Leaflet: Low back pain advice and exercises

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Last updated: April 2020
Next review: April 2022

Low back pain advice and exercises

Introduction
Low back pain can be frightening but isn’t normally caused by anything serious. Most people will experience some low back pain at some point in their lives. This usually improves within a few weeks/months, although some people may experience flare ups and others may have more persistent low back pain.

A key thing to remember is that the back is a strong structure. The spine consists of bones, muscles, ligaments and discs which all work together to provide you with a strong back. The spinal column consists of 24 bones (vertebrae) and is split into the cervical, thoracic and lumbar spine.

The vertebrae are connected by discs, ligaments and facet joints. Your muscles and discs act as ‘shock absorbers’ in the spine and, along with the facet joints, help to provide the spinal column with its flexibility. You also have nerves which exit from each level of the spinal column.

Changes within the spinal column are completely normal with the ageing process, and these changes will occur at different rates in different people – much like the appearance of grey hair and wrinkles will happen at different ages in different people!

Common Myths

Myth 1: Moving will make my back pain worse!
Research has shown that resting for long periods is actually likely to make back pain worse. One of the most important things to do is to keep moving! You may need to moderate your activity levels, but you should then gradually increase this. Moving little & often is the key!

Myth 2: I should avoid exercise!
Studies show that continuing regular exercise/activity can help to get you better earlier. There is not a ‘one-size fits all’ approach – the most important thing is that you enjoy the exercise/activity! Start slowly and gradually build on this.

Myth 3: I need a scan – it will show me what’s wrong!
Scans often show ‘normal’ changes and can cause more problems than solutions as they can make people more worried about their back. Investigations tend to only be requested if there is cause for concern (to rule out other causes) or if invasive management is being considered.

Myth 4: Pain equals damage!
Your pain often does not mean that your back is damaged. It is also important to remember that it is normal to feel aching after exercise or activity. This can take up to 48 hours to reduce.

Management

The most effective way to manage your low back pain is through exercise. The NHS currently advises that adults aged 19-64 should aim for the following levels of activity in order to stay healthy:

150 minutes of moderate aerobic activity* or 75 minutes of vigorous aerobic activity** or a mixture of moderate and vigorous aerobic activity each week

Strengthening exercises on at least 2 days a week

*Moderate aerobic activity = raises your heart rate and gets you slightly out of breath
**Vigorous aerobic activity = gets you out of breath; you won’t be able to say more than a few words

Key Tips: For a Flare Up    

  1. Keep moving! Avoid bed rest
  2. Gradually increase activity levels
  3. Pace yourself – allow more time for tasks
  4. Stretch little & often daily
  5. Stay in work & resume normal activities
  6. Use painkillers, as advised by GP/pharmacist
  7. Use hot/cold packs; whichever is comfortable
  8. Try to stay positive

Key Tips: General

  • Consider manual handling techniques
  • Find a type of exercise that you enjoy and do this regularly
  • Consider your posture when sitting, standing and lying
  • Avoid prolonged static postures – move little and often
  • Complete a work station assessment
  • Maintain a healthy weight

You can find more information regarding the general management of low back pain via the following links:

  • Chartered Society of Physiotherapy: www.csp.org.uk
  • National Institute for Health & Care Excellence: Low Back Pain Guidance: www.nice.org.uk
  • Arthritis Research UK: www.arthritisresearchuk.org
  • GetUBetter smart phone app: www.getUbetter.com

If you would like some more specific advice regarding your work duties/work station please email the Staff Physiotherapy Service and/or discuss it with your manager.

Posture

There is not a ‘one size fits all’ approach to posture. What is comfortable for one person may not be comfortable for another. The most important thing is to make sure that you are changing position and moving regularly during the day. Bodies do not like staying in the same position for a long time, no matter what that position is.

As an aim: try to change position every 20-30 minutes. This may just involve doing a couple of quick stretches.

If you are unsure whether your workstation is set up correctly for you or you continue to get pain, you may wish to consider asking your manager for an ergonomics assessment.

