Emergency and Urgent Care - Lower Back Pain Advice

Lower back problems are very common, with over 90% of the population experiencing at least one episode of back pain. Many patients can experience recurrent or ongoing episodes, but by keeping active it can reduce the frequency, duration and intensity of these painful episodes.

Lower back problems often start for no obvious reason. Your back problem may cause aching, hot, burning, shooting or stabbing pains in your back, and sometimes into one or both of your legs (sciatica). You may also get pins and needles (paraesthesia). The spine is one of the strongest parts of your body and is surrounded by strong ligaments and muscles which support and protect the spine. Back pain is rarely due to any serious disease or damage. Back problems should settle within 6 weeks of following the advice provided here.

Keeping active is very important when you have back pain. Resting for more than a couple of days is not advised; this is because the spine needs movement in order to start to get better. Doing an activity may actually increase pain at first, but an increase in pain is very unlikely to mean you are causing any harm.

You will NOT normally require an X-Ray or MRI scan.

DO’s and DON’Ts

• DO keep moving, even if slowly at first – this will prevent the joints in your spine becoming stiff, which could lead to more pain. Moving will keep your muscles strong and reduce the severity of your pain
• DO take painkillers – this will relieve your pain and keep you active
• DO keep living and working normally – this is important and the best way to get better
• DON’T worry if your back still hurts at work; consider doing light duties at first – you will need to speak to your manager about any work concerns you have
• DON’T sit down for too long, change positions regularly wherever you are
• DON’T rest in bed during the day
• DO stay active and remember to re-introduce activities like heavy lifting gradually
• DO exercise – this really helps your back and can relieve pain. Keeping active is the best thing you can do. It is safe to train and play sports

Pain relief

• Initially it may be helpful; to use a covered ice pack to ease your pain. NEVER apply ice directly onto your skin. DO NOT use for more than 15 minutes 3-4 times a day
• Alternatively, heat can be soothing, so a covered hot water bottle may be used, or you can buy heat patches from the supermarket. If using a hot water bottle DO NOT use for more than 15 minutes 3-4 times a day
• Painkillers may help to keep you moving, so sensible use of painkillers such as paracetamol and ibuprofen will help. However, if you are already taking medication for another health condition, it is advised that you check with your local pharmacist before taking painkillers. ALWAYS follow the instructions on the packet
• Occasionally, stronger painkillers such as codeine phosphate may be recommended. If you are taking these, you should drink plenty of fluids and eat foods high in fibre, such as fruit and vegetables, to avoid constipation
• Diazepam or similar drugs are occasionally prescribed for 1-2 days to relax the muscles in the lower back

Exercises

• Movement is the most important component to managing pain and is safe to do so
• Consider any general exercise such as walking, swimming, cycling, yoga or any activity you enjoy
• You can also try the exercises in this leaflet to get you started
• These exercises can be completed on the floor or your bed
• Remember to start exercising slowly and build up gradually

Knee rolling/back stretch

• Lie on your back with your knees bent and your feet flat on the floor/bed
• Try to put your hand behind your head
• Gently roll your knees to one side, keeping your feet on the floor/bed.
• Hold the stretch for 10 seconds
• Repeat 3 times on each side

Pelvic Tilt

• Lie on your back with your knees bent and your feet flat on the floor/bed
• Tighten your stomach muscles, flattening your back onto the floor/bed
• Then slowly release
• Repeat 5 times

Knees to chest 

• Lie on your back with your knees bent and your feet flat on the floor/bed
• Bring one knee up and pull it gently into your chest for 5 seconds
• Repeat 5 times on each side

Back extension

• Lying face down on the bed or floor with both hands under your shoulders
• Your elbows can be pointing either down to your toes or out to the side, whichever is more comfortable for you
• Straighten your arms so that your upper body lifts off the bed/ floor
• Keep the front of your hips on the bed/floor and your pelvis and legs relaxed
• You may find that you can only partially straighten your arms – this is fine
• Repeat 5 times

Comfortable positions

• Lie on your back with a pillow or two under your knees
• Lie on your side with a pillow between your knees

To get out of bed: roll onto your side, slide your legs off the bed, put your hand onto bed and push yourself up into a sitting position

What should I look out for?

If you experience any of the following in conjunction with your back pain, you need to speak to your doctor as soon as possible:

• Generally feeling unwell
• Back pain that starts when you have other problems, such as rheumatoid arthritis or cancer
• Numbness, pins and needles, or weakness in one or both legs that has not improved after 1 week
• Unsteadiness when you walk
• Your back problem has not improved within 6 weeks

Cauda Equina Syndrome

There is a rare, but serious back condition, Cauda Equina Syndrome, which can lead to permanent damage or disability if not attended too quickly. If you experience any of the following symptoms, then you must go to an Emergency Department as soon as possible.

• Loss of feeling/pins and needles between your inner thighs or genitals
• Numbness in or around your back passage or buttocks
• Altered feeling when using toilet paper to wipe yourself
• Increasing difficulty when trying to urinate
• Increasing difficulty when you try to stop or control your flow of urine
• Loss of sensation when you pass urine
• Leaking of urine or recent need to use pads
• No knowing when your bladder is either empty or full
• Inability to stop a bowel movement or leaking
• Loss of sensation when you pass a bowel motion
• Change in ability to achieve an erection or ejaculate
• Loss of sensation in genitals during sexual intercourse

Driving

It is important that you contact your insurance company to let them know about your injury. You may be able to drive once you are able to perform an emergency stop safely and fully operate your vehicle.

Physiotherapy

If your back symptoms are still interfering with your ability to do normal things after 6 weeks, this is the time to seek further professional advice from either your GP or NHS Physiotherapist.

If you live in the Heywood, Middleton and Rochdale area, you can refer yourself by using the following link:
www.physiodirect.northerncarealliance.nhs.uk

Further advice and guidance can be found on social media and the internet:

Versus Arthritis website: www.versusarthritis.org

Start Back: Targeted treatment for back pain

Exercises for the back | Versus Arthritis

Five ways to help manage back pain | Versus Arthritis

Back pain | Causes, exercises, treatments | Versus Arthritis

Work

If you do not feel capable of working either due to pain or reduced movement/mobility, you are able to self-certify sickness for the first 7 days.

You must complete a self-certification form found on the government website and give this to your employer. This entitles you to statutory sick pay from your employer for up to 7 days.

To access the self-certification form follow this link:
https://www.gov.uk/government/publications/statutory-sickpay- employees-statement-of-sickness-sc2

If you feel you need longer than 7 days off work, you must contact your GP for a sick note. The Urgent Treatment Centre does not issue sick notes.
 
For further advice or information please contact NHS 111 via telephone or on their website, or contact Rochdale Urgent Treatment Centre – 01706 517023.