This article was featured on HADO's website when the consulted with Damien on advice for low back pain.
To get some expert advice into the subject, we questioned Damien Kelly, Director and Physiotherapist at Physica Health about how 10 different everyday tasks can exasperate existing back pain, giving tips for those suffering about how they might be able to minimise their discomfort during these activities.
Sleeping in an awkward position can result in a restless, and sometimes painful, night’s sleep. Depending on a person’s type and location of low back pain, the optimal sleeping positions can vary, however there a couple of good rules to follow…
Generally, if a person sleeps best on their back, then using a pillow or 2 underneath their knees can help them maintain their natural curve of their lower back and reduce pain and discomfort.
The same can be said for side sleepers - however this time it would be advisable to pop 2 pillows underneath their top knee or else sleep with both knees bent and have a pillow in between them. This reduces rotation in their lower back while sleeping and offloads the lower spine and surrounding muscles.
There are no absolute “no-no’s” for sleeping positions – just listen to your body – if a position is uncomfortable or you find yourself sore waking up the next day then that position may not be for you.
2. Going to the toilet
Going to the toilet can exacerbate back pain. Sometimes bowel movements can be uncomfortable due to the position you have to hold for good defecation. The perfect position to open your bowels is sitting with your feet on a stool and leaning forward onto your knees with your elbows.
As you can imagine, it can be very difficult to comfortably hold this position if you are experiencing back pain. Some may experience difficulty in opening their bowels due to an increase in analgesia, if this is the case it is important to increase the amount of fibre and water in your diet or ask a pharmacist for a suitable laxative.
Another reason it may be difficult to open your bowels is that when we have back pain some of the aligned muscles can become quite tight, making it very difficult to relax our pelvic floor and bottom muscles in order to easily pass a stool. In extreme cases, some people experience a loss of bowel and bladder control along with their back pain. In these instances, it is very important to seek medical help quickly.
3. Bathing and showering
Hot water in general can have a soothing and relaxing effect on any muscles that are in spasm. However, it may be worth waiting until 24-48 hours after the onset of back pain as heat may exacerbate the inflammatory response if used too early after injury. After this time frame, both showers and baths can be useful.
The best advice would be to say if a sitting position in a bath is comfortable then this will be most beneficial for local muscle spasm and pain as you are immersed in the warm water allowing your muscles time to warm up and relax.
However, many low back pain sufferers particularly those with disc-related issues find these sitting or flexed positions painful. In this case showering is best, and the flow of water can be directed over the painful area.
4. Getting dressed
The most common feedback from patients in relation to getting dressed is that activities where they need to bend forward (creating flexion in their lower spine) tend to aggravate their back pain. This tends to be activities such as putting on socks and shoes, or the movement or straightening up again after these activities.
If this is the case, the main advice would be to take your time and select items of footwear and clothing that are very comfortable and easy to put on.
Some find driving very painful due to the position you have to remain in for a prolonged amount of time. We would recommend on long journeys to take regular breaks to ensure that you can get out of the car and move around.
Cars with bucket seats can be worse for back pain sufferers so trying to raise your chair out of a bucket position can be helpful – for example, using a seat pad. A lot of cars these days have a built-in lumbar support so ensure you use this feature to support the lower back, which in turn will help you position yourself in a good position. Try and have hips at 90 degrees to the back and not less, with the back support upright into a supported sitting position.
6. Sitting at a desk The best advice for sitting at a desk is to get up and move as often as possible! If you need to keep working then try and find a way to alternate between standing and sitting while continuing to work - this can be done by utilising a standing or height adjustable desk, or by moving to a countertop every now and then. If you do have to sit down for an extended time then try to ensure you have a good chair, with adequate lumbar support that keeps you relatively upright and close to your desk. Make sure your screen monitor is high enough that you can look straight ahead and that your keyboard and mouse are close to your body so you don’t have to reach forward to access them for long periods of time. If you want to find a more “active way of sitting” then some people find sitting on a Swiss ball for short periods quite useful – this allows some movement while sitting but also encourages activation of the local spinal stabilisers of the back.
