Rehabilitation for back pain

Starting from the right idea

The belief that back pain means bed rest is one that modern guidelines have moved away from. The systematic review of high-quality guidelines for musculoskeletal pain distilled eleven agreed recommendations, which include educating patients, promoting movement and exercise, and trying to keep people at work.

Your back is more robust than many people assume, and pain does not always equal damage. That understanding matters for recovery in itself, because fear of movement leads to moving less, which weakens muscle and tends to mean more pain in the long run.

Which form works

A systematic review with network meta-analysis pooled 75 randomised trials with 5,254 participants, comparing 20 forms of exercise for chronic low back pain.

Tai Chi, yoga, Pilates and sling exercise improved pain more than conventional rehabilitation; yoga and core or stabilisation exercises improved physical function more.

The authors’ own conclusion, however, was that given the quality and quantity of the available trials, no single form can yet be definitively recommended over the others. Larger, higher-quality trials are needed.

Through the stages

While pain is bad. Reduce what causes sharp pain but keep walking and moving. Change position often; do not sit or stand in one posture for long. If you need pain relief, ask your doctor or pharmacist which class suits you.

In between. Begin exercises that move the back gently through its range, and start strengthening the muscles around the trunk and hips.

Returning to normal. Practise what you actually need to do, particularly lifting. Train controlled lifting and add weight gradually, rather than avoiding lifting for good.

Getting back to work

One of the eleven agreed recommendations across high-quality guidelines is to try to keep patients at work. Long absences do not generally speed recovery, and make returning harder.

If your job involves heavy lifting or long static postures, talk to your doctor about temporary changes — lighter loads, or alternating tasks so you can change position — rather than stopping altogether.

When to see a doctor

Questions to ask your doctor or physiotherapist

• What is likely causing my symptoms, and is there anything specific to be careful about?
• Which form should I start with, and how many times a week?
• What should I reduce for now, and when can I return to it?
• How do I tell an ordinary increase in symptoms from a warning sign?
• How should I adjust my work or my working posture?