YOUR BACK PAIN

Idea

Treatment of low back pain has undergone a recent sea change. Experts now appreciate the central role of exercise to build muscles that support the back.

Bed rest, once a key part of treating back pain, has a limited role in healing sore backs. In very small doses, bed rest can give you a break when standing or sitting causes severe pain. Too much may make back pain worse. Here is how to do bed rest “right.”

To get the most from staying in bed, limit the time you are lying down to a few hours at a time, and for no longer than a day or two. You can rest on a bed or sofa, in any comfortable position. To ease the strain on your back, try putting pillows under your head and between your knees when lying on your side, under your knees when lying on your back, or under your hips when lying on your stomach. These positions reduce forces that sitting or standing impose on the back — especially on the disks, ligaments, and muscles.

An extended period of bed rest isn’t helpful for moderate back strain at any stage of therapy. While your back may feel a little better in the short term, too much time in bed can trigger other problems. Muscles lose conditioning and tone, you may develop digestive issues such as constipation, and there is some risk of developing blood clots in the veins of your pelvis and legs. And being on prolonged bed rest does nothing for your mental health and sense of well-being. Depression, as well as an increased sense of physical weakness and malaise, is common among people confined to bed.

Is it okay to try to get active as quickly as possible? Well-designed clinical trials suggest that an early return to normal activities — with some rest as needed — is better than staying home from work for an extended period.

If you suffer from back pain, the range of treatment options can feel overwhelming. The right choice for you depends on what is causing your pain as well as the physical and other demands of your life. For many people, back problems clear up with little or no medical intervention within a few weeks.

But that doesn’t mean you shouldn’t do anything while you are deliberating. There’s a lot you can do to ease your pain and speed your healing. An exercise program designed to stretch and strengthen your back and core muscles can help you heal from a bout of acute back pain and help prevent a repeat episode.

Developing a suitable exercise program — best done under expert supervision — will help you build strong, flexible muscles that will be less prone to injury. If you have acute back pain, the goal of an exercise program is to help you resume normal activities as soon as possible and to remain symptom-free going forward. If you have chronic back pain, work with your physician to define your desired functional goal, whether it involves being able to take a tour of European museums, play with your grandchildren, or simply sit comfortably.

Any exercise program should be customized to meet your needs and introduced gradually. One golden rule about any exercise program is to stop if it becomes painful. Exercise is meant to help, not hurt. If you were exercising before an episode of back pain and then had to slow down or stop for a while because of the pain, don’t resume exercising at the same level as before the episode. Deconditioning occurs quickly; if you try to pick up your exercise routine where you left off, you might hurt your back again. Start by doing less (fewer minutes or repetitions) and gradually build back up to where you were before.

Weak back and abdominal muscles can cause or worsen low back pain. That’s why stretching and strengthening your back and abdominal muscles is important not only for treating low back pain, but also for helping to prevent a recurrence of the problem.

A stretching and strengthening regimen should target the back, abdominal, and buttock muscles. Strong abdominal or flexor muscles help maintain an upright posture, as do strong extensor muscles, which run the full length of the back. Strengthening the buttock muscles, which help support the back during walking, standing, and sitting, and the two iliopsoas muscles, which run from the lower spine to the hips, is good for the back. The muscles of the upper legs also need to be strong and flexible and strong because, when they are weak and tight, they can strain the supporting structures of the back.

Stretching is a valuable component of a treatment plan for anyone plagued by back problems. Supple, well-stretched muscles are less prone to injury, while less flexible muscles and connective tissues restrict joint mobility, which increases the likelihood of sprains and strains.

Stretch regularly but gently, without bouncing, as that can cause tissue injury. If you aren’t used to stretching, start by holding a stretch for a short time and gradually build up to roughly 30-second stretches over time.