Back pain - your questions answered

8 March 2017

For this topic, lead physiotherapist Jan Vickery, and her experienced team of musculoskeletal physiotherapists here at AXA PPP, answer your questions about coping with back pain.

Aches and pains can have a negative affect on your mobility, mood and even your ability to work productively on a day-to-day (and sometimes long-term) basis. However, there are treatments and coping mechanisms that can make a real difference.

Here we’ve rounded up the best of the team’s support and insights around the most commonly asked questions:

What exercises can I do at home for small back pain?

The truth is ANY exercise is likely to help. We suggest finding the type of exercise that you enjoy and suits you and your lifestyle because you are more likely to stick with that. In general, most exercise programmes contain exercises for strength, stretching and for mobility. Pilates is great for strengthening core muscles and yoga is great for mobility and stretching. If you need help with a programme that is specific for you then you can ask a therapist or personal trainer for help. Being active will definitely help your back - whether you have pain or not. And remember pain does not necessarily mean harm!

When cycling I often get a pain after in my lower back, what can be the issue?

Back pain from cycling often relates to how the bike fits you and your posture on it. A quick Internet search on bike fitting can give you some ideas to try first. However sometimes it takes an expert eye to spot something subtle, so give your local bike shop and call - it's surprising how a small change to your bike can make a big difference.

I’ve been diagnosed with sciatica; what is it and how can I help myself?

Sciatica is the name given to any sort of pain caused by irritation or compression of the sciatic nerve – the longest nerve in your body. It runs from the back of your pelvis, through your buttocks, and all the way down both legs, ending at your feet. The pain of sciatica is usually felt in the buttocks and legs, much more than the back.

The main thing is to keep moving. It’s helpful to take pain medication, such as Ibuprofen, to help you keep moving or check with a Pharmacist if you have doubt about your ability to take medication. Most pain relief works better if taken regularly. Try to keep positive and not to worry about it happening again - this is not uncommon. If you find that you are not getting better after a few weeks then see you GP about getting some form of face to face assessment by a manual therapist.

I have suffered from pain in my lower back on the right side (it's not Sciatica). I've been to the doctor and osteopath but nothing seems to work. It's worse in the mornings and if I've had a lazy weekend and done a lot of sitting.

An active lifestyle is the key to preventing back pain. Sitting is the biggest contributor to back pain and it's important that you get up and move every hour. Doing regular exercise can help alleviate stiffness and pain, strengthen muscles and prevent further problems. Start slowly with things you enjoy, like walking, swimming or light jogging. Pilates and yoga can also be very beneficial for improving flexibility and strength. If you have a busy week and then slow down at the weekend (and relax or sit a bit more) then it can be more problematic - so find a balance of movement and relaxation!

I enjoy walking outdoors, however sometimes I get a pain in my back after a long walk - roughly 3-4hours - what can I do? Is it the way I walk?

Yes - think about your shoes, back-pack position, your environment - uphill and downhill, rough terrain. It could also be a strength issue - perhaps you would benefit from some core muscle strengthening (Pilates is great). I would work through all these logically and rule them out. Then perhaps try shorter walks and train yourself up to the longer distances. You could consider a gel insole in your shoes to absorb some pressure. It may also be worth trying to walk with some walking poles to assist with posture and off-loading your joints.

Can you give any advice on a constant sore neck and right shoulder?

In our experience, there is often overlap between problems in these two areas and one or both can be the source of your pain. Rarely, other things - like chest problems - can give symptoms in these areas too. The bottom line is to get an assessment from a physiotherapist or doctor to work out what's going on and the best way forward.

I wake up most mornings with lower back ache which gradually wears off once I'm up. Is this likely to be down to the way I sleep?

Back stiffness in the morning is very common. When we sleep, we are not moving about so our joints in our spine stiffen up making us feel achy upon rising. We also retain more fluid in our bodies when we sleep which can make any disc type problems worse as they reabsorb more fluid. As we age, we do get stiffer backs and joints. The key is a good mattress; try not to sleep on your stomach and to do some gentle stretches in bed before you get up. If the stiffness lasts more than an hour and is severe (i.e. affecting your ability to walk and do the usual morning activities of daily living) then it’s best to discuss this with your GP.

Even slightly bending over makes my back ache. Apart from not bending over, can you advise on how to avoid this?

Being more active is likely to help rather than avoiding any physical activity. Don't be concerned if exercising is uncomfortable at first, you need to break the vicious circle of pain-inactivity-avoidance that happens when people have back pain. Any form of exercise is good - choose the one YOU prefer. There are some simple exercises and stretches for lower back pain that can help, too.

I’m experiencing back muscle pain after two knee replacements. Are there any exercises I should be doing?

If you’re recovering well after your knee replacements you may well notice your posture and your walking style have changed due to better movement and less pain in your knee joints - often people find they are standing straighter after surgery! We would suggest some general back exercises like half push ups (where you leave your hips on the floor) and hugging your knees to your chest (if this is comfortable for you) to see if either or both help. Also look at your posture when you are sitting and moving about - this may well be affecting your back. If you have the all-clear from your surgeon then swimming or gentle gym work can also help to alleviate either joint aches or pains. If these simple strategies don’t help then you could see your GP or a Physiotherapist for further advice.

Further reading

Useful resources for help and support

Back pain – NHS factsheet

Sciatica – NHS factsheet