Back Care and Posture Practical Help for a Sore, Stiff Back

Back pain is one of the most common reasons for visits to the GP and for time off work. At some point, most people experience it. Because it can be intense, and because the spine is so central to the body, it is natural to fear that something serious has been damaged.

In the great majority of cases, however, low back pain has no serious underlying cause. It is often described as non-specific, meaning that no single damaged structure can be identified. It can follow an awkward movement, a period of unaccustomed activity, prolonged sitting, stress or poor sleep, and it often has no clear trigger at all. Most episodes improve substantially within a few weeks, although recurrences are common.

Scans are not usually helpful. Imaging often shows changes such as disc bulges and degeneration in people who have no pain at all, and these findings correlate poorly with symptoms. For this reason, current NICE guidance does not recommend routine imaging for low back pain in primary care unless a serious cause is suspected.

Pain is also influenced by the nervous system, mood, sleep, stress and expectations. When you are worried or tense, the system becomes more sensitive. This does not mean the pain is imagined, but it does explain why reassurance, activity and reducing stress can all help.

Because most back pain is not serious, it is important to know the rare signs that suggest something more is going on. Knowing them lets you relax when they are absent.

See your GP promptly if back pain follows a significant injury such as a fall or accident, if it is accompanied by fever, unexplained weight loss or feeling generally unwell, if you have a history of cancer, if the pain is severe, constant and worse at night so that you cannot find a comfortable position, or if it began for the first time after the age of 50 and is not easing. Also see your GP if you have pain radiating down the leg with numbness, tingling or weakness.

For most people without these features, the recommended approach is to stay active, to return to normal activities as soon as comfort allows, and to give the pain time. If it has not eased after a few weeks, or if it keeps returning or interfering with your life, see your GP or a physiotherapist, who can assess the problem and suggest treatment.

Sciatica, which is pain that travels down the leg, below the knee, often with tingling, is common and usually improves on its own over weeks to months. Keep moving, and see your GP if it is severe, not improving, or accompanied by weakness.

A generation ago, people with back pain were told to lie flat in bed. The advice was wrong. Prolonged rest tends to lead to stiffness, weakness and slower recovery. Today, the consistent message from research and guidelines is to stay as active as pain allows.

NICE guidance for low back pain recommends self-management and exercise as first-line approaches. Group exercise programmes, which can include aerobic activity, strengthening, and mind-body exercise such as yoga or tai chi, are recommended, along with manual therapy only as part of a package that includes exercise. Psychological support may be helpful when pain is persistent. The guidance does not recommend spinal injections for most low back pain.

Start with walking. Begin with short, frequent walks, then lengthen them gradually. Change position often. If sitting is painful, take regular standing breaks, and if standing is uncomfortable, sit. Heat, such as a hot water bottle or warm bath, can ease muscle tension. If you take pain relief, speak to a pharmacist about suitable options.

Expect some discomfort as you move. A moderate increase in pain during or after activity that settles within a day or so is usually acceptable. Pain that is sharp, escalating or that spreads down the leg should prompt you to ease back. Pacing, which means doing a consistent amount each day rather than overdoing it on good days and resting on bad ones, helps to build tolerance.

Once pain has settled, or if it is mild, exercises that improve strength, endurance and mobility help to reduce the chances of recurrence. Start gently and progress gradually, and stop any exercise that increases leg pain or produces sharp pain.

Cat-Camel

On hands and knees, slowly round and then arch your back, moving smoothly through a comfortable range. Do eight to ten repetitions. This gently mobilises the spine.

Bird Dog

From hands and knees, extend one arm forward and the opposite leg backward, keeping your back still and level. Hold for a few seconds, return and swap. Do six to eight repetitions on each side.

Side Plank

Lie on your side, supported on your forearm, with your knees bent. Lift your hips until your body forms a straight line from knees to shoulders, and hold for 10 to 20 seconds. Progress to straight legs as you become stronger.

Glute Bridge and Curl-Up

Lie on your back with knees bent and lift your hips by squeezing your buttocks. For the curl-up, rest your hands under your lower back and lift your head and shoulders slightly, without flexing your spine. These exercises, together with the bird dog and side plank, form a well-known trio of back-friendly trunk exercises developed by the researcher Stuart McGill.

Posture has a powerful hold on the popular imagination. We are told to sit up straight, to keep shoulders back and never to slouch. The research is more nuanced: there is no single ideal posture, and the link between posture and pain is weaker than most people assume.

What does seem to matter is variation. Staying in any one position, even a good one, for too long leads to discomfort. The body is designed to move. Alternate between sitting and standing, change position regularly, and take short walking breaks. Where you work at a desk, set up the chair so that your feet are flat, your knees at about hip height and your forearms supported, and position the screen at about arm's length, with the top at or just below eye level.

When lifting, there is no need to keep the back perfectly straight at all costs, but good habits reduce strain. Stand close to the load, bend at the hips and knees, keep the load close to your body, and avoid twisting while carrying. Do not lift loads that are too heavy, and ask for help when needed. Remember that the spine is robust when it is accustomed to loads, which is why gradual strengthening helps.

For sleeping, no position is universally best. Choose what is comfortable. A pillow between the knees when lying on your side, or under the knees when lying on your back, may help. A medium-firm mattress is often comfortable, but personal preference counts for a lot.

Back pain tends to come and go, and the aim of long-term care is to reduce the frequency and severity of episodes and to prepare you to cope when they happen.

Regular physical activity is the most powerful protection. Aim for the guideline level of aerobic activity, with strengthening exercises for the whole body on at least two days a week. A strong body is better able to cope with the loads of daily life. Maintaining a healthy weight and not smoking also contribute.

Look after sleep and stress, as both affect pain sensitivity. Poor sleep makes pain feel worse, and worry and tension add to muscle tightness. Relaxation, breathing exercises, time outdoors and social contact all help. If pain is affecting your mood or sleep, speak to your GP, since psychological approaches have a good evidence base for persistent pain.

Adopt a confident mindset. Learn that the back is strong, that flare-ups are common and rarely dangerous, and that a plan is available for when they occur. Keep a few exercises, a walking routine and a pacing strategy in reserve. If you have repeated episodes, a physiotherapist can create a tailored programme.