(with or without leg pain)
Information and Exercise Leaflet
for Patients and Carers
Back pain is very common at all ages of adulthood. 8 out of 10 people will have back pain at some point in their lives and 90% of these cases resolve without specialist input.
- In most cases it is not due to a serious disease.
- Back pain can be associated with a range of sensations. This may present as anything from stiffness, tight/achy muscles to sharp localised/stabbing pains. Occasionally the nerves can become irritated and cause pain, pins and needles and sometimes changes to your feeling in that area. These symptoms are not frequently associated with serious disease or injury.
- Investigations such as X-ray and MRI are rarely beneficial for the diagnosis and physiotherapy management of back pain.
- The spine is strong and resilient and in most cases, back pain improves of its own accord within 6-8 weeks with 8 out of 10 people reporting an improvement in their symptoms after just 4 weeks.
- Keeping active is crucial to assist with recovery of back pain.
- Why does my back hurt?
- There are many factors that can contribute to developing back pain:
- Physical effort that exceeds your capability. All joints and soft tissues in the body have a certain capability for activity that they can tolerate. This can depend on how much activity you normally do and how well your body has adapted to this activity over a period of time. If you do an activity that takes you over this level you can present with a painful reaction.
For example, if you perform an activity such as digging your garden for longer than your joints and tissues can tolerate, you can cause overload and irritation resulting in a painful reaction. This response is protective; the pain is looking after you whilst your tissues settle. It is not an indicator of condition severity and is rarely associated with tissue damage.
- Trauma such as falls, sports injuries and car accidents can expose your body to a rapid change in movement and/or blunt impact. This force can cause injury to the body’s tissues and lead to swelling and inflammation.
- Inactivity and staying in one position for too long. Remember: keeping active is important.
Non-physical factors can also influence your pain such as:
- Emotional stresses for example anxiety, depression; family or occupational issues can make your pain system more sensitive, resulting in you experiencing more pain.
- Lifestyle factors such as disturbed sleep, poor diet, lack of exercise/activity and smoking can also contribute to back pain.
With simple advice provided within this leaflet, your back pain should settle within 6 weeks. It is important that you remain active and continue as normal as much as
possible. However, if your back pain is persistent and severe then you should seek
medical advice for the appropriate treatment.
What about work?
Around 34% of workplace musculoskeletal (MSK) problems (that are related to joints, muscles, ligaments etc.) are of the lower back and your back pain may alter your ability to perform your usual work related responsibilities.
It is important you discuss any concerns or limitations with your employer as remaining in work or returning as soon as you are able is an important contributor to good health.
For free and confidential advice about work, call the Healthy Working Lives Advice Line on 0800 019 2211.
Alternatively, visit the Fit for Work (http://fitforwork.org/) and the HSE website
(https://www.hse.gov.uk/msd/backpain/index.htm) for further resources.
What about sports?
As discussed above, keeping active is crucial to assist recovery of your back pain
however you should pace your return to your sporting activity. You will need to re-start at a lower level than you were used to before and slowly increase this amount. Be prepared, however, for slight discomfort at first and remember to warm up before and cool down following participating in your sport.
What can I do to help my back pain?
Movement and exercise can help to ease back pain.
When you have back pain it is important for you to keep moving and this can contribute to your back pain improving. You may experience some discomfort after moving however this should settle down soon afterwards and does not cause harm.
If you are very uncomfortable after, this may be a sign that you have done too much. However, do not stop moving, you may need to move a little more gently and build up gradually or may require some stronger painkillers to help you to keep moving.
Painkillers can help you keep moving. However, it is important to discuss this with your GP, especially if you are already taking medication for something else before taking painkillers for your back problem.
Crushed Ice can help you if you have had an injury or flare-up of an old problem in the last 2 days:
- Wrap crushed ice in a damp towel and hold it for 5 to 10 minutes
- against the part of your back that hurts.
- You can do this every 2 to 3 hours. Make sure you use a damp towel between the ice and the skin to avoid an ice burn.
- Alternatively, you could try sports sprays and gel packs which do a similar job.
After 2 days you may find that heat is more relaxing:
- You could use a heat pad or a hot water bottle with an insulated cover on it. Make sure this is not too hot and not directly touching your skin. You should do this for 10 to 15 minutes, three to four times a day.
- You can also continue with ice to help reduce the pain and further swelling.
Understanding and discussing the nature of your back pain with your GP or a healthcare professional can help you deal with unhelpful thoughts and emotions.
