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Non-specific low back pain

  • Have you ever experienced an episode of low back pain?
  • Want to know how to self-manage?

Debbie Lawrence shares some excerpts from her book – The Complete Guide to Exercise Referral (published by Bloomsbury Publishing); and some tips which helped her to manage her own personal experience of low back pain.

Around 80% of the UK population will experience low back pain (LBP) at some point during their life. Most low back pain is short lived and will usually resolve within a few days or weeks for most people; however, there are instances when it last for much longer; contributing to a significant restriction in movement, making daily activities uncomfortable, painful and sometimes more difficult; it may also lead to psychological distress (stress, depression).

Most LBP is not due to any serious conditions, it is usually attributed to issues relating to the structures of the spine; however, a GP’s advice should always be sought to confirm this. Medication may be offered to relieve pain but cannot cure the condition. A key recommendation for managing low back pain is self-management.
As someone who has experienced low back pain, these are my top tips:

Keep a positive mental attitude
Probably the hardest thing to do when experiencing pain; but mental attitude has a strong influence on recovery. People who learn to cope and get on with it and who are involved and committed to self-management (correcting posture, lifting correctly, etc.) usually recover much more quickly and have less long-term trouble. People who are frightened of the pain, fearful of further injury, who avoid activity and rest a lot hoping the pain will go away tend to suffer for longer and increase their risk of becoming more disabled by the condition.

Managing the pain response
One of the key things I noticed during my experience of LBP was that I developed some habits that actually reinforced pain. I anticipated feeling pain when moving, so before I moved I tensed my body and grimaced; these became patterns that reinforced the pain. Once I became aware of these patterns, I focused instead on breathing and moving slowly and steadily without tensing my body or grimacing. This was a key part of my recovery!

Stay mobile and keep moving.
Keeping moving is essential. The spine is designed to move, so bed rest does not promote recovery and can actually prolong pain and disability. During an episode of back pain, most activities need to be adapted and modified slightly, some movements may feel uncomfortable, but pain doesn’t necessarily mean harm. The focus should be on getting on with life.

Abdominal breathing
Deep abdominal breathing was another key part of my recovery. It helped with relaxation and pain management.

Instructions:

  • In a comfortable position with open posture
  • Place the hands on the tummy with middle fingers touching at the tummy button.
  • Breathe in and the tummy will rise and the fingers move away from the tummy button
  • Breathe out and the tummy lowers and the fingers move back together
  • Focus on deeper, slower breathing
  • Aim to practice for 5 minutes (this can be done first thing in the morning before getting out of bed and last thing at night, before going to sleep!)

The key is to really fill and expand the tummy when you breathe in!

Correct lifting
This is another important tip. Be mindful of how you lift and move. Correct lifting technique should be practiced when lifting and moving anything. This includes lifting envelopes from the floor and taking plates from low cupboards.

Instructions:

  • Bend the knees
  • Brace the abdominals – very basically – tighten the mid-section (and breathe!).
  • Keep the chest lifted

Avoid bending from the spine and hanging the body weight on the back!

Stay mindful of posture
Prolonged muscle imbalance by holding an incorrect posture will lead to increased muscle tension and tightness.
Learning to stand and sit correctly can be essential as part of self-management. You can set a reminder on your PC or wear an elastic band around the wrist as a reminder to think about your posture.

Standing posture:

  • Stand with feet hip width apart, feet parallel
  • Distribute weight between heel bone, big toe & little toe (3 point weight distribution)
  • Spread toes
  • Align second toe with knee and hip
  • Find neutral pelvic position (pubic bone and hip bones in line to ensure minimal forward or backward tilt of pelvis)
  • Lengthen torso and neck
  • Engage the deeper abdominal muscles (so that the contraction can be maintained)
  • Look forwards – chin parallel to floor
  • Shoulders relaxed and down
  • Shoulder blades squeeze down
  • Arms relaxed, hands by the side of body

NB: A similar alignment should be maintained when seated. The sitting bones should be positioned on the chair and the feet aligned under the knees.

Work stations/desks
Assessing the height and positioning of chairs and desks used at home or work is recommended; so too is getting up and moving around and stretching regularly to avoid stiffening up. When driving for long distances, aim to take regular breaks and stretch out the body.

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