Backpain

Chairs and workstation
Backpain is often made worse by our sedentary lifestyles. Sitting at desks, especially with computer monitors is notoriously challenging. Do make sure that you get the best advice for setting your chair and monitor so that you are not crouched over the screen – many offices will have access to independent consultants for this purpose and you may be able to get personal advice. Ideally you should be looking up at your screen, in a seat that fully supports your back, especially the low (lumbar) area. You should have the seat itself flat or sloping slightly downward and you may try putting a foam pad or cushion at the base of your back so that you are also pushed forward on the seat a little. A foot rest is most often helpful.

The Health and Safety Executive has published a Display Screen Equipment Workstation Checklist. For further advice about workstation set-up see ergonomic trends.

Standing workstations are becoming more popular but access to this option is not widespread. If you work from home however it may be very helpful to have at least part of your day standing at a table with a box or other raised platform on it. If so make sure the monitor is at shoulder height so that you do not stoop.

When you settle down for the evening be careful about very soft settees. You may already have noticed that your back gets worse if you are sunk into a unsupported lounging position. For back problems the best reclining chairs have firm supports, arm rests and a leg rest or foot stool so your legs are raised.

One chair design to consider mimics squatting, with forward-sloping seats and a knee rest. These have no back rest but the angle of your hips and knees allows your back to find a healthy poise. However these seats are not cheap when bought new.

One of the best pieces of advice is to keep changing seating and other work positions as often as possible during the day. If you are forced to sit in the same seat at work at least make sure that you are able to get up and move about for a few minutes at least every hour.

Bed
We spend a third of our lives lying down so the mattress can be a critical factor in managing backpain. An old, uneven or too soft a mattress can be very bad for your back and new sleeping arrangements can be a priority.

We evolved to sleep on the ground and many back sufferers move to the floor or insert a board under their back. Usually a firmer mattress is better for you, especially if you are heavier and tend to sleep on your back, but this is very much an individual matter. If you sleep on your side you will want something softer round your shoulders and hips. Pocket-sprung, memory foam and latex mattresses may all be good choices. The term ‘orthopaedic mattress’ has little meaning here.

You should aim to try different mattresses before settling on your long term choice. Most information on mattresses is commercial promotion. You can check out a relatively independent review of mattresses for bad backs, including budget prices, here.

Summary
Stiff muscles hurt but moving won’t harm them. If you have acute back pain, you might feel like resting and staying still as much as you can. But in fact people with back pain who rest in bed take longer to get better. This is probably because their muscles get stiff and tight when they aren’t moving and stretching enough. Therefore, once the worst of the pain has eased off, try to carry on with your normal activities, even if you have to use a mild painkiller (such as paracetamol, co-codamol, aspirin or ibuprofen) to take the edge off the pain. Most people find that this works. Prolonged time off work also seems to slow recovery down. So, if you are not back at work after a fortnight, you should definitely go back and get more medical advice. And rather than staying off work for a longer period, ask your employer to you find you lighter work for a time. Generally speaking, staying fit and active will speed up your recovery and help prevent further problems.

Evidence
There is good evidence that staying active and taking regular exercise is helpful for people who are prone to getting lower back pain. Choose the sort of exercise you enjoy. There is no particular ‘back strengthening’ exercise that is better than another for preventing back pain. Just half an hours brisk walk every day can improve your long-term fitness and mood.

Safety
Build up gradually. Don’t exercise immediately before bedtime because it might keep you awake. See Go See Someone for other types of exercise. If you have a heart or breathing problem, and you’re not sure about getting more active, check with your doctor.

Cost
You can exercise at home for nothing – walking and gardening is all exercise. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme.

Further information
Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes. See also the Classes section for more information.

Summary
If you have acute low back pain, you may find that putting a hot or cold pack on the painful area will help your back muscles relax. You’ll need to try both hot and cold to find out which works better for you as an individual. You can use a bag of frozen peas, or a warm hot-water bottle. Always wrap the hot or cold pack in a thin towel or cloth so it doesn’t burn or freeze you. Usually, applying heat or cold for about 20 minutes will help your muscles relax so that you are less stiff. Then you may feel loose enough to try some slow stretches and get the blood flowing back into cramped muscles. You may find it helpful to alternate between hot and cold packs every few minutes. In this case apply each long enough for the heat or cold to sink in, and then swap: the effect is to create a circulatory pumping action that can be quite effective.

Evidence
Research has shown that heat can reduce pain and stiffness in back pain that has lasted less than three months, though the effect is small and short-lived. Stretching exercises, combined with heat, seem to be more helpful. It is not clear whether heat works for pain lasting longer than three months.

Safety
There are no safety problems with hot or cold packs, as long as you remember to wrap the pack in a thin towel or cloth to protect your skin.

Cost
You can buy special heat packs or use something you already have, like a hot water bottle. Other possible heat sources include: soft heated packs filled with grain, poultices, hot towels, hot baths, saunas, steam, heat wraps, heat pads, electric heat pads and infra-red heat lamps.

Summary
Meditation is a state of mind, not a religion, though it features in most major religions, especially Eastern ones. Meditation seems to harmonise the activity between the two sides of the frontal brain, and encourages a ‘relaxation response’. The relaxation response happens when the body and mind do the opposite of what they do when you feel stressed. In meditation the body is relaxed while the mind is alert. You don’t need an experienced teacher or a spiritual faith in order to take up meditation. You can learn the basics from a book or a podcast. Meditation is easily accessible, and it is remarkably effective, both for rapid stress reduction and as a way of promoting long-term health.

Most research suggests that soft, slow melodies, usually classical music, can help you relax. Audio aids, which may take the form of relaxing music or natural sounds like waves or gentle wind or even quiet heartbeat rhythms, can also be useful.

Evidence
It isn’t clear from research whether meditation, relaxing with music or listening to audio aids can help long-term back pain directly. But if they help you relax, they should ease muscle tension, and help break the pain stress cycle.

Safety
There are generally no safety problems with meditation, music or audio aids.

Cost
You can buy special relaxation music, but it’s really a matter of finding out what works for you. Meditation involves certain (simple) techniques that can be easily practised at home. There are many books and audio aids available and some people find it useful to join a class initially.

Summary
Progressive muscular relaxation works by tensing and relaxing various muscle groups in your body, starting from your feet and working your way up. At each level, try to notice how it feels when your muscles are tense, and how it feels when you let go and relax. Gradually you will get used to the feeling of relaxation and learn how to make it happen at will. As with most relaxation methods, you need to start by finding a quiet, relaxing place to practise. Get yourself in a comfortable position, sitting or lying, and start by allowing your out-breath to get softer, longer and deeper.

Evidence
Three small studies suggest that progressive relaxation helps for a short time with back pain.

Safety
Relaxation techniques are generally safe unless you have a severe or long-standing mental health problem (see our section on Stress and Anxiety).

Cost
Progressive muscular relaxation can be learned from a book, CD, DVD or during exercise classes such as yoga classes (go to ‘Go see someone’ in this section for more information). No costs are involved, although you may need to buy a CD, DVD or book.