Mr James Langdon

BSc (Hons) MB BS MRCS (Eng) FRCS (Orth) Consultant Orthopaedic Spinal Surgeon

Conservative management of back pain

Back specialists often use the term conservative management to describe any treatment option that does not involve surgery. Treatment for your back problem may be as simple as reassuring you that there is nothing seriously wrong with your back. However, anyone who has had a back problem should consider some preventive measures to protect their back from further problems in the future. Most patients will benefit from seeing a physiotherapist, an osteopath, or a chiropractor.

There are a number of things that you can do to help you manage your back pain:

Stretching: The aim of stretching is to maintain the range of movement of your spine. You should also stretch your hamstrings and the rest of your body, as this will reduce the amount of movement required of the spine.

Core stability: The strength of the spine comes from the muscles of the stomach, back and upper thigh. These muscle groups form your own ‘internal muscular corset’ that serves to support and protect your spine. Your physical therapist (physiotherapist / osteopath / chiropractor) will teach you specific core strengthening exercises. As you become more comfortable with these exercises then you may benefit from joining a Pilates class.

Developing and maintaining your core muscle strength is most important part of your back rehabilitation, and is an investment against back problems in the future.

Anti-inflammatory medication: Inflammation of structures in the lower back is a big factor in lower back pain. Anti-inflammatory medication can be very effective in helping to reduce this inflammation and improve your symptoms.

When taking any medication always follow the instructions on the leaflet, and do not exceed the recommended dose. Anti-inflammatories are not be suitable for everyone, especially if you have a history of asthma, high blood pressure, kidney or heart failure, or heartburn or stomach ulcers. You should check with your GP or pharmacist if you have one of these conditions or if you are taking any other form of medication.

Lifestyle modification: Many people with low back pain will have particular things that they like or have to do in their daily lives that aggravates their back. You should consider your daily activities both at home and at work. Rather than giving up some activities, you should aim to reduce or modify those activities that appear to aggravate your back. This may bring down the amount of strain that you place on your spine to below the level at which you experience the onset of symptoms.

There are a number of activities in our daily lives that can contribute to back pain and which can be easily modified:

Workstation modifications: The back of your chair should be high enough to support your shoulders, and the back of the chair should be at right angles to the seat. The chair should be at a height that allows your knees to be bent at 90 degrees with your feet resting on the floor. Your computer screen needs to be raised off the desk, as the position of your screen determines the position of your head. You should never sit at your desk for more than one hour at a time.

If you spend a lot of time on the telephone then use a headset so that you do not sit with your head and neck tilted over to one side.

If your back is aggravated by long journeys in the car, allow a bit more time for your journey so that you can take regular breaks. Likewise, if you have to do heavy physical tasks at home such as hovering the house or digging the garden, then try to avoid doing it all at once and have regular breaks. Ideally you should try and avoid heavy lifting, but if this is not possible then make sure you lift by bending your knees, keeping your back straight.

High impact sports should be avoided if possible. These include squash, long distance jogging, fast bowling and rowing. Less high impact sporting activities such as tennis, cycling, badminton, golf, and football are usually fine. You will often feel sore the day following heavy exercise, rather than at the time of exercising. If you have a longstanding history of back pain then it is important that you increase your activity levels in small amounts so that you hopefully avoid getting into a cycle of activity followed by pain and subsequent inactivity.