Written by Daniel Wray (BSc Hons Physio/ PG Dip Sports Physio)

Why does my back hurt?

Back pain is common, if you’re reading this i’m sure you have suffered at least one episode of back pain in your lifetime and in all likelihood more than that. It’s frustrating and restricting and can have a huge negative impact on your quality of life.

There are many reasons for back pain and unfortunately it’s rarely a quick fix. The most common form of back pain is often referred to as mechanical pain which is an umbrella term describing dysfunction in the soft tissues and joints preventing or impeding normal function. This may be stiffness, weakness, muscle shortening, joint wear and tear or any combination of these plus other factors.

In the absence of acute trauma back pain rarely appears suddenly or overnight and for most it’s a gradual and cumulative process related to lifestyle. Our modern lifestyles are simply too sedentary with too many hours spent in static positions meaning our joints and muscles don’t get the movement stimulus they need to stay flexible, hydrated and healthy.

For many people what began as a minor back ache or stiffness spirals steadily into chronic pain and disability and it can seem like you’re stuck in a repetitive cycle of injury and pain. We try to make changes but the daily grind means we continue to rack up hours of sedentary, static, and repetitive behavior trapping us in this negative cycle. The pain can force further lifestyle changes meaning less movement and exercise which reinforces the negative cycle and it can seem impossible to break free. Having a dodgy sore back slowly becomes the norm and we just accept it and carry on.

It’s not all bad news - here’s what you can do…

It all seems pretty grim and depressing right? Well the good news is that for the most part the majority of back pain, even when extremely painful and debilitating, is not due to serious pathology and it can get better. There are of course exceptions to this and we would always advise you seek advice from a qualified health professional if you have serious concerns about your back pain.

The bad news, if you look at it that way, is that the fix is rarely instant and usually requires significant effort on your part to make lifestyle changes and prioritise time every single day to look after your back. Of course if you Google hard enough (we’ve all done it) you will find some ‘Guru’ promising an overnight fix in exchange for a significant amount of your hard earned cash but truthfully the magic bullet doesn’t exist. Below we have listed some strategies you can implement to make a real difference.

6 self help strategies to help manage back pain:

1- Keep moving. Complete rest is not going to help and generally increases stiffness, pain and fear avoidance behaviors. Of course we must adapt our movement depending on the level of pain and there may be a need to avoid certain postures, positions or movements for a short period of time which is fine. I don’t recall any scenario with a patient where we couldn’t find at least one simple movement they could do to keep some gentle activity in their back to promote healing and relaxation while building confidence that they are not going to stuck in pain forever. Experiment with different movements and stretches (see below video) gently and slowly and see what you can manage comfortably and that will give you a starting point which you can gradually add other movements to as your pain allows.

2- Establish routine & be proactive not reactive. You need to act consistently and with purpose. Don’t wait until your pain is crippling to decide you need to try some exercises to relieve it. Even if you’re feeling okay find a rhythm that allows structured gentle movement and exercise to be part of your daily routine ideally multiple times a day. Frequent exercise micro breaks to interrupt static postures will reduce the build up of pressure and stiffness and are more desirable than trying to undo hours of sedentary behaviour with a single bout of exercise. Think 2-3 minutes activity every hour rather than a 30 minute blast at the end of the day. Use a timer to remind you.

3- Accept responsibility & seek guidance. It is your body and your back and you need to find a way forward, nobody can do it for you. Don’t pass responsibility onto any therapist (no matter what some ‘Guru’ promises) and assume that by chucking money at it that will be enough to fix you. Do find help from someone you trust who has your best interests at heart and involves you in all aspects of any treatment or rehab plan. Passive treatments such as massage, acupuncture, and manipulation can be great for pain relief but long term are only as good as the agreed exercise plan and responsibility you take in changing your lifestyle. Be wary of any therapist promising to fix you but providing no education or prescription of exercises you can use to help yourself.

4- Exercise for fun. Find a form of exercise you genuinely enjoy and commit regularly to it. Don’t drag yourself to the gym if you hate every minute of it, exercise should be enjoyable and a way to relax your mind as well as your body. Try new things and see what you enjoy. Ultimately your long term compliance will wain if you pursue something because you feel you have to rather than because you really want to.

5- Manage stress. One of the biggest silent assassins to any life goal is high stress levels. You can have all the good intent in the world in changing lifestyle and exercising more but if you are under high levels of stress you can easily sabotage any progress. I realise this is a broad blanket statement and stress management is a big topic beyond the scope of this article but at the very least be aware of how it contributes and can damage your progress, then start to look for solutions.

6- Be patient. You won’t change things overnight and chances are you will have many peaks and troughs in your recovery. This is normal. Try to be patient and remember a backward step with increasing pain symptoms is not the end of the world, try to continually adapt but keep taking positive actions even when you feel frustrated and annoyed. If you follow the steps above you should see over time the more severe episodes of back pain decrease while your ability to manage and recover from any acute episodes will improve.

Picking Exercises - Where to start?

