What should you do with back pain?
It is a fact that 60-70% of us will experience back pain throughout our lives. It is the 2nd most common reason for time off work behind the common cold. The majority of times it is not down to a structural issue so when it is something to worry about and when can you train through it?
Reassuringly the majority of back pain episodes resolve naturally in a couple of weeks. Time is a good healer however 2 weeks out of action can still feel like a long time. Historically bed rest would be prescribed for most musculoskeletal problems but we now know that is counter productive and actually harmful in a lot of ways.
So what to do if pain strikes:
Keep moving - regardless of pain level moving as much as you can manage will pay off long term in preventing stiffness and encouraging normal movement. Pain can often feel better after exercise.
Stretch - sometimes it won't feel very nice to stretch your back but even stretching around it can help the lower back feel better i.e. your glutes/upper back and hip flexors. Even when not in pain it's a good idea to keep these structures mobile as if your upper back for example is stiff (as most desk workers will be) then your lower back will take on extra work.
Be sensible - having said how important it is to keep moving at the same time if you are having a back pain episode it's not the time to go for a PB on your back squat!
Use heat/cold - I'm often asked which is best and generally my answer is it's whatever you prefer. On the lower back people often prefer heat as it's more tolerable but if ice feels better then go with that. Ice can feel quite numbing whereas heat can often feel more comforting and relaxing but it's whatever your preference is.
Change your mindset - Remember pain does not equal damage. This is a difficult thing to get your head around but especially with back pain it can feel like something is really wrong when actually it's just in spasm. So it can feel awful but try to remember pain is just an output of the brain and if you believe it's not harmful and act as such (i.e. by continuing to exercise) it can help.
Make your back and surrounding structures strong - often people think of 'core training' when thinking of strengthening your back which definitely has it's place but remember the legs provide a support for your back to sit on so keeping them strong is a good idea. When exercising you want to be able to keep good form throughout with your spine to avoid overloading it.
Be mindful of scans - scans are not needed for the majority of cases but if you have had a scan be mindful of the results. It is well documented now that scan results DO NOT correlate with pain so even if a report says you have a degenerative or bulging disc rest assured that a large number of the population will have the same thing but not all of them will have pain.
When to seek help:
If your pain is severe and unchanging - generally if your pain is close to 10/10 and there aren't any positions you feel comfortable in you need to see a doctor to rule out any structural or medical reasons for the pain.
If you have pins and needles or numbness in your legs - this can be something that comes and goes but it is worth having checked with a physio or doctor as this can mean you are having some nerve compression.
If you are having any bladder or bowel problems - this sounds obvious but it is surprising how people continue on with incontinence, retention or numbness in the saddle area without seeking help. This can be a sign of cord compression so definitely needs assessing.
The pain has been going on for a few weeks - if your finding your pain is not improving or your having multiple episodes of bad back pain it would be worth seeing a physio to see if they can break the cycle of pain episodes or accelerate the recovery process.
Back pain is a very common phenomenon but in the majority of cases you don't need to panic just keep moving and it will get better. If it doesn't improve it's best to seek help early to nip it in the bud. I am a firm believer in strength training to protect yourself from pain and make you more robust to changes and overload, so including some back exercises and core work in your programme is a must.
Brinjikji et al, (2015) MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis
Searle et al (2015) Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials; Clinical Rehabilitation 2015, Vol. 29(12) 1155 –1167
Swinkels-Meewisse, I.E.J. et al., 2006. Acute low back pain: Pain-related fear and pain catastrophizing influence physical performance and perceived disability. Pain, 120(1-2), pp.36–43.
Waddell, G., 1993.Simple low back pain: rest or active exercise? Annals of the rheumatic diseases, 52(5), p.317.
Wynne-Jones, G. et al., 2014. Absence from work and return to work in people with back pain: a systematic review and meta-analysis. Occupational and environmental medicine, 71(6), pp.448–56.