Stop the football and heavy weights – and try swimming, especially backstroke, experts say
If you’ve experienced the unbearable ache of lower back pain, you’re not alone. Around one in six adults experience it, according to Arthritis Research UK.
Exercise has been shown to be highly effective – but it can make things worse if you overdo it. We asked the experts for their tips.
Why do we get back pain?
“The back is a complex structure which does a lot of different things and there are numerous ways to trigger symptoms,” says Ian Gilham, a physiotherapist at Opus Biological.
Gilham sees many people who experience lower back pain from a lack of movement, whether it’s sitting too long in a car or train, or at a desk all day.
Cameron Harris, who has been a personal trainer for nearly two decades, has a similar view. “[Back pain] happens because people are weak and they’re not moving anymore,” he says. “I’m pretty sure cavemen didn’t get it because they were lifting stuff up and moving a lot.”
Dehydration raises the risk of back pain
“People that have got bad backs are often dehydrated. Some people I work with don’t drink anything,” says Harris. “They have a cup of tea as their water. Their muscles aren’t pliable or flexible; they’re not moving in the way you should. If you’re dehydrated, the chances of getting back problems and muscular problems in general are considerably higher.”
Check your weight
A recent study, published in the BMJ Open, by researchers at Turku University Hospital in Finland and the University of Turku, found that people with lower back issues often have excessive fat deposits within their back muscles, which can predispose them to pain.
Poor sleep doesn’t help either
If you’re chronically under-rested, the chance of injury is also higher, explains Harris. “There’s something called proprioception, which refers to your brain-body connection. When you’re fatigued, your brain understanding exactly all of your muscles all of the time, and sending them messages, is slightly off,” which makes people more injury-prone.
The best and worse exercises for back pain
Adults in the UK sit for an estimated nine to 10 hours a day, with some even longer, and this in itself can cause aches and pains. Here’s how movement can help offer some relief.
Walk, don’t run – and don’t obsess over your step count
A recent study by researchers at Macquarie University’s Spinal Pain Research Group, published in the Lancet, tested 700 Australian adults. Half were asked to start walking five days a week (most managed around 130 minutes a week), while the others did no extra activity. After three years, the regular walkers had fewer bouts of debilitating pain compared with the other group, and longer periods with a recurrence of back problems.
Aim for little and often, says Gilham. “You don’t need to walk for five hours,” he says. “Standing up and sitting back down. A short walk. Cycling to meetings or walking around the office. Even standing up to take a call before sitting back down so your position changes is important.”
If walks are impossible, changing position can help, says Ian Gilham (Photo: Opus Biological)
Don’t rush into too much vigorous movement to avoid further pain. “Walking is the effective middle ground because you can get all the benefits while the chance of injury is reduced,” explains Harris, who adds that the impact of running can cause problems for a lot of joints in general.
Try swimming, especially backstroke
“The good thing about swimming is the water takes your weight away, so you haven’t got that force through your back,” says Harris. “You’re also doing movements which add some rotation, core work, and you’re using your legs and arms”.
According to East Cornwall Osteopathy, some strokes may be more beneficial than others for lower back pain. “The back stroke can help to stretch out the muscles in your back and relieve tension,” they say, “[and] the breaststroke engages your core muscles, which can support your lower back.”
Strength training is great – but start slow
Harris thinks most people should be strength training. “It’s the most important thing because you lose muscle as you age. Strength training should be front and centre.”
For beginners, he recommends starting with bodyweight exercises. “Try a controlled squat. If you are at home, you can stand in front of the sofa and squat down onto it with the weight distribution on the back of the foot, not through the toes. Squeeze the glutes, stand up slowly, for a count of four, hold for a second, and then repeat 10 times.”
Then small weights can be added, but the best option (when bodyweight exercises are pain-free) is to head to a gym and get professional help.
“Deadlifting and squatting are two of the best exercises for building up strength in the lower back and the hips, but it has to be performed correctly,” Gilham explains.
Harris says: “If you don’t know what you’re doing, you may pick up a weight that’s too heavy, your feet could be in the wrong position, and the weight distribution in your toes could be wrong. Then it’s essentially a ticking time bomb. You’re going to make the pain worse.”
Don’t over-work your core muscles
A weak core is sometimes linked to back pain, but it’s not always the case. “Generally speaking, when people have a weak core, they’re weak everywhere,” says Harris. “Ultimately, you need a good balance between the muscles on the front and the muscles on the back.” Doing a lot of sit-ups or crunches could be counterproductive, as the weakness could be elsewhere or everywhere.
A plank could be a good place to start to build strength in the core and back. “Start on your [hands and] knees and slowly raise yourself up onto your shoulders. Work yourself up gradually, raise your glutes and squeeze tight at the top, pull your abs in tight.” Start with 30 seconds and build up to where is comfortable.
You may be getting too old for football
The worst sport for back pain is football, says Harris, because rotation and stopping forces are all a problem for the back. “You’ve got the change of direction and people running at you. Evasion sports, like rugby and football, where you have that real aggressive force, are all up there with the worst.”
Gilham adds that the scrumming involved in rugby has been known to cause spinal injuries and should, if possible, be avoided.
In the world of non-contact sport, he adds that bowlers in cricket are at high risk of back pain. Harris says golfers experience a similar thing with the rotation needed to swing clubs.
Pilates isn’t always going to help
Research by Daniel Belavy, associate professor at the Institute of Physical Activity and Nutrition at an Australian university, found that while Pilates can help some people with lower back pain, it’s not always superior to other types of exercise and depends on the individual.
Gilham says, “If someone gets back pain lying down, you’re not going to put them in a Pilates class. They’ll be better being up on their feet, whether that’s in a gym or walking in a pool. On the flip side, those that have difficulty completing movements on their feet would want to start with reformer or mat Pilates. Any exercise can be good if it’s for the right person.”
When to see a doctor
If back pain persists for a long time (over two weeks) or gets worse, it’s time to seek help. “There’s back pain, which is that residual low-aching and soreness, and then there’s the next step – the shooting pain that could be triggered by movement. When you see people in pain lying on their back, feet up on the sofa, that could be a nerve impingement or a tear. Then you need to speak to an expert – he says this can be a GP or physiotherapist.
“If you’re hydrated, you’re sleeping, you’re moving, and still getting back pain, something isn’t right. If you’re getting repeated back pain whilst ticking off all the basics, you need to see a physio and a good personal trainer.”
Gilham says general onset lower back pain should alleviate within a week or two, but the big red flags are any secondary symptoms that arise, such as nerve pain down the legs and issues with bladder and bowel control. That’s when you need medical help.
The main thing is to be proactive, not reactive, says Harris. “If you get to the point where you’ve got back pain because you haven’t been proactive and just left it, there’s a problem. I coached a 55-year-old guy who never worked out or looked after himself, and now he’s got a heart problem and is changing his habits. That’s reactive. Proactive would have been him starting out 10 years ago. Being proactive always trumps being reactive.”