Lower back pain is one of the most common conditions we see as physiotherapists, it is rarely serious but can be very distressing and disabling for some. Everyone has a different experience with back pain and how it affects their lives. It can have a severe impact on your well-being and mental health as well as your everyday activities.

There can be many different causes of lower back pain but in this blog we are discussing the management options of the most common type- non-specific low back pain. Pain tends to be localised to the lower back, although it can radiate into the buttocks or top of the legs and is often worse on certain movements. Pain can come on suddenly or may have a gradual onset and can affect all age groups.

Your physiotherapist will help to screen the cause of your back pain and will recommend onward referral in rare cases.

What you can do to help-

Keep active-

It can be hard to know what to do when you are in pain as you may be worried you are doing more harm than good. It is safe and normal to feel some pain when you move and exercise and should settle down as you are able to move around more. Treating back pain with movement and exercise is usually the best way to reduce pain.

The spine and muscles can become oversensitive and it can be painful when you first start to move. It can take some time for this to settle down. It is best to try and move little and often during the day and avoid sitting or standing for long periods. Try going for a short walk, cycling or any gentle activity that you enjoy to start getting moving.

Heat-

Applying heat to the sore area of the back such as a hot water bottle or wheat bag can help to reduce pain and ease muscle tension around the area. Leave on or around 15 minutes, checking the skin occasionally.

Pain management-

Consider taking pain killers to reduce the intensity of pain to allow you to keep active and moving in a more “normal” way. When we are in pain, we often tense the back and surrounding muscles in fear of pain. If we do this for a long time then this can change our “normal” movement patterns and put stress and strain on other structures. This can cause altered movement patterns and prolonged stiffness around the spine and is unhelpful for our long time management. Discuss with your GP or pharmacist what pain relief is appropriate for you.

Relaxation-

Finding time to relax and reduce stress levels can have a reduction in pain levels and associated stress and anxiety levels. Ensure you are getting enough sleep. There is sufficient evidence to support the importance of sleep tp help restore and regulate normal body functions, with 7-8 hours of sleep each night recommend. Matthew Walker, neuroscientist has published some fantastic research on the importance of sleep and how lack of sleep can heighten our response to pain.

You may want to consider acupuncture as this can be beneficial in reducing stress levels as well as having a reduction in pain.

How physiotherapy can help-

Your physiotherapist will spend time listening to your experience, they will examine you and discuss the best treatment plan to suit you. Physiotherapy can be very effective in treating back pain. Suitable exercises will be prescribed to help restore normal movement patterns, reduce pain and desensitise painful structures. In addition, your physiotherapist may recommend some manual therapy techniques or acupuncture if appropriate. Your physiotherapist will provide education and advice and help you to get the most out of your treatment plan to allow you to return back to your normal activities as soon as possible.

When to seek medical assistance- (taken from cauda equina syndrome information card)

Many people can experience back and leg pain along with weakness and reduced sensation. A rare condition to be aware of is cauda equina which is a medical emergency and you must seek urgent medical attention in event of the following-

• loss of feeling or pins and needles between your inner thighs or genitals

• numbness around your back passage

• altered sensation when using toilet paper to wipe

• difficulty trying to urinate or trying to stop your flow of urine

• loss of sensation when passing urine or emptying your bowels

• urinary or bowel incontinence

• reduced awareness if your bladder is empty or full

• loss of sensation in genital region