Eating a well-balanced diet, maintaining a healthy weight and stopping smoking have all been shown to help back pain.
What actions can I take to improve my health?
Evidence tells us that making healthy lifestyle choices can have a big impact on influencing problems with your muscles and bones and can play a major role in your overall health. Some of the most effective areas to address are below:
Maintaining a healthy weight - www.nhs.uk/live-well/healthy-weight/
Increasing levels of physical activity - http://www.nhs.uk/live-well/exercise/
Avoiding poor sleep patterns - www.nhs.uk/live-well/sleep-and-tiredness/how-to-get-to-sleep/
Reducing alcohol consumption - https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/
Stopping smoking - http://www.nhs.uk/live-well/quit-smoking/
Maintaining a healthy mind - http://www.nhs.uk/conditions/stress-anxiety-depression/
The good news is that you are able to influence lots of these by modifying your lifestyle. Therefore it is important that you consider addressing these areas alongside your current treatment.
You may wish to discuss any of these factors with your treating clinician who will be able to work with you and guide your long term management and support you to improve your wellbeing.
There will be information about the local services that exist within the waiting areas of the physiotherapy department and your treating clinician will be able to help signpost you to appropriate services.
The websites listed below give more information on local services available:
- Blackburn and Darwen - https://refreshbwd.com/
- East Lancashire - http://www.upandactive.co.uk/
- Public Health England - https://www.gov.uk/government/organisations/public-health- england
Sleeping Positions
Sleep is really important for healing and reducing pain sensitivity, therefore getting good quality sleep can help you whilst recovering from back pain, you may find these sleeping positions helpful:
If your symptoms are made worse by walking and standing activities; start with the below sleeping positions:
Lie on your least painful side with knees and hips slightly bent, support head with pillows as desired and one or two pillows placed between your knees.
Lie on your back, head supported with pillows as desired and one or two pillows placed beneath your knees with heels rested upon the bed.
If your symptoms are made worse by sitting and bending activities; start with the below sleeping positions:
If sleeping on your front, try placing one or two pillows beneath your lower stomach and hips.
Additional support can be provided by placing pillows beneath your ankles.
If you don’t follow either of the above patterns and your symptoms are worse with any position for a prolonged period of time, try and find which positions benefit you the most from either section and work on those initially.
Resting Positions:
Being able to relax your body and mind is an important strategy to aid recovery from back pain; you may find these resting positions helpful:
If your symptoms are made worse by walking and standing activities; start with the below resting positions:
Lying on your back with your knees bent and your hands resting by your sides.
Lying down with both legs on a chair with both your knees and hips at a right angle.
If your symptoms are made worse by sitting and bending activities; start with the below resting positions:
Lying face down with a cushion under your stomach. You may need several cushions for this.
Lying face down, leaning on your elbows/forearms.
If you don’t follow either of the above patterns and your symptoms are worse with any position for a prolonged period of time, try and find which positions benefit you the most from either section and work on those initially.
Applications (Apps)
The ORCHA website will recommend useful and rated apps to support your wellbeing. https://www.orcha.co.uk/
Aims of Physiotherapy:
Physiotherapy may form one part of your management, helping you identify the main contributory factors whilst working together to plan your rehabilitation.
Your physiotherapist may spend time talking with you about your back pain, providing advice, reassurance and helping discuss any concerns you may have.
As mentioned previously, exercise is one of the most effective treatments for back pain.
A physiotherapist can provide and help oversee a personalised exercise programme focused on what you want and need your body to achieve.
WARNING SIGNS
If you have severe pain which is getting worse over several weeks, or if you are unwell with back pain, you should consult your doctor.
The following symptoms are very rare, but if you suddenly develop any of them, you should seek medical advice by attending an accident and emergency department as soon as possible.
- Severe pain in back, buttocks, perineum (the area between your front and back passage), genitalia, thighs and legs, and loss of sensation, pins and needles or weakness in one or both legs
- Saddle numbness (loss of feeling in the body areas that sit on a saddle – buttocks, anus and genitals, inability to feel toilet paper when wiping)
- Recent onset of bladder dysfunction (inability to urinate / difficulty initiating urination / loss of sensation when you pass urine / incontinence/ loss of the full bladder sensation)
- Recent onset of bowel dysfunction (bowel incontinence / constipation / loss of sensation when passing a bowel motion)
- Recent loss of sexual function (inability to achieve erection or ejaculate/ loss of sensation during intercourse)
If you are experiencing any of these symptoms, please seek immediate medical advice by attending an accident and emergency department promptly.
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