Back pain can be excruciating – and it will affect most of us over the course of our lifetime. But what can you do about it? Here, osteopaths share the secrets to preventing, managing and overcoming a bad back.
Avoid triggers
“Prevention is better than cure,” says John Corfield, an osteopath who runs a clinic in Wilmslow, Cheshire. “There are things you can do to help avoid the common causes of back pain, such as swimming, engaging the core and not sitting for prolonged periods.”
Get up as much as possible
“The best thing you can do is move regularly,” says Emma Hayward, a Kent-based osteopath. “Even if that is just to get a glass of water and sit back down. It is about regular, small movements, so that your body is not in one static position for several hours.” Nick Mann, a GP and NHS osteopath at the Royal London Hospital for Integrated Medicine, says: “I’ve got two grownup children and I’ve spent my adult life trying to find ways to teach them not to use their laptops in a curled-up fashion, with their neck strained over it.”
Consider a standing desk
“People sit at desks for way too long,” says Corfield. “You should be up and about every 20 minutes for five minutes or so. In Scandinavian countries, they are big on standup desks. We seem to be so far behind, considering there are more work days lost to lower back pain than any other injury in the UK.” Equally, you don’t want to be standing for a whole day, says Hayward: “Being able to change the position your body is in regularly is probably the best way you can prevent pain.”
Address stress
“I rarely see someone with an injured back who hasn’t also got very stressful things going on in their life,” says Hayward. “I think that primes our body to be more vulnerable to injury.” The osteopath James Davies, who is the author of Body, agrees on the significance of stress as a factor. When injured, “managing stress and ensuring you have a calm, balanced state of mind is integral to recovery”, he says.
Build up core strength
There are a range of exercises you can use to do this, says the osteopath Anisha Joshi, who runs clinics in London and Hitchin, Hertfordshire. She recommends focusing on strengthening the glutes by doing glute bridges: “This can be really effective at helping to support the lower back. Also, thread-the-needles (which involve kneeling on all fours then stretching one arm under the other) are good to get your mid-back moving, while planks gently engage your core to help the deeper pelvic floor muscles support your lower back from the inside.”
Slouch (occasionally)
Posture is not as important as people think, says Joshi. “There is no evidence to show that posture predisposes you to getting back pain. There is this common saying that we practitioners use, which is ‘the best posture is your next posture’, because it is all about moving. Even if you’re sitting up straight, you are still going to get back pain, so I’d encourage slouching a bit.” That said, adds Davies, “incorrect posture can lead to various problems, affecting everything from blood flow to muscle strain. It is essential to be conscious of how we sit, stand and move throughout the day.”
Treat back pain like a cold
Joshi points to the statistic that up to 80% of people will experience back pain at some point. “There is a lot of fear around back pain,” she says. “I try to get my patients to reframe it as almost like having a cold, because it is that fear that makes people panic.” It is also difficult to avoid. Corfield had his last episode six months ago: “I was going to the gym, doing everything right – I was in great shape.” He was getting a chopping board out of a cupboard when he felt his back go.
Don’t assume it’s sciatica
“It’s a common misconception that all back pain is synonymous with sciatica,” says Davies. “This is not the case. Sciatica specifically refers to pain that radiates along the path of the sciatic nerve, which extends from the lower back down through the legs. This condition is typically the result of pressure on the nerve at various points along its course, not merely a general state of back pain. Distinguishing between these different types of pain is vital, as it informs a more accurate diagnosis and, consequently, a more tailored and effective treatment approach.”
On feeling pain, act quickly
“Some people will say it will correct itself in six weeks,” says Corfield. “The issue is, if it doesn’t correct itself in six weeks, you’ve gone from it being an acute problem to becoming chronic. So it’s the flip of a coin. It could turn into a bigger problem than it would have been if it were dealt with sooner.” Joshi adds: “If you’re experiencing any pain or discomfort for longer than three days, you should get it checked.”
Understand the meaning of pain
Try not to be afraid of pain, says Hayward, as hard as that may be. Understand what the body is doing when it sends out pain signals. “Pain can be really frightening,” she says. “People think that pain equals terrible damage. Often the pain is the body protecting against damage. So if someone strains a joint or a disc in their back, the body will very quickly create a muscle spasm, which restricts movement, but what that does is protect against further injury. But the muscle spasm itself is incredibly painful. So a big message for people is not to be frightened that they’ve damaged something. Actually, pain levels and damage don’t correlate.”
Nick Potter, an osteopath who works for the Centre for Physical Medicine and is the author of The Meaning of Pain, says: “It sabotages you deliberately, because the brain’s perception is something is harmed or dangerous and therefore it stops you. If you can learn to breathe and relax your muscles, the pain instantly improves.”
