Low Back pain The following information has been written to help you fully self-manage your low back pain.

However, please self-refer straight away to be assessed by a Physiotherapist if you:

have had recent trauma to your back and have significant pain or loss of movement

constant day & night pain that you cannot settle

you are off-sick and struggling to return to work due to your back pain

you are experiencing persistent pins & needles or numbness down one or both of your legs

your symptoms are worsening and are not improving despite following advice below over the course of the next six weeks

If you have acute low back pain and/or any leg symptoms (being pain/pins and needles/weakness/or

numbness) please view this important link regarding Cauda Equina Syndrome.

If you have a history of cancer, immunodeficiency or TB and have new, unexplained and constant pain then please speak to your GP whilst you attempt the following self-help advice.

What can I do to help? Back pain is really common; around 80% of people will experience an episode of back pain during their lives.

Most people recover from their back pain within six to eight weeks, with the majority resolving completely

within three months. If you are struggling with your pain, the following initial advice should help you to get

started:

Pain relief: Basic painkillers (like paracetamol) or non-steroidal anti-inflammatory gels (such as

Ibuleve/Voltarol) are easily available over the counter without the need for prescription. These can be very

effective as they lessen your discomfort and importantly allow you to keep moving/active. However, please

check the labels for instructions/safe usage and any possible reasons why you should not use them. If you

are currently taking any form of medication it is advisable to consult your GP or Pharmacist before taking

additional pain relief.

Heat or Ice: Heat is often useful for easing pain or spasms using a hot water bottle or wheat pack. Use for 15-20 minutes at a time and repeat several times a day as necessary. However, if you have had a recent injury or a flare-up you may find it more therapeutic to use an ice pack to reduce your pain/irritation. A packet of frozen peas wrapped in a tea-towel works well. Leave in place for up to 15 minutes at a time. Again, this can be repeated several times a day if found helpful. Rest vs. activity: Remain active. You may need to adapt some of your activities at home or work but research shows us that continuing with your normal activities and staying at work sees people recovering quicker from back pain. It is important not to wait for the pain to go before deciding to get moving. During the first few days of back pain it might be helpful to do less of certain activities for a while but keep moving. Scans or imaging: Scans or imaging are rarely indicated as these often correlate very poorly with symptoms. Most people without low back pain have ‘unfavourable changes/findings’ on scans or imaging that do not cause any symptoms at all.

Exercise

Exercise can be an extremely beneficial treatment for your back pain as it can gradually build the tolerance to

certain activities and helps ease stiffness and soreness. Choose an exercise that you enjoy as you more likely

to stick at it. Walking is a great example and often very helpful for low back pain.

We have listed some additional exercises below to ease your pain and stiffness and allow you back to start

tolerating and become more confident with movement again. With all of these exercises, move as pain

allows and try not to force the movements. Do stop short of any spasm if this occurs. Be aware of your

breathing; breathe out and relax into the movements and try not to brace or anticipate the pain.

Repeat the following exercises several times a day. A small increase in pain is OK; you just need to work

within your own tolerable pain levels. If you feel you have done too much and it is not tolerable, don’t

worry, do smaller movements next time and then gradually build up again. Aim to gradually increase the

range of movement as your pain allows. It may take a few weeks before you start to see improvement.

If your low back pain does not improve over the next 5-6 weeks, or gets worse despite the exercises, you

will need to self-refer yourself to see a Physiotherapist for an assessment.

Exercise 1 – Lying Knee Rolling

Lie on your back with your knees bent and feet resting on your bed

Let your knees roll together from side to side to feel a stretch in your back. You may find one direction to

more comfortable. Just avoid any sharp/pinching pain

Repeat 5-10 times each direction

Exercise 2 – Lying Knee Hugs

Lie on your back with your knees bent and feet resting on your bed

Hug one or both knee to your chest to feel a stretch in your lower back

Repeat 5-10 times with each leg

Exercise 3 – Pelvic Tilting

Lie on your back with your knees bent and feet resting on your bed. Place your hands on your pelvis

Press your flat of your back firm again the bed, hold then relax back to the starting position

Repeat 5-10 times

Exercise 4 - Seated Lumbar Flexion

Sit on chair or edge of your bed. Place your hands on your knees

Slide your hands down your shins towards your ankles then roll back again. Do not force the

movement if painful. A slight pulling/stretching sensation is OK

Repeat 5 times

Exercise 5 – Standing Extensions*

*Perform only if pain relieving. If this causes a worsening of your symptoms or any

spasm/sharp pain then either go more gently or stop completely. This exercise can be

particularly helpful if you spend long hours sat in the office or driving.

Stand with your hands in the small of your back

Gently lean back before returning to the start position

Repeat 5-10 times as regularly as you feel you need