Did you know that around 85% of adults will experience low back pain at least once in their lives? In most cases it is not due to serious disease and often the exact cause of the pain is not clear. This is referred to as non-specific lower back pain. Acute back pain refers to pain that lasts less than 6 weeks. If managed well in the early days and weeks, acute non-specific low back pain should be no more than a little bump in the road, and most of us should recover relatively quickly without long term complications. If managed poorly, pain can become chronic, recurrent and potentially quite debilitating.
There are a lots of ways to keep your body moving while your back is fully supported
Back pain itself can be caused by a range of conditions. Mechanical causes are by far the most common and include disc issues, muscular spasm, and vertebral joint problems. They are often precipitated by poor biomechanics, such as those affected by years of bad posture and weak stabilising muscles. Back pain can also be caused by trauma, scoliosis, inflammatory arthritis, or pregnancy, just to name a few. There are some rare but quite serious causes and complications of back pain, so if you experience any of these, make sure you see your doctor early: numbness or tingling down your legs, numbness around your anus, severe pain that does not improve with rest, pain after a fall or injury, bladder or bowel trouble, weakness in one or both legs, fever, unintentional weight loss, or night pain.
In acute, non-specific low back pain, the most important thing is try and keep active and do normal activities as much as possible. Often in order to achieve this, you will need to get in control of your pain first. This might mean seeing your General Practitioner to get some help with pain relief, or it might mean using some simple pain medication from the pharmacy. The important thing is DO NOT REST IN BED for days on end. Gentle mobilisation is vital from the beginning. And if the pain is so bad you can’t move – see your doctor. When you do need to rest in those early days, do so for short periods of time and rest well. This means not sitting down for hours on end, but often lying down in a position that works for you with pillows to support your knees or side.
There is no evidence to support one particular exercise or activity to improve back pain, but we do know that gentle mobilisation is crucial to recovery. So go for a slow walk, do a couple of very gentle, low range stretches or try walking in water. Whatever you do, just keep it low intensity, and focus on simply moving. As your pain improves, and you start moving better, you can start building your activity up again, but don’t go overboard! This is not the time to be jumping straight back into your high intensity gym session. In general, exercise will not aggravate or worsen you injury or back pain. If you feel like your back pain is a little worse the next day, it might be a sign that you need to back off the intensity the next day or so, but it is highly unlikely you have extended the injury provided that you are starting low and going slow.
If you struggle to lie down there are always alternatives
There is little evidence to support any specific complementary treatments for acute back pain, although things like massage or osteopathy might help in the early days with pain and function. After that nothing is really any better than simple exercise. If there is something you want to try and you are sure it won’t do any harm, you can make your own choices. There is also little evidence for any radiological imaging in acute back pain, so if you see your GP and they don’t send you off for an X-ray, CT or MRI straight away, they are actually showing very appropriate management. If pain isn’t improving in the way we would expect it, or any of those ‘red flag’ symptoms listed above are present, we might consider early imaging, but more often than not, it’s not needed.
There are ways you can work on your core strength and still protect your back.
It is a great idea to work with someone once you are out of that really acute (first 72 hour period), to find out about any poor biomechanics and explore how you might be able to prevent any further episodes. Often this is best done with a physiotherapist, as they are well placed to do a full biomechanical assessment and then give you a specifically targeted program to manage any individual issues. From there you can get back in to exercise, but don’t overdo it! Time and again, I’ve seen people get straight back in to the gym, often lifting heavy weights, or trying to get straight back into HIIT or Metafit or boot-camps or step classes….your back is still vulnerable! And until you work out if there is something specific you need to work on (weak abdominal muscles, unilateral tight buttock muscles, poor posture etc), you are setting yourself up for re-injury. And just a little note – whilst ‘core’ is important to posture and back stabilisation, it is all about function. Doing a hundred crunches a day or holding plank for 2 minutes might give you a six-pack, or a nice rigid ‘rack’ but they aren’t going to give you a healthy, strong, flexible and functional core and they might just set you up for a back injury. Find a health provider or fitness instructor that understands how to help you do exercise safely with a focus on function, not just on looks. And remember, if you aren’t getting on top of your back pain in the way we would expect, see a health professional.