Key Tips: Things to Consider

  • Break up your tasks: instead of doing the same activity for a couple of hours, mix your activities up so that you are not repeating the same movements or staying in the same position for too long
  • Go for regular short walks, even if this is only to the printer or to get a drink
  • Stretch regularly – find stretches that help you and do these little & often throughout the day
  • Avoid being in awkward postures e.g. twisted to the side
  • Avoid holding the phone between your ear and shoulder – consider use of a headset if you are on the phone a lot
  • Ensure you are using correct manual handling techniques when lifting or moving object
  • Make sure that your workstation is set up for you
  • Use the stairs instead of the lift
  • Take breaks if you drive long distances – the Highway Code recommends that drivers should take at least a 15 minute break every 2 hours.

Exercises

N.B. You do not need to do all of these exercises. Find the ones that seem to help you and focus on these. Do as many repetitions as you feel able to, without working into high levels of pain. Please download the PDF of the left-hand side of this page – there are images in the document which will help you to do these exercises. 

Here are some exercises which may help you to manage your low back pain. It is beneficial to do a combination of flexibility and strengthening exercises. When doing exercises:

  • Do them in a comfortable range
  • Ensure you do them regularly – little and often through the day is ideal!
  • Progress them if they are becoming too easy (e.g. increase repetitions)
  • Regress them if they are too difficult (e.g. decrease repetitions)
  • Persevere! If you have had back pain for a while, they won’t work overnight
  • Expect to ache afterwards – this is normal and should ease fairly quickly

Flexibility exercises

  • Roll your knees slowly side to side.
  • Lie on your back with your feet on the ground and your knees bent. Flatten your lower back whilst tightening your stomach muscles. Hold 3 secs.
  • Hug your knee to your chest. Hold 20-30 secs Progress: hug both knees at the same time.
  • Get onto your hands and knees. Curve your back up and then arch it again. Focus on slow movement.
  • Lie on your stomach and push up onto your forearms. Hold 15-20 secs. Progress: fully straighten your arms.
  • Sit on a chair. Stretch one leg straight in front of you, with the other leg’s foot flat on the floor. Lean forwards until you feel a gentle stretch in the back of your thigh. Hold 20-30 secs.

Strengthening exercises

  • Lie on your back and squeeze your buttocks together. Hold 5 secs. Progress: Squeeze each buttock alternately.
  • Lift your hips up. Hold 3-5 secs. Progress: Straighten one leg out once you have raised your hips
  • Lie on your side, with your legs together and slightly bent. Lift your top knee up, keeping your hips slightly forward. Progress: Tie a theraband around your knees.
  • Lift your top leg up, leading with the heel. Progress: Use an ankle weight.
  • Go onto all fours and straighten one leg behind you. Hold 5 secs. Progress: Straighten out your opposite arm at the same time (‘superman’).
  • From standing, step forward with one leg bent and the other leg stretched out behind you. Bend your back knee and then stand up again. Progress: Lunges.
  1. Gym Ball Exercises

Gym balls can also be very good in the management of low back pain. Here are a couple of exercises you may like to try:

Sit on a gym ball:

  • Move your hips in small circles, both directions
  • Bounce gently up & down
  • Pelvic tilts – slump your lower back and then sit up tall
  • Lift your foot off the floor.
  • Hold 3 secs.

Lie on the floor with your calves and feet on the ball:

  • Lift your hips up, keep the ball still. Hold 5 secs.
  • Progress: Lift your arms alternately off the floor.

When to Seek Help

You may want to seek help if you have tried the advice in this booklet and one or more of the following statements apply to you:

  • Your pain doesn’t start to improve
  • Your pain continues to stop you from doing day-to-day activities
  • Your pain is very severe and is getting worse over time
  • You’re worried about the pain or are struggling to cope

Symptoms to be aware of:

It is rare that your back pain is due to a serious problem, but you should contact a doctor urgently if you experience any of these symptoms:

  • Difficulty passing urine or having the sensation that you cannot empty your bladder
  • Loss of bladder or bowel control
  • Numbness or tingling in your genitals or buttocks
  • Sudden weakness in your legs
  • Tripping or difficulty lifting your foot up
  • Very severe and on-going back pain that continues to get worse

Key Messages

  • Back pain is common – it affects most people at some point
  • Don’t be afraid of the pain – it is unlikely that it indicates serious damage
  • Back pain usually gets better quickly if you keep moving and use the ‘flare up’ advice
  • Be proactive in the management of your back pain – exercise regularly
  • Remain at work or return to work as soon as possible, even if you have to request light duties
  • Be aware of when to seek help, and do so accordingly