
Self-care for low back pain
Ngā mea e oti i a koe e āwhina ai i te mamae ā-tuarā
Most low back pain gets better with self-care. But at times you may need to get help from a health professional. If your pain doesn't start to improve in two weeks, gets worse or you have any concerns, seek advice from your GP, physiotherapist, osteopath or chiropractor.
Although it's rare, back pain can be a sign of something serious.
See your health professional immediately if you have:
- any difficulties going to the toilet (not being able to go, or not being able to control when you go), either in your bowel or bladder (poo or wee)
- numbness, loss of feeling or pins and needles around your genitals, buttocks or anus (bottom or back passage)
- pain that seems to get worse or that spreads down your legs
- a loss of power in your legs
- a redness or swelling on your back
- a constant pain, especially at night
- an unwell feeling, such as a fever or sweating at night
- a rash in the same area as your pain.
Stay active
One of the best things you can do to help your back pain get better is to keep doing your normal activity as much as possible. Walking, cycling and swimming can help.
You may have some minor discomfort as you try to keep active but do what you can without causing any significant pain or discomfort. If you notice an increase in pain, stop doing the activity straight away.
Bend backwards rather than forwards
- Decreasing the amount of bending forward you do and instead doing backwards-bending exercises can help a lot.
- While lying on your front, do 10 back bends every one to two hours. You may be able to do this exercise while standing but ask your health professional first.
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Change what you're doing
One of the main ways you can help your back pain is to change what you're doing whenever you notice the pain. Give your usual activities a try but if they bring on or worsen your pain, either work out another way of doing it that doesn't hurt or stop and try again later.
Pay attention to your posture
Watch how you're sitting
- Good sitting posture is important. Put a cushion or folded towel (or lumbar roll) in the small of your back when you're sitting.
- If you sit at work, make sure your chair is adjusted properly to support the small of your back.
- Make sure your feet are flat on the floor or a footstool and your chair points straight at your desk or screen.
- Avoid sitting for long periods. Stand up every 30 minutes and walk around for a few minutes.
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Be careful lifting
- Try to avoid any bending or lifting until your episode of back pain is over.
- If you do have to lift something, point your feet towards the thing you're lifting, bend at your knees and hips. Keep items close to you while you're lifting and carrying.
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Pain medication
As well as exercise and watching your posture, you may want some pain relief. If so, take it regularly, as that's more likely to ease the pain enough to let you exercise and stay active. Pain relief won't completely take the pain away, but it may take the edge off it.
As non-specific low back pain is mechanical, you may find medication doesn't help at all. If so, it doesn't mean you have a serious condition and need stronger medication.
- Anti-inflammatory pain relief medicines can help you manage back pain in the short-term. Examples include ibuprofen, diclofenac and naproxen. Never take more than the recommended dose.
Some people shouldn't take anti-inflammatories. For example, people with asthma, stomach problems, high blood pressure, kidney failure or heart failure. If you aren't sure, ask your GP or pharmacist.
- A stronger pain relief medicine, such as codeine, is an option if anti-inflammatories don't suit you or don't work well. You should only use codeine for short-term pain relief and under the supervision of your GP.
Codeine often causes constipation, which may make your back pain worse if you need to strain to go to the toilet. To prevent constipation, drink lots of water and eat foods with plenty of fibre.
If you feel that pain relief medicines aren't helping, talk to your GP about other options, including seeing a physiotherapist, chiropractor or osteopath for manual therapy.
Sleep
Sleep in any way that's comfortable on the most comfortable surface, as long as it's flat and not sagging. We used to advise people to sleep on a firm mattress but there's no evidence that this is better than any other type of mattress.
Some people find that a small, firm pillow between their knees, or a folded towel under the small of their back makes them more comfortable when sleeping.
Work
Get back to work as soon as possible – you don't need to wait for the pain to go away. Returning to work (or staying at work if you can) generally helps to reduce your pain by keeping you active.
If you're worried about your work, talk to your employer and treatment provider about what you can and can't do. Some people need to gradually ease back into their usual work tasks, perhaps doing fewer hours and not doing physical tasks like heavy lifting or twisting.
ACC can also help you get back to work if you're having problems returning to your normal duties.
Next steps
If you do all the things mentioned above, your back pain should start feeling better within a few weeks, even if it doesn't go away completely. If it hasn't started getting better or if your pain is getting worse, you should see a doctor, chiropractor, osteopath or physiotherapist.
On the next page: Getting help for low back pain
Written by HealthInfo clinical advisers. Last reviewed May 2022.
Sources
The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public
ACC – Non-specific acute low back pain, part 3 – return to work (http://www.acc.co.nz/PRD_EXT_CSMP/groups/external_providers/documents/guide/prd_ctrb113162.pdf), retrieved March 2017
Bell J.A., & Burnett A. (2009). Exercise for the primary, secondary, and tertiary prevention of low back pain in the workplace: a systematic review. Journal of Occupational Rehabilitation. 19:8-24. DOI: 10.1007/s10926-009-9164-5
Choi B.K.L., Verbeek J.H., Tam Wai-San, Jiang J.Y. (2010) Exercises for prevention of recurrences of low-back pain. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006555. DOI: 10.1002/14651858.CD006555.pub2
Christiansen D., Larsen K., Kudsk J.O., Vinther N.C. Pain responses in repeated end-range spinal movements and psychological factors in sick-listed patients with low back pain: is there an association? J Rehabil Med 2009; 41: 545-49.
Wong J.J., Coté P., Sutton D.A. et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. Eur J Pain 2016; 21: 201-16.
Hides J., Jull G., Richardson C. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001; 11: e243-e248
Larsen K., Weidick F., & Leboeuf-Yde C. (2002) Can passive prone extensions of the back prevent back problems? Spine. 27(24):2747-52
Martimo et al (2008) Effect of training and lifting equipment for preventing back pain in lifting and handling: systematic review. British Medical Journal published online 31 Jan 2008; doi:10.1136/bmj.39463.418380.BE
Muller et al (1999) The influence of previous low back trouble, general health, and working conditions on future sick-listing because of low back trouble. Spine. 24(15):1562-1570
Roffey D.M., Wai E.K., Bishop P., Kwon B.K., Dagenais S. Causal assessment of occupational sitting and low back pain: results of a systematic review. Spine J 2010; 10: 252-261
Stanton T.R. et al (2008). After an episode of acute low back pain, recurrence is unpredictable and not as common as previously thought. Spine . 33(26):2923-2928
Williams M.M. & Grant R.N. A comparison of low back and referred pain responses to end range lumbar movement and position. 1992
Image and embedded video sources
Arching back image – From iStock (image ID 20844690). January 2016.
Manual therapy image – From Shutterstock (image ID 1202838715). May 2022.
Modified push-up, back bend lying, back bend standing, sitting, lifting images – Provided by Richard Hopkins physiotherapist. January 2017.
Normal spine image – From Shutterstock (image ID 65496961). Image labels added. July 2014.
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