I have back pain, my back is “stuck”, what should I do?

In this case my most important question would be: WHEN?  We must differentiate between different stages of back pain.  In the initial stage- usually lasting for a week or two following the injury/ “bad movement” the goal is to relieve the pain. A complete rest is recommended only for a couple of days, afterward it’s important to try to move as much as possible within tolerable levels of pain. At this stage, you can use medication & start physiotherapy or guided therapeutic movements.

At a later stage the emphasis will be to try and reduce the chances of recurrence by exercising and behavioral changes.

I have back pain, should I put Heat or Ice?

As for the first 48-72 hours, the answer would be Ice, after this period there is no definitive answer, you can try both and decide which one suits you best. If you are cooling the area do it with a damp towel. If you are heating it please be careful not to burn yourself.  Consult a physiotherapist to get more specifics on this matter.

I have back pain, should I get an X-ray or an MRI?

This is one of my favorite questions. Firstly, you need to consult your physiotherapist or family physician and, in most cases, they will be able to determine whether or not you need one after performing a detailed history and physiotherapy evaluation. The imaging results will, in most cases, not give us a full picture and in a significant amount of the cases it might even cause more confusion than anything else. Save yourself the radiation (X-RAY) and the money (MRI).

I have back pain; how do I know if it’s just a “common” back pain or a disc herniation?

The notorious disc is a tissue that is located between 2 vertebras, and is designed as a shock absorber. A complete disc herniation means that the outer layer of the disc is ruptured and some of the internal disc content (called nucleus pulposus) exited out into the central nerve canal. This is a very uncommon condition (about 2% of the patients). In a “true” disc herniation there would be a very significant pain down the leg, usually below the knee. In many cases, there would be no back pain at all, weakness of usually one leg and other neurological symptoms. Again, it’s a very uncommon condition. Over 95% of the disc problem would never be that bad.  The much more common condition, which is also a very treatable condition is what we call “disc bulging”. In this more common scenario, the disc is not ruptured. It would be wise to be assessed by a Physician and in most cases by a physiotherapist. Preferably a physio with  extensive training in the “McKenzie method” which specializes in short term, focused treatment for low back pain from a disk origin.

I have back pain, should I stop working after an episode of low back pain?

Definitely not, but you might need a few days off. However, all the research out there shows that early return to work and normal activity will speed up your recovery. That being said, you have to go back gradually and build the load on your body wisely. It would be best to plan the return to work with either an occupational therapist or a physiotherapist.

I have back pain, is swimming/ yoga / pilates the only physical activities that can help my back pain?

Well, that’s a myth. High quality research shows that any controlled physical activity that works on core stability, strengthening and aerobic function would help to reduce your pain. It is important to consult a physiotherapist and get proper guidance as to which activity will suit you best.

I have back pain, are we allowed to bend forward when we have pain?

Bending is the most functional activity done by our backs. An average person bends forward more than 2000 times a day whether is sitting or standing. Therefore, this is a highly unrealistic demand. Moreover, this kind of instruction can put our nervous system in a state of stress, causing us to adopt an unnatural moving pattern that can increase our pain. In some cases, for a very time limited period we will instruct you to minimize flexing forward in. However, the physiotherapist will flex you back A.S.A.P.

I have back pain; can physiotherapy help my back pain?

Yes, definitely, very much so. A certified physiotherapist, especially one with extensive training in the McKenzie approach, can diagnose the source of your problem, treat your symptoms, guide and support you all the way to full activity and recovery. Physiotherapists that specialize in the McKenzie Method go through a long and extensive postgraduate training designed exactly to give you the answers to your back problem.

I have back pain; which position is best for me? Sitting? Laying? Standing?

In the first 2-3 days, you will probably need a bit more of bed rest, under no circumstances that this means to stay in bed 24/7. Staying in bed for a long period will probably prolong your back pain. After this 48-72-hour period, the best thing to do is to move and change positions, you may find out that sitting with a support of a small pillow placed in the small of your back is more comfortable. Often walking significantly relieves the pain. The main thing is to try and be on the move as much as possible.  You can contact a physiotherapist to be properly guided along the way to getting pain free.

I have back pain, what are the odds for recurrence of my back pain?

Back pain tends to return often however, this is very much up to you, if you will adopt a healthy lifestyle, with physiotherapy exercises that would help you maintain strong back muscles, you’re less likely to have a recurrence. Even if it would happen again, most likely it will be shorter in duration and with reduced intensity of pain.


A few physiotherapy exercises for the acute phase of low back pain for the acute phase of pain

  1. Try laying on stomach and leaning on your forearms for 30-60 seconds, If you feel relief or reduction in your back symptoms try to do it for 3-4 times every 2 hours.
  2. Extension in lying – If you feel better with the previous exercise, you may progress to the next exercise, 12 repetitions every 2 hours should be enough.
  3. Stretch your back in a 4-point kneeling position, If you feel relief or reduction in your back symptoms try to do it for 3-4 times every 2 hours.

Click here for a video on low back pain