Back pain is a chaotic battlefield, and while our strategy at BackPain.online is always to help people get better, there are a variety of tactics available to us. Some are well-known, and others less so. Perhaps you’ve heard of them, but aren’t quite sure what to do?

Here are 5 pointers for helping back pain...

1. Sit Right: Preventing back pain while sitting

With more people working from home thanks to the COVID pandemic, sitting is a big issue nowadays. Or rather, the lack of movement. You must keep moving, as this will prevent pain building up. 

Let’s be clear, there is no link between any type of posture and whether it will cause back pain, regardless of how unhealthy that posture might look! We need to be able to bend our spines in every direction, so sitting in any given position won’t necessarily cause pain. But not moving will.

We’re big advocates of “active” sitting, which involves people sitting with a neutral spine and moving it constantly to keep upright and alert. 

• A neutral spine is the shape it assumes when you stand up tall. 
• The biggest hindrance to attaining this shape when sitting is having your knees too high relative to your hips. This tips your pelvis backwards, and makes you curl your spine forwards to get your head back over your bottom.

• We like people sitting slightly higher, and we then teach them to move their spine in every direction. This training is included in everyone’s therapy programmes, and we also have some useful information about maintaining a healthy back when working from home.

This approach can take some practice, but we think it’s really important! You will still get back pain if you sit still in a single position for too long, no matter how evangelical it is. But if you know how to move your spine around, give it a wiggle and a stretch, you’re going to feel better for it.

2. Sleep Right: Back pain support in bed

Sleep is a tricky subject. 

Often, we tell patients to lie on their backs with legs supported so their knees are lifted and a small pillow under their head if necessary. This position is great for taking tension out of our spines, and we recommend it to people who are really struggling. Sometimes we suggest they lie like this for a few periods during the day, regardless of sleeping.

But when it comes to getting sleep at night time, it’s vital to get good-quality sleep, and the position is secondary to this. Certain groups of back pain sufferers won’t like lying on their tummy, and lots of people sleep well on their sides, but ignore any advice about sleeping position if it just doesn't let you get to sleep.

Last, don’t ignore the option of sleeping in a chair. If you can get comfortable enough sitting in your favourite chair to get to sleep, then do it. You might be sore when you get up, but some movement will help that ease off, and in the meantime, you’ve had some good quality sleep.

3. Use Props: Pillows to help patients cope with back pain

Lumbar pillows can help people maintain the correct shape at the bottom of the spine when sitting or lying down, preventing the pelvis from rolling backwards. But there’s still some  learning to do and a new habit to be created in order to use this effectively.

A simple seat cushion can help lift people higher in their seat, reducing the angle at the hip joint so they get good contact under their buttocks and are more aware of their shape. Bar stools also fulfill this.

For side-sleepers, a knee pillow can be a game-changer. Everyone has a pelvis wider than their knees, so lying on your side creates a downslope of your top leg towards the ground. This can put some muscles under strain, and even irritate some of the joints of the lower back and pelvis as you sleep. A knee pillow helps lift the top leg up closer to parallel, and this can reduce the strain that the patient feels.

4. Weight Loss: Being overweight contributes to some causes of back pain 

This is especially the case when related to any osteoarthritic changes, otherwise known as wear and tear.  But before everyone panics, it’s important to know that there are many other factors to consider as well, such as lack of exercise, poor diet and sleep, incidents and accidents, and past surgery.

What we can be more sure of however, is that when recovering from back pain, excess weight slows patients down. It’s what we call a modifiable factor - it can be altered - whereas age and gender can’t. So weightloss is something that patients should consider. Even small weight losses can help, and they can kick start a health drive with more exercise and better sleep.

The real frustration comes when efforts to be more active are hindered by back pain, so these cases need careful management. Patients may need to be coached through small doses of activity, which although considered painful, are not causing any further irritation, and the benefits are seen to outweigh the discomfort.

5. Heat & Ice: Why back pain is like cooking dinner 

Nearly all the pain we feel is an inflammatory reaction to something that is irritated or damaged. Inflammation is the method our body uses to heal things. It’s a function of our immune system. 

Here’s an analogy I often use: Inflammation works like the gas that cooks your dinner. 

It needs to be on so that your dinner gets cooked. The inflammatory process is how your body heals things!

But if your gas is on too high, the pot boils over, and your dinner will get burnt. So you should turn the hob down. When inflammation is too high, pain is intolerable for the patient, and you are going to help yourself by turning  it down.

• So use ice! It will cool things down.
• You can also take anti-inflammatories, as they slow the inflammatory process down a little, making any pain more tolerable. They don’t mask the pain - they’re not painkillers!

However, if you turn the gas down too far or for too long, your dinner will never get cooked! 

• Don’t use anti-inflammatories over a prolonged period - remember; inflammation is healing - so anti-inflammatories are “anti-healing” tablets. They’re vital in some cases and very helpful in others when used at the right time. Overused, they cause problems of their own.

• When the gas is on too low, you might want to heat the injury back up again. This will promote more inflammation, and therefore, more healing. We sometimes recommend this in clinic with certain non-threatening injuries when we’re up against a deadline.

Back pain can fluctuate

When patients feel like their back pain is constant, these pointers can provide relief, even if only temporarily. If that’s the case, it’s down to the patient to apply them as part of a larger back pain management strategy, accepting that their back pain will fluctuate. 

Flare ups are normal, and it’s important to remember that most back pain, although troublesome, is not necessarily something to be worried about.