Exercise for back pain

Back pain is very common and usually improves within a few weeks. The NHS advice is to stay active and carry on with daily life as far as possible, since long periods in bed slow recovery. Exercise is the main treatment for back pain that persists, and the best protection against its return.

Why backs hurt

Often no single cause can be found. A strained muscle or ligament is the commonest identifiable reason. Less often the pain comes from a slipped disc, from sciatica, in which a nerve is trapped or irritated and pain runs down the leg, or from an inflammatory condition. Serious causes such as a fracture, infection or cancer are very rare.

In the first days

• Normal activity is continued, within the limits of the pain.
• An anti-inflammatory painkiller such as ibuprofen can be taken by those for whom it is suitable. The NHS does not recommend paracetamol alone for back pain.
• An ice pack wrapped in a cloth eases pain and swelling; a heat pack or hot water bottle eases stiffness and muscle spasm.
• Gentle exercises and stretches are started early, and stopped if they make the pain worse.

Gentle exercises

These are done slowly, a few repetitions at a time, once or twice a day.

• Knee rolls: lying on the back with knees bent and feet flat, the knees are rolled together to one side and then the other, shoulders staying on the floor.
• Pelvic tilts: in the same position, the lower back is flattened gently into the floor and released.
• Knee to chest: one knee at a time is drawn towards the chest and held for a few seconds.
• Bridge: the hips are lifted until the body makes a straight line from shoulders to knees, then lowered.
• Cat stretch: on hands and knees, the back is slowly arched upwards and then allowed to dip.
• Back extension: lying face down, the chest is raised on the forearms while the hips stay on the floor.

Longer-term exercise

Walking, swimming, yoga and Pilates are all suggested by the NHS. No one form of exercise has been shown to be better than the others, so the best choice is the one that will be kept up. Strength in the muscles of the trunk, hips and legs takes load off the spine; see strength training.

Everyday habits

• Long spells of sitting are broken up every half hour or so.
• Loads are lifted by bending the knees, keeping the object close to the body and avoiding twisting.
• A desk, chair and screen set at the right height reduce strain.
• Excess weight and smoking are both associated with back pain.

Treatment through a GP

For pain that is severe or has not improved after a few weeks, the options include group exercise programmes, physiotherapy, manual therapy and cognitive behavioural therapy to help with coping. In many areas people can refer themselves to NHS physiotherapy without seeing a GP.

When to see a GP

The NHS advises an appointment for back pain that has not improved after a few weeks, stops normal activity, is worse at night or not eased by rest, is felt between the shoulders, or comes with unexplained weight loss, a swelling or a change in the shape of the back.

Emergencies

A 999 call or a visit to accident and emergency is needed for back pain with any of the following:

• pain, tingling, weakness or numbness in both legs;
• numbness around the genitals or the back passage;
• difficulty passing urine, or loss of control of the bladder or bowels;
• chest pain;
• onset after a serious accident.

Back pain with a high temperature or feeling generally unwell, or severe pain that starts suddenly or worsens quickly, needs an urgent GP appointment or a call to NHS 111.