Employee guide to back pain

At the 2003 combined conference of the Australia and New Zealand Pain Societies, the work of the New Zealand Accident Rehabilitation, Compensation and Insurance Corporation (ACC) and the National Health Committee (NHC) in the management of Acute Low Back Pain was recognised.

The NZ ACC/NHC developed evidence based guidelines for the management of Acute Low Back Pain, these guidelines are updated regularly as new evidence is made available. Download the complete NZ Patient Guide to Low Back Pain.

Acute low back pain management

Acute (short-term) low back pain is very common. Back pain is a problem and being in pain affects every part of your life. Other problems seem larger when you are in pain. Back problems that do not go away can cause all sorts of problems - with your work, family and social life. It is important to stay in control of your pain from the start so that you do not end up with long-term problems.

The following information is based on the latest international scientific evidence. It outlines:

what advice and treatment you can expect when you go to a treatment provider (doctor, nurse, physiotherapist etc)
what you can do to help yourself. If you set goals and achieve them, you will be able to get back to your usual activities and return to work as soon as possible. This also helps to prevent further episodes of pain.

It is worth doing everything you can to get back to your normal activities as soon as possible.

Self help is the best medicine

If you have acute (short-term) low back pain, doctors can help you by advising you to stay as active as possible, prescribing medication if the pain makes it difficult to stay active and prescribing manipulation if you need it.

But the most important steps in dealing with low back pain are the things you do to help yourself. No-one else can do them for you. It is important to take the initiative and help yourself from the start.

At first you may be in a lot of pain, but remember pain can be controlled. Ask your treatment provider for pain control and if you are having difficulty doing your usual activities, ask what other support and assistance is available.

Bed rest for more than two days is not good for your back - this has been proven by scientific evidence.

Research also shows that it is important to stay active, but specific back exercises do not help you get better quicker. They can help you feel better and may help with pain control. Once you have recovered, being fit will help prevent another episode of back pain.

Most back pain gets better quickly

Fortunately, most back pain gets better quite quickly - often within a month - though it is not unusual to still have some niggles.

Keep active. You will need to build up your strength again gradually and steadily, but moving around and doing normal physical activities will not harm your back - not doing them will reduce your chances of recovery.
Set yourself goals to build up your fitness. Do no more on the good days and no less on the bad days.
Learn to relax. Your muscles get tight and tense if you are stressed.

'Live your life not your pain'

What to expect when you go to a treatment provider

When you got to a treatment provider (doctor, nurse, physiotherapist etc.), they will ask you questions about your back pain and examine you.

Red Flags - serious but rare

The first thing they will do is look for serious medical problems, like bone infections, fractures or cancer. These are called Red Flags and are very rare. If you have any of these signs, your treatment provider will refer you to a specialist.

Often when you have back pain the nerves in the back are irritated, which causes pain in other areas of your body. This is not usually serious unless you lose bowel or bladder control or feel numb in the groin. If you have those symptoms, you should contact your doctor urgently.

Yellow Flags - barriers to recovery

Sometimes there are other things going on in our lives, like problems at work or home, that make coping with pain harder. These are called Yellow Flags.

If you have any Yellow Flags, your treatment provider might refer you to a health professional with special skills in managing back pain. You might also need help to sort out other problems in your life. Ask your treatment provider to refer you to someone who can help you with these problems.

Here is a quick reference chart to guide your recovery.

Green Light - on the way to a full recovery

If your treatment provider finds no Red or Yellow Flags, you have the Green Light to get moving and can expect to be better, or nearly better, within a month. Everyone has a role to play is a quick reference to how you can stay in work or return early on modified activities if needed.

Ask for advice

If your treatment provider does not give you advice on how you can help yourself, then ask them. If they still do not give advice then ask yourself whether you need to seek advice from another health professional.

Check ups

Your treatment provider may recommend that you come back for a check up if your pain persists. At the check up, they will ask you about your back pain. They should also ask you how you are coping and what progress you are making returning to your usual activities. Talk to them about your goals.

