Low back pain

• Keep moving, even if slowly at first.
• Keep living and working normally. This is important and is the best way to get better.
• Don’t worry if your back still hurts at work, consider doing light tasks at first, speak to your manager about work concerns that you may have.
• Don’t sit down for too long, change positions regularly wherever you are.
• Avoid bed rest during the day.
• Stay active and remember to re-introduce activities like heavy lifting gradually.
• Exercise really helps your back and can relieve pain. Start with light fitness training.
• Moving will make you stronger and keeping active is the best thing you can do.

It is important to stay active and return to normal activity as quickly as possible. This will help the recovery process and will help to stop your muscles getting weak and your back getting stiff.

What about pain relief?

If you need pain relieving medication to help you to keep moving and gradually return to your normal activities, speak to your GP or a pharmacist. Although back pain is very unpleasant and may increase with certain activities, the pain does not mean that any damage is being caused.

Do I need to see a doctor or a physiotherapist?

Not usually, if you follow the right advice, your back problem should improve over time. If your back symptoms are still interfering with your ability to do normal things after 6 weeks, this is the time to seek further professional advice from either your GP or NHS Physiotherapist.

So, what is causing my back pain?

We know from many years of research that back pain is very unlikely to be due to one specific cause, that is why we use the term non-specific back pain.   We know X-ray and scans are really not very helpful for diagnosing non-specific back pain.

Back pain can be influenced by a variety of factors, including lack of exercise, or working the back too hard or too quickly. Being overweight, having poor sleep, high stress or anxiety levels, and previous experiences of back pain can all influence the onset of back pain and recovery. It is important that all these areas are considered as they may impact your back pain.

You may find this short YouTube video helpful for information on back pain.

This information is for people with central low back pain which may also be felt in the upper part of the legs.

What is low back pain?

Low back pain (LBP) can come from a number of sources including muscles, ligaments, discs, joints and nerves. Most LBP will resolve within six weeks without any treatment but some may continue past this time.

Diagnosis

If your low back pain is severe or it is not resolving, it is best to see your GP for advice. You may then be sent to see a physiotherapist who will assess you and advise the best course of treatment.
The GP may also decide to order tests such as an MRI scan if they feel your pain is because of fracture or serious disc involvement or cancer, otherwise it is not advised to have X-rays or scans as they will not help in determining a diagnosis.

What treatment might you be offered?

You may wish to control your pain by taking
paracetamol initially but if this does not help your GP may be able to prescribe you with some anti-inflammatories or stronger pain killers. Always consult your GP or local pharmacist if you are unsure about what medication to take.
Your GP or physiotherapist may also offer you one or more of the following:

• an exercise programme or group
• a course of manual therapy
• acupuncture

There are other forms of treatment for LBP but those mentioned earlier are recommended by the National Institute of Clinical Excellence

Do I need surgery?

Very few people with back pain will require spinal surgery but if you fail to improve and your pain is still very severe then they may decide you need to see a specialist.

What can you do?

These suggestions may help you manage your LBP, recover more quickly or treat your LBP in future.

• Staying active:
  It is very important to avoid excessive bed rest as this will increase stiffness and weakness in your back. Try to stay active even if this is by taking regular walks or range of movement exercises (see below).
• Regular medication:
  Take simple painkillers such as paracetamol or anti-inflammatories regularly as they are more effective in managing pain than if you take
  them when your pain is already very high. Your body warning signs will still let you know if you’re doing too much. If you have weakness in your leg muscles, reduced feeling in your legs or you generally feel unwell please see your GP immediately. Please note that constipation is common with pain medication and if you have a problem with this please see your GP. If you are unable to pass urine, are incontinent or lose feeling in the genital area please go to A&E immediately.
• Change lifestyle factors:
  Avoid everyday activities that may increase your pain, for example, sitting on a sofa or in a car for long periods, repetitive bending movements at home or work, or stressful situations as stress can also increase your pain.

These are a few exercises that may help you maintain your range of movement whilst your LBP resolves, but any exercise that does not make your LBP worse may be beneficial. You must not do any exercise that makes your pain worse or makes your pain spread into your legs.

Flexion in Lying

• Lying on your back, pull both knees up towards chest.
• Hold for 5 seconds.
• Repeat 10 times.
• Perform exercise 3 times a day.

Extensions in lying

• Lying on your front with your hands in a ‘press up’ position.
• Push your shoulders back off the bed keeping your hips on the bed then lower back down.
• Repeat 10 times.
• Perform exercise 3 times a day.

Knee rolls

• Lying on your back with your knees bent up.
• Lower knees to either side then return to the middle.
• Repeat 10 times times to each side.
• Perform exercise 3 times a day.