Your Back Pain Questions Answered: A Comprehensive Guide to Understanding and Managing Back Pain

Whether it’s a dull ache or sharp pain, back pain can be debilitating and affect your daily life.

Back pain is one of the most common health complaints among people of all ages and we answer questions on the topic on a daily basis. As such, we aim to address some of the most frequently asked questions regarding back pain in this post.
 

What is the one thing you would tell people to do, to reduce the likelihood of back pain occurring?

Stay healthy, stay fit (don’t do too much at once, and don’t do too little), maintain a neutral posture (see here: for a neutral spine), look after your mental and physical health, enjoy life. Whoops that’s more than one thing – but if we take anything away from this – it would be to
stay healthy, happy and balanced.

What is the right balance between resting and continuing to stretch and strengthen as I seem to be experiencing more pain following sessions.

First of all – is it a good pain or bad pain?

Good pains:

• Stretch ‘pain’
• Delayed onset muscle soreness (feels like your muscles worked hard the day before). DOMs peak 1-3 days after your workout.
• After a session of manual therapy. Your injury should get better but you might get latent treatment soreness which occurs for 1-2 days after treatment.

Bad pains: Pain from overload. Pain from joints and nerves.

And back to the Relieve-Restore-Perform framework of rehab, are you working within the framework? If we get the progression right, you shouldnt be pulling up from sessions sore for more than a period of time. If you are consistently, find out where you’re at and calibrate your exercises towards the right section/phase.

How can you tell the difference between joint, nerve and muscular back pain?

It’s important to note that it is rarely one over the other. You often get symptoms from one or more sources, as they lie so close to each other. Any dysfunction in one structure affects the area around it. Think about cause and effect.

But very generally, the information below might answer your question:

Nerve: The quality of pain is usually sharp, shooting or burning, and may radiate to a location beyond the primary location. Radiating pain may feel sharp/shooting/burning or dull. You might also get pins and needles, or numbness.

Muscular: Tends to feel more superficial, and when you press on muscles with your fingers, they will feel tender as you press on them. They may even feel ropey/knotty under your fingers. Deeper muscles may require you to press a little deeper to get to them.

Joints: The location – if there are joints underlying the area of pain, the pain feels quite deep, or if it feels quite stiff, it might be coming from the joint. If you still feel quite stiff after a massage that works through your more superficial muscles, it might be a sign that it is coming from your joints.

If you get a “muscular” back pain that plays up once every few months/every year – it is likely to be more than just muscle. It is always best to seek an appropriate health professional’s opinion on your pain sources and how to treat them.

What’s the best way to sleep to reduce back pain in the morning?

Often people blame how they’re sleeping, but it’s part of a bigger problem such as inflammation setting in overnight, or doing too much the day before. Because if you think about it, when you lay in bed, there are actually lower forces going through your spine.

There are specific things you can do in your sleeping position for less stress/irritation in your spine.

• When lying on your back, if you find your lower back sinking too deeply into your mattress, a rolled up towel or pillow crosswise to your body underneath your waist to support the lumbar curve, might do the trick.
• If you’re a side sleeper, having your knees together can put pressure on your hiper and compress the underlying shoulder and neck. Having a pillow between your knees can offload the pressure on your hips.
• A mattress topper to firm or soften your sleeping surface. Softer surfaces are more supportive for side-sleeping, while firmer ones support back-sleeping more.

Pillows

Back sleepers: pillow height should be low. Having too many pillows forces your neck into flexion. You can reduce the height your head is raised with 1 pillow or even using a flatter one.

Side sleepers: pillow height should be medium to adequately support your head and neck.

What causes flare-ups in back pain and how can they be avoided?

It is rarely ever the “one thing” that flares it up. It is usually a ‘tipping point’ from a multitude of factors. They include but are not limited to:

• Not moving through the RRP rehab framework appropriately – getting ahead of where you’re really at or not progressing yourself enough
• Not having enough buffer in strength
• Improper heavy lifting
• Poor posture

To avoid them, address the possible contributing factors above.

What’s the best way to maintain a healthy back in a job where you sit at a desk a lot?

Two key things: desk ergonomics, and regular movement.

Desk ergonomics

You might find the following resources helpful on desk ergonomics:

• Video on how to set up your desk chair.
• Video on how to sit better and desk ergonomics.
• Blog post that explains more about sitting, also has a section about standing desks and posture by the standing desk.

Movement

It is important you break up prolonged postures, whether it is sitting or standing. Break up your day by spacing out mini walks to the pantry, toilet or a coffee break. This helps with both neck and back health.

Other movements you can incorporate into your day will be this desk circuit – set an alarm for every 30-40 mins and do one of the following:

• Pec stretch at 2 heights – maj and min
• Seated pelvic tilts → correct seated posture → towel if needed
• Chin tucks
• Simple mobility – shoulder circles, chin retraction with rotations
• Lev scap stretch
• All 4s – swan dive → Cat/Cow (if working from home)

Can Pilates and exercise actually improve quality of life by reducing back pain?

Yes! Exercise, including core exercises like Pilates has moderate-level evidence in effectiveness for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain (Hayden et al., 2021). This study by Hayden et al. (2021) is actually one that objectively summarises the findings of 249 studies. Exercises included in the studies were pilates, coe strengthening, general strengthening and mixed exercises. The exercise settings included both 1-on-1 exercises and group classes. All of which we provide at Viva.

