When struggling with back pain, people want to know what they can do, and perhaps what they should avoid.

Sadly, confusion can set in pretty quickly!

The minute you are affected by back pain, everyone around you becomes an expert, yet they all offer conflicting advice. Not very useful...

Divide and conquer

We encourage everyone to "work the problem". Take things step by step, and respond to what you find out.

Try one thing, and see how it makes you feel.

Better or worse?

It's not rocket science. If something makes you feel better, consider doing more of it. Within reason of course! Don't go taking triple the dose of a medication and hope for triple the effect! You might get a nasty surprise.

Similarly, if something makes you feel worse, try to avoid it. Cut it back, do the minimum, restrict yourself to small doses.

All too soon, however, you might find yourself with a list as long as your arm of all the things you've learnt to do or to avoid. And some things might be written down in both columns!

In this maelstrom of advice, can we suggest a framework to help choose what to do?

Let's stop you from getting worse

People debate RICE and suggest it's wrong. Not whether you choose to eat rice grain, but the advice of rest, ice, compression, and elevation. Some will say that it doesn't make people better, and can even delay recovery.

There's a good case to say that they're right to question RICE, but hang on, when people have suffered a recent, sudden injury, their body will often react strongly, and it is the nature of this reaction that can cause problems.

Inflammation is the body's way of tackling damage, but when it really gets going, it can cause secondary problems. Swelling occurs and can crowd out other parts of our body. For example, sciatic pain can result from the sciatic nerve being pushed into a corner when other objects nearby are damaged and become swollen. 

Inflammatory chemicals can also cause irritation despite their purpose being to facilitate a healing process. It seems counter-intuitive, but it's about getting the dose right - the same as with medications. Enough to help, but not so much as to cause damage.

Therefore, a good deal of advice following acute injury is about trying to stop things from getting worse.

• Ice can keep an inflammatory reaction in check, as can compression and elevation.
• Running a burnt area of skin under cold water for 10 minutes doesn't heal the burn, but it does stop the burn from spreading deeper into your tissues.

How do I know when I've had enough?

Good question.

The reason people struggle is that there is no one definitive answer. Every injury is different in its causation and how it plays out. Every person is different too.

So in clinic, we rely on the judgement of experts; those who have dealt with such matters for a living, and seen it all a thousand times over. Experience matters.

You must also trust your intuition. Patients can often sense what the best idea might be.

We should also consider a person's demands. A teenager itching to play a big game might choose to tolerate more pain for a speedier recovery, where in contrast an elderly patient who already struggles might prefer to get things calm and under control sooner, even if it means a slightly slower recovery overall.

Consider it a game. Learn the rules, and then start playing.