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Back pain Q&As

Published by Bupa's health information team, February 2009.

Answers to questions about back pain

This section contains answers to common questions about this topic. Questions have been suggested by health professionals, website feedback and requests via email.

 

Are there any easy and safe exercises I can do to help relieve my back pain or prevent it returning?

There are many exercises that you can easily do at home to keep your back healthy. However, if you currently have back pain, you must talk to your GP or physiotherapist before doing any exercise in case it's not appropriate for you.

Explanation

Back exercises developed by Robin McKenzie have been found to be of benefit to some people with back pain.

Examples of McKenzie back exercises include:

Relaxation 1 - Lie face down with your arms beside your body and your head turned to one side. Take a few deep breaths and concentrate on removing all tension from the muscles in your lower back. Once relaxed, remain in this position for around five minutes.

Relaxation 2 - Lie face down and place your elbows on the floor directly under your shoulders so that you're leaning on your forearms. Again, take a few deep breaths and concentrate on removing all tension from the muscles in your lower back. Once relaxed, remain in this position for around five minutes.

Lying extension - Lie face down and place your hands flat on the floor with your elbows bent (as if about to do a press up). Keeping your lower body (from the hips) on the floor, straighten your arms as far as you comfortably can, pushing your upper body up and off the ground as far as possible. Hold for a couple of seconds and then return to the starting position. Repeat several times, trying to straighten your arms a little more each time.

Standing extension - Stand upright with legs straight, your feet slightly apart and your hands on the small of your back with your fingertips touching in the middle and your thumbs pointing forwards. Bend backwards from the waist as far as you can, keeping your legs straight as you do so, hold for a couple of seconds and then return to the starting position. Repeat several times, trying to lean back a little further each time.

Lying flexion - Lie on your back with your knees bent and your feet flat on the floor. Bring both knees up to your chest and hold with your hands, gently pulling your knees as close to your chest as you comfortably can. Hold for a couple of seconds and then return to the starting position keeping your knees bent at all times. Repeat several times, trying to bring your knees closer to your chest each time.

Sitting flexion - Sit on the edge of a steady chair with your feet flat on the floor, your knees and feet well apart and your hands resting between your legs. Bend forwards until your hands touch the floor and then return immediately to the starting position. Repeat several times, trying to bend further each time until your head is nearly touching the floor.

General fitness

If you have back pain, there are many general fitness activities which you can do as long as you get approval from your GP first and do them with care. Suitable examples include walking, swimming, yoga and cycling.

Before starting any form of exercise, you should talk to your GP or physiotherapist, who can advise you which exercises you should and shouldn't do. The best form of exercise for you is one that you enjoy because then you will keep doing it and the benefits will be greater and longer-lasting.

Further information

Sources

  • Van Tulder M, Becker A, Bekkering T et al. European guidelines for the management of acute nonspecific low back pain in primary care. Eur Spine J 2006; 15 Suppl 2:S169-191. wwww.eurospine.org
  • Exercises for pain relief. Communigate. www.communigate.co.uk, accessed 16 May 2008
  • Engers A, Jellema P, Wensing M et al. Individual patient education for low back pain. Cochrane database of systematic reviews 2008, Issue 1. Art. No: CD004057.pub3. www.cochrane.org
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I do a lot of lifting and carrying at work. How can I prevent back injury in the work place?

Nearly five million working days are lost each year because of back pain caused, or made worse, by work. In particular, heavy lifting is known to increase the risk of back pain. If you already have back pain, you should talk to your employer about ways to prevent making your pain worse while at work.

Explanation

If you have back pain and have been off work, it's important to try to get back to work as quickly as possible as this may actually help your recovery. Talk to your employer about making a gradual return to work and whether your duties can be adapted to prevent further back injury.

Common workplace activities that are known to cause or aggravate back pain include:

  • stooping, bending over or crouching
  • lifting, pushing or pulling bulky, heavy or awkward objects
  • stretching, twisting and reaching
  • prolonged periods in one position, leading to postural strain
  • jobs in which your whole body is subjected to vibration, jolting and jarring (such as drilling)

In order to prevent back pain caused by lifting and carrying, the following tips may be helpful.

  • Before lifting, stretch your back.
  • Always bend from your knees, not your back.
  • Turn using your whole body; don't twist your back.
  • Carry objects close to your body.
  • Don't try to carry too many things at once.
  • If something is particularly heavy, get someone to help you lift it.
  • Whenever possible use mechanical handling equipment to lift things for you.

