A patient Guide for management and treatment of Low Back Pain

Back pain is very common and can be alarming, even a minor back strain can be very   painful.  It is natural to think something dreadful has happened but serious or permanent  damage is rare and in most cases the pain isn’t caused by anything serious and will usually get better over time.

The facts

• Most back pain are not because of any serious diseases and should be fine in the long-term.
• The pain usually improves within days or a few weeks but may last longer. Most people can get moving quite quickly even while the pain remains.
• What you do in the early stages is very important. Prolonged rest may increase pain and disability.
• Your back is designed for and needs movement. The sooner you can get moving and doing your ordinary activities despite the pain, the sooner you will feel better.

Causes of back pain

• Only a few people have a slipped disc or trapped nerve. Even then, most of these will get better by themselves.
• X-rays and MRI scans can detect serious spinal injuries but will not diagnose the cause of most back pains.
• X-rays nearly always show a degree of ‘degeneration’, this is a normal change with age. A physiotherapy assessment is designed to pick up any serious spinal problems, which would then be discussed and appropriately managed
• Most back pain comes from the working parts of your back – muscles, ligaments and small joints. Pain often suggests that the back is not working as it should do and is out of condition. If you get your back moving and working properly again, it will help stimulate your body’s natural ability to recover.

Rest or stay active?

Bed rest for more than a day or two can cause changes that can prolong the pain:

• Your joints get stiff.
• Your muscles and bones get weaker.
• You lose physical fitness.
• You may feel depressed.
• It becomes harder to be active.

You may need to rest more than usual at the start to help control the pain but it is very important to get moving as soon as possible.

Coping with a flare up of back pain

Most people manage to cope with a flare up themselves and what you do may depend on how bad your back feels. It is important to remember that serious damage is rare and you can usually:

• Take painkillers to help control the pain.
• Modify your activities for a time, if necessary.
• Stay active and get on with your life.

For people who have more persistent pain, the same principles apply.

Back pain can make you feel depressed, which can sometimes result in weight gain which leads to increased pain and worsening depression.

Anxiety, stress and muscle tension

Anxiety and stress can increase pain and tension can cause muscle spasm and more pain. Many people feel anxious about back pain, particularly when it is very severe or doesn’t improve as fast as they expect it to.

It is common to receive different advice from doctors, therapists, family or friends and to feel confused about what is best to do. Serious damage is rare so do not let your fears hold back your recovery. If stress is a problem, you need to recognise it at an early stage and try to do something to reduce it. Speak to your doctor or therapist and try some relaxation exercises.

There is no instant answer; ups and downs are common with recovery. It’s your back, remember how your back affects you depends on how you react to the pain and what you do about it yourself.

Managing the pain

There is no miracle cure but some things may help manage the pain to allow you to be active:

• Painkillers: these can safely mask pain to support you to be active. Over-the-counter painkillers are often the most effective for back pain when taken correctly. You should always take the full, recommended dose and take them regularly for a few days or longer if required.
• Heat or cold: either of these may be used for short-term pain relief and to relax muscle tension. Try a bag of frozen peas wrapped in a damp towel on the sore area for at least 10 minutes or, if you prefer heat, a hot water bottle or wheat bag.
• Massage: many people find this temporarily eases pain and helps relax muscles.
• Manipulation: this is safe if carried out by a qualified professional and may help back pain. You should feel benefit early on. It is not a good idea to have treatment for months on end.

Other treatments: acupuncture or other alternative therapies may help your pain but are no longer recommended by NICE (2016). Some people find a transcutaneous electrical nerve stimulation (TENS) machine relieves their pain, however, its effectiveness is based on individual experience rather than scientific evidence.