More than half the studies included education/advice, electrotherapy, or manual therapy. This means that sometimes, just exercise is enough. But depending on you, your lifestyle, condition, and how you present, combining exercise with other treatment modalities might be indicated.

In the subacute and chronic phase, it is especially important that the exercises are at the right level for the phase of rehab that you’re at, with gradual increase and progressions (Oliveira et al., 2018). This is why at Viva, we put so much emphasis on the rehab framework of Relieve-Restore-Perform – so that we are providing you with treatment/exercise that meets you where you are at and takes you higher.

The way the research quality is determined limits how research around exercise treatment is rated. The gold-standard of research is double-blinded, randomised controlled trials tested against placebos. However, this is limited in the nature of studies addressing physiotherapy treatment type (how do you make a person unaware that they are performing exercise?). Considering that, moderate evidence is actually quite significant. Combined with the findings of adverse/unwanted effects being minimal and minor e.g. the natural delayed onset muscle soreness, there really isn’t much to lose in taking part in exercise (at the right level for you).

References
Hayden, J.A., Ellis, J., Ogilvie, R., Malmivaara, A., van Tulder, M.W. Exercise therapy for chronic low back pain. Cochrane Database of Systematic Reviews 2021, Issue 9. Art. No.: CD009790. DOI: 10.1002/14651858.CD009790.pub2. Accessed 30 January 2023.

Oliveira, C.B., Maher, C.G., Pinto, R.Z. et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J 27, 2791–2803 (2018). https://doi.org/10.1007/s00586-018-5673-2

Will I ever get relief from back pain again and live pain free?

It is definitely possible 🙂

The cause of back pain is usually multifactorial and that means a multifactorial approach to treatment. A few things to consider are:

• Is the diagnosis right?
• Where are you on the Relieve-Restore-Perform framework of rehab?
• Are you doing exercises appropriate to where you are on the framework?
• Rehab takes time and persistence – have you given it enough time and have you been consistent with rehab?

What are the top 3 things that we can do daily to manage back pain?

• Determine where you are at in the Relieve-Restore-Perform framework – because that determines what is appropriate for you to be doing “daily”.
• Watch your posture in sitting and standing and when doing chores or working – are you standing with your hips swayed forward or leaning on one leg for a prolonged period of time?
• Have your basic needs met – sleep, nutrition, hydration, movement, work-life balance, stress management.

Why is back pain felt once we stand up after sitting, and not while sitting?

Structures are worked, stretched and compressed to help you in the action of moving from sitting to standing.

What are the most beneficial daily exercises to assist with the pain of a disc bulge in the lower back?

First: determine where you are in the relieve-restore-perform framework. If you are not sure, book in with a physio.

Examples of exercise in each of the respective phases (although it can differ person-to-person):

Relieve Phase

• Cobra stretches

Restore Phase

• Pelvic tilts
• Breast stroke prep, level 1
• Plank

Perform Phase

• Shoulder bridge
• Breast stroke
• Roll up/down

To tackle back pain holistically, what resources would you recommend for me to educate myself about the science behind the pain experience and latest research?

Books by David S. Butler and G. Lorimer Moseley:

• Explain Pain
• Explain Pain Handbook: Protectometer
• Explain Pain Supercharged

What are the best core exercises to alleviate lower back pain?

It depends on the mechanism of your lower back pain, your baseline strength, as well as the rehab phase you’re in (relieve, restore or perform).

If your LBP is a disc injury and it is quite acutely flared up, extension-type stretches would be best e.g. cobra stretches

If it is an acute facet injury or stenosis, flexion-type stretches e.g. child’s pose, forward fold, leaning forwards in a chair, would be the way to go.

If your LBP is mechanical/non-specific, or you are ready for the perform phase, there are a plethora: planks, 4 point kneel hovers, abdo prep, alternating scissors in double table-top – all while maintaining a neutral spine of course!

What is the main cause of back pain postpartum?

During pregnancy, a few things happen, including but not limited to:

• Hormones that relax ligaments and reduce support around your back and/or pelvis.
• The expansion of your rib cage through the front to accommodate for your growing belly – this places strain on your mid back.
• Posture due to change in weight distribution in your bust and belly.

Back pain postpartum can be due to:

• Those above changes being unaddressed and reaching a ‘tipping point’
• Decreased activation of pelvic floor muscles postnatally = decreased deep core support for lower back.
• Change in weight distribution after your baby is born – is your body used to holding you up without your baby’s weight in front?
• Nursing – this can be tedious on your upper back, shoulders and arm
• Reduced rest

How to prevent it and strengthen my body for pregnancy and postpartum

Pelvic floor exercises

• Strengthen the right muscles and mobilise the right joints.
• Classes: stay fit in pregnancy, and mums and bubs class. Book here for a consultation to ensure you are ready for them.
• Or build your own personalised exercise program. Book here.
• Watching posture
• Wearing a supportive pair of shorts – get fitted with us!
• Wearing an SIJ belt for support if you get SIJ pain

Check out our post ‘Back Pain in Pregnancy: Causes, Symptoms and Treatments‘.