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Managing a First or Acute Episode of Low Back Pain

What is low back pain?

Low back pain is very common. So common, in fact, that most (80%) Australian adults will experience at least one episode of low back pain during their lifetime. Although often very painful, most low back pain is not caused by a serious problem and will resolve with some simple care. Physical activity is an important part of that care.

Occasionally, however, low back pain can be caused by serious disease or damage to the tissues of the back. You should seek advice from a health care practitioner as soon as possible if your back pain:

  • occurs after a traumatic event, such as a car accident or a fall;
  • wakes you during the night;
  • does not reduce or change, no matter how you move or change position;
  • accompanies numbness, tingling, or ‘pins and needles’ in your bottom, legs or feet;
  • or accompanies changes to your bowel or bladder control.


How do I manage my low back pain?

If you simply have low back pain without any other issues, then your pain is likely to be ‘uncomplicated low back pain’ that will resolve. Perhaps surprisingly, staying as physically active as possible helps you manage your low back pain. You might also want to apply a heat wrap. Finally, try not to worry too much about your uncomplicated low back pain. This is particularly important because thinking the worst apparently increases the pain; with the worry (called ‘catastrophising’) eventually becoming a bigger problem than the pain itself.


How should I stay active?

Exercise is great medicine for low back pain. You can choose from many options of exercise, with no specific type being the best. Just stay as active as you can, allowing for the restrictions in movement that may come with pain. Staying active means different things to different people: think for a moment what staying active means for you. If you enjoy gardening, then staying active may mean pottering in your garden, even if heavy jobs such as digging or pruning are too much for you. If you run marathons, staying active may mean continuing training but reducing the distances you run each week.

If you do not exercise regularly, an episode of low back pain may be your prompt to start. Walking, swimming and cycling allow people with low back pain to become active and stay active. Some forms of dancing, yoga and tai chi are popular too. People with low back pain usually do not compete, work for medals or train hard in these activities. They use these leisure activities for therapy, and to experience the joy and pleasure of movement.


What are the benefits of exercise?

Exercise is a powerful tool for moderating strong emotions, such as anxiety and depression. In fact, participating in enjoyable physical activities keeps you connected, happier and more focused on the important things in life. Also, while you are in pain, staying active prevents loss of physical fitness, muscle strength and cardiorespiratory function (e.g. deconditioning). Staying active therefore helps you ensure that other aspects of your health do not decline too — being in pain is quite enough!


What happens as I start to recover?

When you had severe low back pain, you were using exercise to stay active and to stop yourself from getting worse. Now you want to get better and stay that way. As your low back pain reduces, you can increase your program of preferred exercise to include ‘graduated training’ and specific exercises that increase your range of spinal movement and strengthen the trunk and abdominal muscles. There is moderate evidence that doing exercise at this post-back pain stage can help stop another episode of low back pain.

Graduated training: To keep physically improving, your exercise program must become increasingly more difficult; this is called graduated training. For example if you stayed active by walking, to gain further health benefits you now need to walk further or faster, walk up hills, or carry extra weights. Accredited exercise physiologists can help you plan a suitable graduated training program in your preferred form of exercise.

Increasing your range of motion: Your spine and the surrounding muscles are designed for movement. As your low back pain subsides, add some stretching and reaching exercises that increase the amount that you move your back. This is an ideal time to begin some tai chi, yoga, stretching or dancing if you have not done so already.

Strengthening: Muscle strength, particularly in the small muscles that stabilise the lower back, does not return automatically when low back pain eases. To regain this strength, you may need to do some specific strengthening exercises, with graduated difficulty to progressively increase strength. An accredited health professional or sports trainer can help you plan an exercise program to strengthen your low back. It is important you seek assistance with planning exercise if you have had multiple episodes.

Adapted from

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