Painkillers can be useful, but mask the problem
You can take ibuprofen or paracetamol to ease the pain, says Joshi. “Also, there is some evidence to show that diclofenac gel can be quite good for specific injuries. If you take ibuprofen, it will flood your whole system with anti-inflammatories; diclofenac gel can go directly to the point of pain.” Corfield adds: “If you go to a GP, you will be prescribed medication that is going to mask symptoms. There is not a single medication you can take that’s going to make a disc retract again away from the nerve root. That can only be done with manual therapy.”
Use ice and heat
Consider heat and ice instead of painkillers, says Corfield. “Heat will relax the muscle and get the blood flowing, while ice will reduce the inflammation,” he says. “So there is nothing wrong at all with alternating between the two: 20 minutes of heat then 20 minutes of ice for an hour or two will cover both sides of the problem.”
Keep moving ...
“There might be cases where people physically can’t move,” says Hayward. “But, generally, movement helps and being sedentary can make things more painful and stiff.” Often, people will feel stiffer in the morning, as inflammation builds when you are still, but Hayward advises getting the spine moving as much as possible.
“Hug one knee, or two, to your chest, depending on what you can manage, then let the knees drop to the side.” Once out of bed, “get the spine moving in each direction by standing and bending forwards, if you are able to, then lying on the back and flexing the hips into a bridge, before standing again and bending to each side”. She adds: “If people can introduce different planes of movement to their spine, backs love that. It’s really simple. They could be doing that at their desk, just leaning to the side and twisting regularly during the day.”
... unless you are in severe pain
“If you have an acute disc injury, you can’t move,” says Corfield. “Spend a couple of days in bed, getting up only to go to the toilet.” Mann adds: “Moving is not always the right thing – sometimes it is harmful.”
Adapt fitness regimes accordingly
“Regular activity is a cornerstone of recovery and overall health,” says Davies. “It is not about intense workouts, but rather consistent, moderate exercise that suits your condition and lifestyle. The key is to start slowly, especially after an injury, and gradually build up to your previous level of activity, ensuring you don’t overdo it and cause further harm.” If you were very active before back pain, says Hayward, “it might have to be a staggered return”.
Diversify activities
Hayward says: “If someone is trying to get back to exercise and they are doing one sort of activity, I’d advise them to see if they can diversify their training to keep their body moving in lots of different ways. This is a great way to prevent further injury and help rehab. So if you’re a cyclist and you want to do really long endurance events as part of your training, maybe also do a bit of swimming, pilates or yoga. It will make you stronger and more balanced.”
Mann believes all schools should teach the Alexander technique – a series of movements designed to foster the efficient use of muscles – but says it is never too late to learn. “By undoing patterns of adverse neuromuscular spinal reflexes, students learn to reduce joint and muscle strains in everyday activities,” he says. “Research in the British Medical Journal showed that the effects of AT reduced chronic back pain and disability more than physiotherapy and were preventive one year later.”
Get more sleep
“There is evidence to show that lack of sleep affects back pain more than back pain affects sleep,” says Joshi. “Focus on your sleep as one of the key areas of trying to heal your back through sleep hygiene and relaxing before bed. If you have to take painkillers to get off to sleep, do it.”
Hayward says: “If you’re waking up very uncomfortable in the morning and you’ve got a mattress that is quite old, that could be something to look at.” The best kind of mattress “is very individual”, she says, but she would recommend something relatively firm, provided that is not too hard on your body: “A soft topper can be a good compromise, so you’ve got the comfort on your shoulders and hips and it’s not hard on your body, but you’ve got the support underneath.
“I often advise people to experiment with sleeping with a narrow pillow between their knees, which can line up the knees and hips. That can often be a really comfortable position to sleep in if your back is sore.”
Hold your phone differently
When holding phones, “most people hang their necks and gradually drop down so that they end up looking downwards, which is an obvious risk factor for neck pain”, says Mann. “What I would recommend people do is stand up and hold the phone out in front of you. Use the other hand to support underneath your armpit, so you’re supported at the elbow, and instead of holding it downwards the whole time you’re holding it in front of you.”
Listen to uplifting music
When working with clients, Potter asks what their go-to “happy song” is. He tells them to put it on when they are doing exercises, “because the neurological distraction means you can’t attend to the pain as much”.
Relax on your back
What is the one thing we should all be doing to promote better back health? “Lie down on a flat surface,” says Davies. “Ensure your back is comfortably straight. Elevate your legs by placing them on a chair or sofa, forming a gentle angle. This position naturally aligns your spine and reduces the stress and pressure often exerted on your back muscles and spinal discs. As you lie in this restorative pose, allow your entire body to relax completely. This not only alleviates the tension in your back, but also promotes overall relaxation.
“You can enhance this peaceful experience by engaging in calming activities, such as listening to soothing music, enjoying an audiobook or reading, making this not just a physical respite, but a holistic relaxation practice. Regularly incorporating this simple technique into your routine can significantly diminish back discomfort and contribute to your spinal health; you don’t need to wait for a back pain crisis to do this.”