It’s imperative to get moving ASAP with pretty much every kind of back pain or injury but the exact type of exercise or stretch you choose to get started with will differ depending on your level of pain, stiffness and disability. Below is a back mobility exercise flow covering a multitude of different exercises and positions. Try it but STOP if you feel any specific movement aggravates your pain. At most a slight awareness of stiffness or aching is permissible but do not force anything and take it slowly and gently.

You may decide that only a couple of these exercises work for you in your current situation and that is fine, identify what you can do and exclude what you can’t. That will be your start point and I would advise doing these exercises a minimum of 3 times per day but ideally more frequently at least initially. As you become more comfortable hopefully you can add more of the movements to your repertoire.

Long term most people will require a combination of strength and flexibility exercises but it is important that these are specific to your own individual requirements. The routine below is provided as a starting point but is not all encompassing so please seek advice on your own needs but do use these stretches to try and initiate positive change through movement. The exercises are broken down individually in the pictures below the video & you can download a PDF cheatsheet to keep for your reference at the end of this blog.

Back Mobility Flow Video:

Seeking Guidance? We Can Help

Our experienced team at Physio Effect Glasgow are specialists in back pain and have helped 1000s of people recover and get back their quality of life. We talk the talk and walk the walk and will combine exercise based rehab with highly skilled hands on therapies to ensure you get the best possible treatment.

Most importantly we will listen and work with you in partnership to identify your specific issues and formulate an agreed unique treatment plan. We will relieve your back pain and give you long term self management strategies to strengthen your back and reduce the chance of pain relapse.

Please contact us if you have questions or to book an appointment and get your journey to back pain recovery under way.

Exercise Breakdown:

Here is a breakdown of each of the exercises included in the back mobility flow video. These are available in a handy PDF download from the Subscription box at bottom of the page.

Exercise 1

Cat & Camel Stretch

• Begin in all 4s position. Cat posture - Allow your spine to soften and hollow along its entire length. Tilt your tailbone gently to the ceiling. Relax you lower back, rib cage, shoulders and neck

• Camel Posture - Arch your whole spine slowly and gently to the ceiling in one large ‘C’ shape. Tuck your tailbone between your legs

• Hold each position for around 10 seconds. Transition from one to the other 6-8 times.

Exercise 2

Childs Pose to Cobra

• Begin in all 4s position. Childs pose - Gently sit bottom back towards heels as far as is comfortable opening knees and hips softly and as required

• Cobra Pose - Allow weight to come forward and lower hips gently to floor. Stay relaxed in hips and lower back and if required bend elbows slightly so that hips can rest in contact with floor.

• Hold each position for around 10 seconds. Transition from one to the other 6-8 times

Exercise 3

Childs Pose Side Bend

• Begin in Childs Pose - Walk you hands around to one side into side bend aiming for at least a 45 degree angle, you should feel a good stretch down your side. Hold 20-30 seconds.

• Walk hands around in same way to other side and again hold 20-30 seconds in side bend.

• Repeat 2-3 times on each side

Exercise 4

Lunge Hip Flexor Opener

• Begin in Lunge position. Gently engage your lower tummy muscles and tuck your pelvis in. Aim to feel a stretch in the front of your hip and top of thigh

• Gently engage your buttock muscles and lean slightly forward taking care not to arch your lower back

• Hold the position 30-60 seconds. Repeat 1-2 times left and right

Exercise 5 - Part 1

Lunge Hip Opener with Alternate Arm Rotations

• From Lunge position reach hands forward and rest on floor beside front foot. Take outside arm and reach under and between legs ‘threading the needle’ holding for a few seconds

• With the same arm rotate outward and upward toward ceiling trying to get arm to a straight vertical position, hold for a few seconds then return to ‘thread the needle’

• Repeat this 10 times

Exercise 5 - Part 2

Lunge Hip Opener with Alternate Arm Rotations

• After completing Part 1 of this series stay in the same position but extend out your back leg as far as is comfortable

• Take inside arm now and rotate upward to the ceiling trying to achieve the straight arm vertical position, Hold for a few seconds

• Bring the same arm down and with bent elbow drive your elbow towards the floor down the inside of your shin. Hold for a few seconds then rotate back to the vertical arm position

• Repeat this 10 times

Exercise 6

A-Frame Walk to Squat

• From the all 4s position drive your hips into the air with straight knees and gentle lower your heels towards the floor into the A-Frame (it does not matter if you can’t fully extend knees or reach the floor with your heels). Hold for 10 seconds feeling stretch in back of legs

• Keeping hands on floor slowly walk feet in towards hands and slowly sit down into a squat, hold for 10 seconds

• Walk back to A-Frame position and hold for another 10 seconds

• Repeat 4-6 times

Thank You

Thank you for taking the time to read this post, we sincerely hope that you find it useful and can use it to implement some positive changes and reduce your back pain. Take your time and work at your own level but be persistent and try to gradually improve on your own baseline.

Please download your own FREE PDF Cheatsheet to keep and to help with your practice and share this post with anyone who could benefit. If you have any questions or comments please just ask we would love to hear from you. Stay healthy and move well.