Physio · 8 minute read

You bent down for the washing basket and something in your lower back grabbed. Now you’re stuck halfway, breathing through your teeth and working out how you’ll ever reach the couch. It feels catastrophic, and it almost never is.

Your back rarely goes during something impressive. You’d at least have a story if it happened on a ski slope. It goes while you’re picking up a sock, lifting a toddler out of the car seat or reaching for the dog’s bowl, and then you lie on the floor wondering how a sock did this to you.

You’ve got company on that floor. About 8 in 10 Australian adults have had low back pain at some point. The first thing most people want to know is whether they’ve done something terrible. Usually they haven’t.

Why it hurts so much

The muscles around your back can spasm, which is why you can feel locked in place, and the pain can feel far bigger than the problem. It’s real pain, and it’s also a poor guide to how much damage there is, because a sharp flare during a movement doesn’t mean you’ve hurt anything new.

Of 1,172 people in Sydney who saw a health professional for new back pain, just 0.9% had something serious.

Your back is more likely to go when you’re tired, distracted, in an awkward position or holding something heavy, and mornings are the worst. That comes from a study of 999 people in Sydney. So if you were rushing the school bags out the door on four hours’ sleep, your back may have had a point.

What to do in the first 48 hours

1. 1Get comfortable firstSome people find it easier lying on their side with a pillow between the knees, or on their back with pillows under the knees.
2. 2Then get up, little and oftenWalk to the kitchen and back, then do it again a bit later. You don’t need to wait for all the pain to go before you move, and staying active is the best way to recover.
3. 3Try some heatA heat pack or wheat bag can take the edge off for a while. Wrap it in a towel so you don’t burn your skin.
4. 4Keep your day as normal as you canGo to work if you’re able to and do the school run. It’s fine to swap out the things that hurt most for a few days, like heavy lifting.
5. 5Ask your pharmacist about pain reliefThe point of medicine here is to turn the pain down enough to keep moving. Paracetamol on its own did no better than a dummy tablet for new back pain in a big Australian trial of 1,652 people. Anti-inflammatories help only a little. Opioids aren’t usually recommended. A pharmacist or GP can tell you what’s safe for you.
6. 6See a physio early if you canYou don’t have to wait it out. A physio can check for warning signs, explain what’s going on and show you which movements to start with, which makes the first few days a lot less frightening.

Book a physio appointment

Do you need a scan?

Most people don’t. Without warning signs, a scan done early doesn’t help people get better any sooner.

When researchers pooled the scans of 3,110 people with no back pain at all, 30% of 20-year-olds had a disc bulge, and by 80 it was 84%. Think of them as grey hairs on the inside. A physio or GP can examine you and work out whether you need a scan.

Why you can stop being scared of bending

Lots of us grew up being told to lift with a straight back, and after one bad episode it’s easy to start moving like you’re made of glass. There isn’t much behind that rule. People with and without back pain bend much the same way when they lift, at least in 9 of 11 studies. They weren’t great studies, so we can’t be certain, but a rounded back at the washing basket looks a lot less dangerous than we were taught. The exception is osteoporosis or a past spinal fracture, where loaded forward bending isn’t recommended, so ask your physio what suits you.

How to make it less likely to come back

Once the pain goes, life rushes back in and you forget about your back until it goes again. In one study, 69% of people had it happen again within a year, and for 40% it was bad enough to limit what they could do.

Keep moving after it stops hurting. Exercise has the best record of anything at keeping back pain away.

Walk. Of 701 Australians who’d just recovered, most of them women with an average age of 54, those on a physio-guided walking and education program typically went 208 days before back pain next got in the way of their day, against 112 days without it.

Build some strength. Doing some strength work two or three times a week, with a bit of stretching or cardio mixed in, seems to mean fewer flare-ups.

Get a plan from a physio. Once the pain has settled, a physio can look at how you move, work out what might be setting it off and build you a program that fits your week.

The takeaway

Give yourself a few minutes on the floor, then get moving a little at a time, even if it’s only as far as the kettle. Your back is almost certainly less damaged than it feels, and gentle movement is what helps most.