Evidence based self care advice for back pain sufferers


The information in this article is derived from “The Back Book” an evidence-based guide to the latest information regarding the management of back pain.  This is published by The Stationery Office and the first edition was in 1998 although the information remains current.

Back Facts

• Back pain or ache is usually not due to serious disease.

• Most back pain settles quickly at least to a stage where you can get on with your normal life.

• About half the people that get back pain will have it again within a couple of years.  However that does not mean it is serious and between attacks most people return to normal activities with few if any symptoms.

• Back pain can be very painful and you may need to reduce some activities for a time or even bed rest for a short initial period.  But rest for more than a day or two usually does not help and may do more harm than good because you tend to stiffen up.  Keeping generally mobile is the accepted way forward.

• Your back is designed for movement and the sooner you get back to normal activity the sooner your back will feel better although this needs to be a graded return.

• People who stay active and retain their normal pattern of activity despite the pain tend to do best.

Causes of Back Pain

The spine is one of the strongest parts of your body.  It is made of bony blocks joined by discs to give it strength and flexibility and it is reinforced by strong ligaments.  The spine is surrounded by large powerful muscles which are protected.  It is surprisingly difficult to damage the spine’s structure.

Things to remember:

• That many people with back pain do not have any structural damage to the spine and it is due to the mechanics which have gone wrong.

• Very few people with back ache have a slipped disc or a trapped nerve.  For those that do even a slipped disc can get better over an initial period.

• Many of the X-ray and MRI findings in the back are normal changes with age.  However it is important to relate such changes to a clinical assessment of your problem.

In many people it is not possible to pinpoint the exact source of the trouble.  The good news about this is that more serious things are often discounted and the pain can often be attributed to the mechanical way in which your back works.  If this is the case the important thing is to get your back working properly.

Although stress is rarely the cause of the problem it can increase the amount of pain or maintain the problem that you already have.  Tension from stress can cause muscle spasm and the muscles themselves then become painful and it can be important to address this element of your life.

People who are physically fit generally get less pain and recover faster if they do get back pain.  So it is important that once you have had back pain that you try and get back into better physical condition and this can be via controlled exercises such as pilates, yoga, walking, gym or swimming.

In the early days of my career the old fashioned treatment for back pain was prolonged rest but bed rest for more than a day or two is not good because

• Your bones get weaker

• Your muscles get weaker

• You get stiff

• You lose physical fitness

• You get depressed

• The pain feels worse

• It is harder and harder to get going again.

It is not surprising that this approach to managing back pain did not work and nor was the use of corsets effective.

The converse advice is now current.

Regular exercise is useful and gives you

• Stronger bones

• Fit and active muscles

• Increased flexibility

• Makes you fit

• Gives you a better feeling of wellbeing

• Releases natural chemicals called endorphins which reduce pain

Even when your back is sore you can make a start without putting too much stress on your back and even very short periods of things like :-

• Walking;

• Exercise bike;

• Swimming

can be helpful and give you a graded return to activity which you build up within the level of pain that you can handle.

The way back into exercise can be difficult and it does often result in an increase of pain in the early days.  However you can work through this in a controlled way to improve your situation.

Dealing With Acute or Sudden Onset of Back Pain

How you handle this will depend on how severe your back pain is.

You can usually:-

• Do something to control the pain

• Modify your activities

• Stay active and continue work if realistically feasible.

If your pain is more severe, you may have to rest for a few days. You might need stronger painkillers, anti-inflammatories and muscle relaxants from your doctor. You may even need to have some bed rest for a day or two.  Whenever possible, you should try and get up and move around within the limits of the pain and not bed rest continually.
You should build up your activities and exercise tolerance over several days or even weeks.  However, the faster you get back to normal activities and back to work the better. Even if you have some pain and restriction.  If you have a heavy or repetitive job, you may need to control this element of your life, and seek the help of your employer and advice from your doctor or physical therapist.

How You Can Control Your Pain

  • Painkillers.
  • Paracetamol or soluble aspirin are the simplest and safest painkillers.  They are often surprisingly effective when taken at the stated dose.
  • You should often take them for a day or two, but you may need them for a few weeks.  Take them regularly, rather than just when your problem hurts. Do not wait until the pain is out of control.
  • You can also use anti-inflammatory tablets such as ibuprofen, but do not take aspirin or ibuprofen if you have indigestion or an ulcer problem.

Heat or cold?

In the first 48 hours you can try a cold pack on your back for 5-10 minutes of time.  A bag of frozen peas will suffice, but do wrap it in a towel to prevent yourself having an ice burn on your skin.

