7 Tips for Low Back Pain

If you’re experiencing your first really bad backache, you’re probably panicking a little about the pain and its implications — what if it’s cancer? What if it never goes away? If it feels this bad at the age of 30, what will it be like when I’m 60?!

My first piece of advice is, take a deep breath and relax.  Low back pain is very common. About 80% of Australian adults will miss work at some point because of it. And most of the time, it’s neither permanent nor serious: 95% of backaches go away within six weeks, with no specific treatment, and potentially much faster if you seek treatment, advice and management strategies from an expert in the field of manual medicine.  Following are 7 essential things to know about dealing with a bad back…

1. Prevent or Treat spasm first

Being anxious or stressed-out about back pain — or stressed out in general — will increase your chances of muscle spasm, which is itself both a source of back pain and an amplifier of other sources of pain. In addition to psychological stress, caffeine, dehydration, lack of sleep and low sodium are also likely to increase spasm and cramping.  So drink water, limit the espresso’s and get some shut-eye.

Muscle spasm nearly always present to some degree with back pain.  What does spasm feel like? When you’re bent over to one side and just can’t straighten up, that’s typically muscle spasm. The “stiff back” that hurts more than usual is also likely to be the result of spasm. Your first order of business should be rest and heat or Ice (the jury is still out on those two).

2. Listen to your body

If you know it’s going to hurt to try to move that refrigerator right now, don’t do it! Your pain will not lessen or recede any faster if you ignore it and fight your way through. No prizes for stoicism when dealing with a bad back. Forcing yourself to bend, twist or lift makes things worse. Common sense, right?

Take it easy when your back hurts. Sit or sleep in the most comfortable position you can find. In most cases this means lying on your back with three or more pillows under your legs so that the hips and knees are both flexed 80 to 90 degrees.  Lying on your side (usually there’s one side more comfortable than the other) is also comfortable for back pain sufferers.  You can use a pillow between your legs to take pressure off your back in this position too.

When sitting- don’t sit in your favourite slouchy TV sofa!  It will aggravate your pain. Try and sit in a simple kitchen-table chair with a pillow or rolled-up towel in your low back for support. Maintaining a neutral spinal position is what you’re trying to achieve. Even minor slouching in chairs can exacerbate back pain.

Walking can be pretty painful early on, so avoid it at first (usually the first 24-48hrs). As the pain subsides and you straighten, going for a walk — with nothing in your hands, feet pointing straight, head up — is usually beneficial and may help improve your condition.

Listen for danger signals from your body as well. Electrical pains radiating down your legs; numbness or weakness in the lower extremities or crotch; or any loss of bowel or bladder control mean it’s time to seek out a doctor. If so, make the call.

3. Start with the basics

Rest, anti-inflammatory pain medicines like ibuprofen (Neurofen), Voltaren or Panadeine and a 24-48hrs will take the edge off some of your symptoms.  Applying heat or cold on the back relieves some patients’ pain. In the hot-versus-cold debate, I’ve had an equal number of patients benefit from one but not the other. (Sorry, there is no official medical answer.)

Stretches and exercises to relieve low back pain — the kind you read about in self-help books and magazines — can be great or terrible, depending on the exercise and what’s causing the pain. If you’re doing this on your own, it makes sense to play the odds when it comes to these therapeutic maneuvers. For safety and effectiveness I can recommend only one. See Tip 4.

4.  The 90-90 Stretch

When it comes to stretches, my best advice for the most common, “generic” backache is the “90-90” position: lying on the floor with your calves flat on a chair or other horizontal surface, hips at 90 degrees to your body, knees flopped comfortably apart till you are not using any muscle force to stay there. The idea is to rest your spinal muscles and hip flexors completely. With the small of the back flat on the floor, thighs roughly vertical and calves horizontal, the back muscles that have been straining all day to prevent painful motion can relax.

A tall person needs some flat cushions to make the chair higher, a shorter person needs a lower chair — like the seating surface of a couch. A sturdy box of just the right height, covered with a blanket works well too. Arms should rest comfortably out to the sides, head flat on the floor. Once you settle in and get relaxed, stay in that position for 15 minutes. This breaks spasm in some muscles, opens up the nerve spaces and evens out the forces across the small joints of spine. If it feels good and gives any relief the first time you try it, continue to do it three times a day.

5. Know when to seek help

a) Severity. If you are utterly debilitated by your back pain, you need to see a General Medical Practitioner who can prescribe drugs. However, it is not recommended to take narcotics for low back pain for a host of reasons, the most important of which is that the drugs can and usually will make the pain worse if you stay on them for more than a couple of weeks. But if you need drugs, you do need to see a physician — who I hope will have the sense to use every means possible to get you off painkillers as soon as possible.

b) Risk. Yes, some backaches are caused by things that can kill you: an aneurysm, cancer, spinal infection, even kidney problems can present as back pain. M.D.’s, Osteopaths and Chiropractors are trained to watch out for these.

What are the common signs that something rare and risky may be causing your backache? Ask yourself: is it the same old backache you get every time you shovel the walk? If so, then it’s probably not risky. Does the pain get worse at night in bed, boring in like a toothache? That could be cancer or an infection. Weight loss and fever along with the bad back are very bad signs too. Is the pain sudden and severe, ripping down your back or into the groin? It could be aneurysm or kidney stone. This last scenario is one of the few back pain emergencies — go straight to the emergency department with this. Numbness of the crotch region, loss of bowel or bladder control also are serious signs and medical help must be sought immediately.

6. Who treats back pain?

During a debilitating episode of back pain your natural reaction will often be to seek medical help. Your first point of call may be your G.P. who can prescribe appropriate medication to ameliorate the symptoms.  But yes folks, you have to get the cause of the pain seen to also- and that’s where it gets confusing… These days there are a plethora of health care professionals who claim to treat back pain.  Knowing who to see and what sort of treatment best suits you is a veritable minefield that many of my new patients have struggled with.

In Australia you are generally in safe hands if you stick to an APHRA registered health care provider- along the lines of Osteopathy, Chiropractic or Physiotherapy.  Such professionals have undergone many years of stringent training and assessment and are qualified to assess and treat your pain. Which one suits you is a personal choice.  Quite often a recommendation from a friend to seek out a particular professional is a popular choice.  Osteopathy is great for back pain- but I’m obviously biased! My advice: do some Googling and learn about what each of these professions can offer and which may best suit your personal needs. There you go; pretty diplomatic I would say!

7. Self-Management

In our clinic we tend to see many patients in a vicious-cycle that sees them encountering the same debilitating back pain every 18months or so.  Although we encourage patients to continue with their prescribed exercises to prevent recurrence, I guess human nature dictates that it is likely we’ll stop these good management strategies and eventually succumb to back pain again at some point. After a bout of tooth pain I floss and brush like a mad-man… for awhile at least!

If you’re not great with self-directed home exercises, then why not seek out a Yoga or Pilates class.  Yoga is brilliant for improving flexibility in your muscles and it’s a great way to de-stress.  Pilates is focused more on dynamic strength and core strength, than flexibility.  Core strength refers to a few muscles around the abdominal area that help protect and support your spine.

Doing Pilates classes helps you get stronger core muscles- but beware- just doing these classes doesn’t ensure you will be exempt from back pain just because you have a strong core!  Core muscles are under conscious control i.e. you have to tense them and use them when your spine is in a compromised position. I.e. Unpacking the dishwasher, brushing your teeth and picking up dirty washing.  These actions are popular responses from my patients when I ask them; what happened?

I hope you found my 7 tips for back pain helpful!

Enjoy the journey!

Anthony Collins