Your back and how to look after it

This information 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 patients who are receiving conservative treatment only.

Remember:

• Half of all people experience back pain at some point in their lives. 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

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.

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 (bottom) 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/MRI 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. Even people without back pain have changes in their spine so scans can cause fear that influences behaviour, making the problem worse.

You may find it frustrating not to know exactly what is wrong but this is good news because it means there is nothing serious.

The first 2 - 3 days

Take painkillers and/or anti-inflammatories. These will reduce pain and help you to move and keep active (make sure you read the instructions carefully).

Try to keep moving. You might want to rest for short periods in positions that are comfortable. These positions may help:

• 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 when using them.
• 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.
• Choose a chair that supports your lower back.
• Do not sit for too long get up regularly, stretch and walk about. This includes driving.
• Stay relaxed whilst driving and take regular breaks.
• 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.
• 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.

Sleeping

• Find a comfortable bed for you and avoid one that sags or is too hard.
• 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.

Relax yourself

• 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 do things which stop you feeling low. Be positive!

Active ongoing back care

Although a physiotherapist may help you to manage your pain what you do is the most important thing.

Stay active

• 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.
• Don’t fear twisting and bending – it is essential to keep moving. Gradually increase how much you are doing, and stay on the go.

Pace yourself

• It is normal to have good and bad days. Keep doing your normal activities little and often throughout the day 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.

Tablets

• Painkillers 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.

Stay positive

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

Back pain shouldn’t stop you enjoying exercise or regular activities. In fact, studies found that continuing with these can help you get better sooner.

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.

Complimentary therapies

As well as being active some people find they also get relief from activities such as:

• Massage
• Acupuncture

What if it happens again?

• If you do get back pain again, remember, it will go away like it did last time. 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.

Remember:

• 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.

Acknowledgments

This information was produced from collaborative work by the BNSSG physiotherapy working group.

© North Bristol NHS Trust.  This edition published April 2024. Review due April 2027. NBT002023.