Once the pain has been there for more than a few days, you can transfer to heat which will increase the blood supply and help the muscles relax.

Osteopathy, physiotherapy and some injecting techniques by a spinal physician are often very helpful, particularly so within the first six weeks of pain.  Advice that goes with this can help you manage your problem and identify the factors which tend to make your pain worse or make you suffer further episodes.  If your pain tends to recur frequently, then once you are out of the painful phase, it is useful to identify the best ways forward to strengthen your spine.

Stress and tension

If stress is a problem in your life, it can come from overwork, relationship difficulties, or simply the desire to do things well and meet deadlines.  It is important to recognise it early and develop strategies to help reduce its effects.  If you struggle to control these elements in your life, you might benefit from input by a psychologist using techniques such as CBT (cognitive behavioural therapy) or hypnotherapy.

Factors Which Help and Hinder Your Pain

• Lifting.  Know your own strength and only lift what you can handle.  Always lift and carry close to your body and where possible bend your knees to make your legs do the work rather than bending your back.  Instead of bending and twisting, turn with your feet.

• Sitting.  Wherever possible use and upright chair.  You may find it helpful to have a small cushion or folded towel in the small of your back.  If simple support seems to be helpful, you might try a more formal support such as a “Back Friend” (you can find these on the internet).  Get up and stretch every 20 or 30 minutes.

• Standing.  Try and have your work surfaces at a comfortable height. Try to vary your position rather than remaining entirely static all of the time.

• Driving.  Adjust your seat from time to time and use a support in the small of your back.  There is also a specific article on driving in this section of the website.

• Activity.  Gradually increase your physical activity, involving 20-30 minutes walking, cycling or swimming every day and if every day makes it too sore then try it every other day.  Other exercises such as Pilates can be very helpful.

• Some people prefer a firm mattress - If your bed is getting towards 10 years old, you should consider trying another or replacing it.  There is also another article on beds in this section of the website.

• Relax-  Learn how to reduce stress and use relaxation techniques.

Some things which may make your pain worse:-

• Lifting without thinking.

• A low soft chair with lack of support. Sitting for a long time without making reasons to get up.

• Long periods in one position, including driving long periods without a break.

• Sitting around all day without exercising and being generally unfit and overweight.

• Staying in bed too long.

• Worry, general tension and anxiety.

• Heavy and repetitive tasks.

Broadly there are two types of sufferers:-

1. One who avoids activity
2. One who copes

The avoider

• Gets frightened by the pain and worries about the future.

• The avoider is afraid that hurting always means further damage, when in fact it doesn’t.

• The avoider rests a lot and waits for the pain to get better.

The coper

• Knows that the pain will get better and does not fear the future.

• Carries on as normally as possible.

• Deals with the pain by being positive, staying active or staying at work.

Overall the avoiders suffer the most.  They have pain for longer, they have more time off work and they can become chronically or long term disabled.  Conversely copers suffer less at the time and they are healthier in the long run.

Overall How Can You Help Yourself?

• Live life as normally as possible.  This is much better than staying in bed and getting static.

• Keep up daily activities where possible and pacing yourself doing as much as you reasonably can without causing yourself setbacks.

• Try to stay fit.  Walking, cycling, swimming, physio exercises or pilates will help your back and make you feel better.  It is often more important to continue these once your back is well so that you build up your overall body conditioning.

• Start gradually and do a little more each day so that you can see the progress you are making.  If exercise every day is too much and makes you sore, try alternate days.

• Either stay at work or go back to work as soon as possible and if necessary grade yourself in with lighter duties or shorter days for a week or two.

• Be patient.  There are often no quick fixes and you will often go on getting twinges for a time.

• Recognise that self help alone may not be enough. You may need some treatment from an osteopath, physiotherapist or physical medicine doctor.

• Don’t just rely on pain killers.  Stay positive and take control of the pain yourself.

• Don’t stay at home too long or give up doing the things you enjoy.

• Don’t worry.  It does not mean you are going to become an invalid.

• Don’t listen to other people’s horror stories.  They are often nonsense and each person’s problems with pain are their own with a unique diagnosis and regime for getting better.

• Try not to let the down days get on top of you.

The information derived from The Back Book and outlined here is given to you from the perspective of self help.  Whilst there is much you can do for yourself, you may need professional advice to put this into the context of your own problem. Use this information in conjunction with any physical therapy you decide to enlist.
Good luck

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