Light Housework - Cooking and very light housework should be manageable with low level back pain. The priority is to avoid sustained flexion (bending forward) for long periods of this is a movement that aggravates your symptoms. Try to keep moving around and avoid being in any position for too long. If your symptoms are aggravated by standing for long periods which can be more associated with lumbar facet type back pain, then it may be more comfortable to do some of your chopping and food preparation in a seated position.
Heavy Housework - Heavy housework can be problematic for those suffering with back pain. Depending on the source of the back pain repeated bending and heavy lifting can increase your symptoms. Our recommendation would be to try and minimise heavier tasks and chores as best as possible for the short term.
If this isn't an option then to try and break down tasks to reduce the load – for example, instead of carrying the whole load of wet washing out to dry, break this down into stages. First of all, remove the washing by placing a chair at the washing machine and placing individually into a basket on the work surface above. From there then carry 2-3 pieces of clothing out to the washing line. This is a good example of reducing your bending and lifting.
Heavy vacuums can be very problematic so if your back pain is chronic it may be worth investing in a lighter hand-held vacuum to make the task easier.
8. Lounging on the sofa
Sitting or maintaining any one position for long periods can have you feeling stiff and sore – even lounging on the sofa. The best advice for anyone sitting on a sofa or at a desk for any long period of time is to get up and move at regular intervals. Whether this be to do a gentle mobility exercise for your back or just get up and walk around, your back will thank you for it!
When you are sitting, it can be helpful to avoid being too slouched, sit relatively upright (but not too rigid) and support your back’s natural curve with a cushion or pillow. It can also be helpful to support your feet with a futon or similar if you have access to one. As with all advice about low back pain- see what set up works best for you but above all, get up and move a little and often.
Typically, the most common aggravators of back pain within exercise tend to be those involving loaded flexion. These include weightlifting exercises, such as the squat and deadlift. While both are fantastic exercises for building strength in the general population, they would not be recommended for those experiencing back pain due to the loads placed on the lower vertebrae.
Over time, it is possible to return to some variations of this under guidance from a qualified health professional, but a good option is to select other effective leg exercises, such as the leg press or seated variations, where strength can be gained without placing too much load on the lower back.
General cardiovascular exercise can also be beneficial, but the type of exercise selected will depend on whether your back pain tends to occur more in a flexed position (often disc-related) or extended position (often facet-related).
For those who are comfortable to flex, then cycling and static bike can be good options, while walking, jogging and cross trainer machines can be useful for those comfortable into extension. Both groups can often find that getting into the water or swimming pool can provide some relief.
Try to include some gentle low back mobility exercises before and after exercise and most of all listen to your body during and after exercise. Did you feel comfortable during and after? Or did you wake up the next day with increased pain and stiffness. This will tell you if your back is happy to continue doing this type of exercise or if you need to back off or consider something else.
Studies have shown people with back pain have significantly less sex than those without. This is attributed to a number of reasons, such as loss of interest in sex, fear avoidance, low self-esteem, and pain. Sex positions can be adapted to be able to facilitate a better experience together. Depending on the type of back pain you are experiencing, you will want to adapt your sexual positions accordingly.
If your back pain is disc-related (or increases with bending) then positions that require you hold forward leaning postures may not be the best for you. If that is you then your back will feel best in a supported position, such as missionary. For further support it may be beneficial to put a pillow under your hips and under the knees will make you feel much more supported.
If your back pain is worse when arching backwards (or those with facet joint problems, arthritis, or stenosis of the spine), you may find it more beneficial to try the side-by-side spooning position.
If you experience any additional pain during intercourse then it is perhaps better to stop, try a different position, or try again at a later date. Pillows can help to adapt positions to make them more comfortable. Move with your hips and knees as opposed to overusing your back. Take pain relief where needed, seeking guidance from a health care professional. Most importantly communicate with your partner regarding any concerns or worries
You can find out more about our Physiotherapy team here