pillow long ways between the knees when lying on your side can help keep the spine in a good position and make you more comfortable. Back pain associated with leg pain can take a little longer to settle down and may last for 4-6 weeks. If your symptoms worsen, are not settling or the pain goes into both legs, seek advice.
*Care: When applying heat or cold place a towel on your back to protect the skin and test the temperature on an unaffected area.
What Exercises Can I Do?
Here are some gentle exercises that are designed to keep the back moving and can be performed daily within your limits of pain.
Pelvic Tilting
Start lying on your back with your head supported by a small towel or cushion. Allow your arms to relax by your side or place one hand on your lower tummy. Take a deep breath in and allow your ribs to relax into the mat as you breathe out.
Take a breath in to prepare and as you breathe out slowly allow your back to gently roll into the mat and feel your tailbone curl upwards. As you breathe in gently return to your starting position. If you have your hand on your tummy you will feel it slightly dip in. Rock slowly within your limits of pain. Repeat 6-8 times and then come to rest so your spine is lengthened along the mat. Ready for the next exercise.
Hip Twist:
This exercise is good for getting the spine moving and opening up the small joints at the side of the spine.
Allow your arms to move now slightly out to the side and make sure that you are comfortable. Bring your knees and feet together and keep your spine lengthened along the mat. Imagine your legs are now glued and as they move, they move as one.
Take a breath in to prepare, as you gently breathe out start to roll your knees over to one side. Think about the knees leading the movement then allowing your pelvis to follow, continue as you feel a comfortable stretch but do not push into pain. Keep your shoulder blades and upper back on the mat. Breathe in to hold and breathe out to return to the starting position.
Even if the movement is small don’t worry, work to your own limits.
Repeat to the opposite side, alternating 6-8 times.
Cat Stretch:
This is a good way to mobilise the whole of the spine but is NOT suitable for people with Osteoporosis.
Start on your hands and knees, with your hands on the mat aligned under your shoulders and knees aligned under your hips. Try to maintain a level spine
Take a breath in to prepare and as you breathe out start to tuck your tailbone underneath you, allowing your back to round and your stomach to arch away from the mat.
Allow the movement to slowly spread into your upper back and then hold the position as you breathe in. Breathing out slowly to return to the starting position, tailbone first then gradually working your way back to the start. Repeat 6-8 times
Watch points: Watch that your shoulders don’t tense towards your ears and as you return to the start position don’t allow your lower back to dip in and your stomach to drop towards the mat.
Shell Stretch
To finish allow yourself to sit back into a shell stretch. Only go as far as is comfortable. If you have any knee problems you could place a pillow on your calves to rest back on. Hold for a breath in and then return to the starting position.
The best way to prevent recurrence is to keep fit and keep moving. Pilates can be a great way to maintain and increase movement in the spine as well as strengthening the muscles. One of the most important things is to choose a form of exercise that you enjoy. After all, if you don’t enjoy it, you won’t stick at it!
This article should not be taken as any form of diagnosis or a substitute for medical advice. These exercises are designed to gently mobilise the spine and should not increase your pain. If you are in any doubt or your symptoms change, seek advice from a Health Professional.