A Physiotherapist's Approach to Low Back Pain
Lower Back

Most people have back pain at some time in their lives, although often it is preventable. In this article, I will describe what steps to take when an acute episode of pain is triggered. The traditional recommendation of rest has its place when accompanied by gentle activity. If the back is in spasm or you find yourself unable to get up from the floor, try crawling; the back will gradually loosen up.

Next, rest comfortably on your side with a pillow under your head and between the knees. Alternatively, lie on your back with the knees bent over pillows, or a soft stool. Lie on a surface that is firm enough for support and comfortable enough to provide muscular relaxation. Try to reduce pain with heat, ice, relaxation methods or analgesia.

Try also gentle loosening movements, e.g. pelvic tilting, flattening and hollowing the lower back - or knee rolling. For example, with feet together, roll knees from side to side very gently. After between 20 and sixty minutes of rest, repeat these movements and then get up. To get up from the bed, roll onto your side, bend knees over the side of the bed and lower legs as you push up with your arms. Walk around a little, as you feel able.
Avoid lifting and bending, but you may be able to manage tasks while standing for a short while.
Avoid sitting, other than when essential, and then only for short periods in a firm chair, with a lumbar support (cushion or roll). Return to lie down before pain or fatigue increases. As pain subsides, gradually increase the time spent upright and decrease either the frequency or duration of rests. Gentle exercise can start once acute pain is over. If exercise increases pain (especially leg pain), stop and try again in a few days.

I hesitate to describe strengthening exercises on paper for two reasons: they should be taught well and supervised, otherwise there is a risk of badly performed exercises, increasing spinal damage. Appropriate exercises are best chosen after individual assessment by a physiotherapist, as no two backs are the same.