Further information

Sources

  • Back pain - introduction. Health and Safety Executive. www.hse.gov.uk, accessed 7 May 2008
  • Martimo KP, Verbeek J, Karppinen J et al. Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. BMJ 2008; 336:429-431. www.bmj.com
  • What can lead to back pain in the workplace? Health and Safety Executive. www.hse.gov.uk, accessed 7 May 2008
  • 4 Hazards and risks associated with manual handling in the workplace. European Agency for Safety and Health at Work. http://osha.europa.eu, accessed 13 May 2008
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I have seen many different kinds of back supports, cushions, mattresses and chairs advertised for sale. Are any of these effective at preventing or curing back pain?

There are a number of aids and appliances available for people with back problems. Some of these can be useful, others are of no benefit and some may even do more harm than good. You should never use any of these products until you have talked to your GP, pain clinic or occupational therapist (a health professional trained to help people who are ill or disabled learn to manage their daily activities).

Explanation

Before buying any products to help you cope with your back pain or to prevent back pain in the future, you should speak to your GP who can refer you to a pain clinic or an occupational therapist for specialist advice, if necessary.

Back supports

There are a number of back supports, corsets and braces available for the prevention and cure of back pain. However, the usefulness of these supports hasn't been demonstrated in clinical trials. In addition, different types of supports are suitable for different types and causes of back pain - using the wrong type might actually make your back pain worse. Your GP or occupational therapist will be able to advise you whether or not a back support would be useful for you, which type would be best, and may even be able to supply one for you.

Insoles

There is little evidence that using insoles in your shoes will prevent or treat back pain.

Beds

If you have back pain, a good night's sleep is very important, as it will leave you refreshed in the morning and better able to deal with your back pain.

Many people believe that a firm mattress is better for relieving or preventing low back pain. However, this may not always be the case as was recently demonstrated in a clinical study comparing three different types of mattress/bed - a waterbed, a 'memory foam' mattress and a firm mattress. In this study, the waterbed and 'memory foam' mattress were found to improve sleep and back pain more effectively than the firm mattress. Also, regardless of which mattress type was used, people who slept better also reported less pain and better mobility in their backs.

Ideally, your mattress should be soft enough to support and conform to your body shape yet firm enough to allow you to turn from side to side easily, without twisting your back. The best way to check if a mattress or bed is suitable for you is to try it out properly (for at least 10 minutes - or, if possible, get a home trial). Lie down flat on your back and slide your hand between the mattress and the small of your back. If you can slide your hand through easily but it stays in contact with both the mattress and your back, your back will be in what is known as a 'neutral' position and the bed is probably the right one for you. A large gap between your back and the mattress means the bed is too hard. No gap at all means the bed is too soft.

Car seats

If you spend a lot of time in your car, it's important to make sure that your back is properly supported. Make sure that your car seat and headrest are properly adjusted so that you can see your mirrors clearly without having to twist in your seat. Your lower back should be supported (use an additional cushion for your lower back if your car seat has little or no support in that region), and you should be able to reach the foot pedals comfortably, without stretching.

Other aids and appliances

There are many other products including chairs, desks and cushions that are advertised as being particularly suitable for people who are prone to back pain. An occupational therapist will be able to assess your needs and tell you if you would benefit from any of these products. Additionally, the BackCare (National Back Pain Association) website provides links to manufacturers of these types of products.

Further information

Sources

  • van Duijvenbode ICD, Jellema P, van Poppel MNM et al. Lumbar supports for prevention and treatment of low back pain. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No: CD001823.pub3. www.cochrane.org
  • Sahar T, Cohen MJ, Ne'eman V et al. Insoles for prevention and treatment of back pain. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No: CD005275.pub2. www.cochrane.org
  • Bergholdt K, Fabricius RN, Bendix T. Better backs by better beds? Spine 2008; 33:703-708. www.spinejournal.com
  • Drive away bad backs. Health and Safety Executive. 2005. www.hse.gov.uk
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What happens at a pain clinic?

Your GP may suggest that you are referred to a pain clinic if you have lived with persistent back pain for some time. Staff at a pain clinic will try to find out what is causing your pain and help you to find an approach to lessen your pain.

Explanation

If you have lived with back pain over a long period of time, talk to your GP about the possibility of a referral to a pain clinic. Pain clinics are available on the NHS. However, the way NHS pain clinics are organised can vary. NHS pain clinics may have a team of doctors, psychologists, nurses, physiotherapists, occupational therapists and other staff. At the other end of the spectrum, a hospital may not have a formal clinic, but instead may have a single consultant with an interest in pain.

The health professionals at the clinic will assess you and try to find out what is causing your pain. You may then be offered special exercises, medicines and other methods to try and help with your pain. Other methods used in pain clinics can include TENS (trans-cutaneous electrical stimulation). TENS involves using tiny electrical pulses to block pain. Although there isn't any scientific evidence for TENS, some people may find it effective. You may also need to have injections to give you some short-term relief from pain.

Psychological approaches are also often used by pain clinics to help you to live with your pain. This can include a pain management.

Further information

Sources

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Would a pain management programme help me?

Pain management programmes are designed to help you to deal with long-term back pain if other treatments haven't helped you. Talk to your GP about what is available in your area.

Explanation

Pain management programmes aren't designed to cure or treat your pain; they are designed to help you cope with and live with the pain. However, some people may find their pain has lessened after such a programme. Pain management programmes may be run alone or as part of what is on offer at a pain clinic.

You will usually be part of a small group of people with long-term pain. The approaches used may include psychological approaches, relaxation therapy and learning about pain and how to deal with it.

Some NHS pain management programmes are run as part of the NHS Expert Patient Programme. Ask your GP about these and other pain management programmes in your area.

Further information

Sources

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What should I do if my back suddenly 'goes'?

If your back pain comes on suddenly, it can be alarming. There are some things you can try immediately.

Explanation

If your back pain suddenly comes on or gets a lot worse, you could try the following.

  • Use an ice pack. Wrap a bag of frozen peas or gel pack in a tea towel and place it on the affected area for up to ten minutes.
  • Take painkillers, particularly anti-inflammatory painkillers such as ibuprofen. Some people shouldn't take non-steroidal-anti-inflammatory medicines (NSAIDs). NSAIDs can cause side-effects, particularly to your digestive system, including indigestion, heartburn or bleeding or ulceration in the stomach. If you have asthma, NSAIDs should be used only with caution. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or GP.
  • If you have a TENS machine, this may give some relief. TENS involves using tiny electrical pulses to block pain. Some pain clinics offer TENS machines or they are widely available to buy. Check with your doctor whether having a TENS machine at home is right for you.
  • Try relaxation techniques. You will need to learn these techniques and practice them. The techniques include learning to control your breathing, and different types of exercises that aim to relax your muscles. For more information, contact BackCare (see Further information).
  • Try to move around. Even if you are in pain, it's best not to stay in bed or stay lying down.
  • Visit your GP. He or she may also be able to recommend a registered therapist such as an osteopath, chiropractor, physiotherapist or massage therapist to treat your acute back pain.

Most back pain eases after a few days and most people recover fully within six weeks. See the Back pain factsheet for details of symptoms that should be checked by your doctor as soon as possible.

Further information

Sources

  • What to do when pain strikes, BackCare, February 2007. www.backpain.org
  • Low back pain (acute). Clinical Evidence, BMJ, 2006. www.clinicalevidence.bmj.com
  • Back pain - lower, Clinical Knowledge Summaries. http://cks.library.nhs.uk
  • Joint Formulary Committee, British National Formulary. 55th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2008
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When I have back pain, I just want to lie down. Why is it important to keep active?

There is clear evidence that bed rest or being inactive won't help back pain.

Explanation

It was once thought that staying in bed would ease a painful back. Now the advice is to keep as active as you can and get back to your normal activities as soon as possible. Evidence shows that staying in bed can cause your joints to stiffen, your muscles to lose strength and generally cause you to take longer to recover. Staying active can reduce the time you need off work and can reduce the chances of on-going, chronic problems.

If you have back pain, be realistic about what you can do. Most back pain eases after a few days and most people recover fully within six weeks. See the Back pain factsheet for details of symptoms that should be checked by your GP as soon as possible.

Further information

Sources

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Related topics

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This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr R Munglani, FRCA, FFPMRCA; Consultant in Pain Medicine, Spire Lea Hospital, Cambridge and by Bupa doctors. It has also been reviewed by BackCare. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: February 2009

 

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