If you are still in pain after one month, make an appointment yourself. At a one month check up you can expect your treatment provider to check you more thoroughly.They may recommend that you see a specialist or another health professional. You can still make a full recovery - it just may take a little longer.

Remind yourself, the Green Light means:

stay active
continue normal activities
stay positive
take medication if necessary
manipulation may help in the first month

Treatments that help you recover from back pain

Stay active

Expect your treatment provider to reassure you that you can not harm your back by using it. Doing light activities helps the repair process. Not using your back does more harm than good - it is not good for your back to go to bed for more than two days.

Your treatment provider should advise you to stay active and build up your strength gradually by doing as many of your normal activities as soon as you can. Your treatment provider can give you exercise advice.

You can help yourself stay active by:

temporarily modifying your usual activities
setting goals to resume activities and return to work
gradually and steadily increasing your activities

Medication and manipulation

Doctors can help you control the pain by prescribing medication. Controlling the pain helps make you more comfortable while you get back to your usual activities. In some cases your doctor may recommend manipulation by a trained person.

A number of other treatments are sometimes used for low back pain. These treatments may give relief for a short time, but none of them have been found to speed recovery or prevent the return of further back pain.

How to help yourself

Self help works best

If you take steps to help yourself right from the start, you will make a faster recovery.

Treatment providers can support and help you. They can recommend medication and treatments, but you need to keep active and stay positive.

You can take the initiative and stay in charge of your life. There are some things you can do to help yourself. Not everything will apply to you but most will.

Stay positive

It is easy to say and not always so easy to do. Remember- nearly all short-term acute low back pain goes away. Remind yourself of this often. Other peoples horror stories are mainly exceptions to the rule - ignore them.

Very few people have any serious disease and that is the first thing your doctor will check. Expect to get better. Expect to return to your usual activities in the near future. Stay active and keep moving. You can still do most daily activities if you have a positive attitude to them.

When you are in pain you may have some difficulty sleeping, eating and getting on with other people. You may lose motivation and be afraid of hurting yourself more. This may affect your home life, social life and work. Understand these problems and find a way to deal with them. Remember pain can be controlled and managed.

Talk about your pain

Most of us do not like other people feeling sorry for us, but we do like to be understood. Explain your problem to people, tell them what you are doing to help yourself and ask for help if you need it.

Face your fears

If the pain scares you, talk about it with your treatment provider. Living in fear of something will not help you. Become a coper with a positive attitude.

Deal with stress and learn to relax

Stress can increase the amount of pain you feel as your muscles remain tight and tense.

Sometimes other things in life cause us stress, such as work, relationships and money. It helps us to face these problems and do something about them. We can not always remove the causes of stress in our lives, but we can learn how to reduce their effects.

Do things that make you feel calm. Like go for a walk, listen to music or have a warm bath. Learn how to control your breathing and relax your muscles.

Be in control and set yourself goals

Chose to be in control of your back pain and make your own decisions. Stay in the driver's seat and say positive things to yourself.

Set your own goals. If other people set goals for you, you will not have the commitment to them.

It is OK to adjust your goals as you go along. The main thing is to keep making nsteady and gradual progess. You may have good days and bad days - that is normal.

Practical tips to help you continue yor usual activities

There are quite a few things you can do to help make yourself more comfortable while you are getting better. Try some of these:

think about how you are going to lift something before you lift it and know your own strength. Lift and carry close to your body. Use your feet when you turn your body, so that you do not twist your back.
wear comfortable shoes with low heels.
use an upright chair with good low back support. Avoid low or soft chairs. Try a lumbar roll or use a rolled up towel in the small of your back. This may help if you are driving a long distance.
if you have to sit for long periods try using a foot stool ofr resting your feet on the floor. Whenever possible get up and move every 20 to 30 minutes.
if you have to stand for long periods try putting one foot on a low stool.
make sure that your work suface is at a comfortable height.
if you have trouble sleeping, try using a firm mattress or put boards under the mattress. If you sleep on your back, try putting a pillow under your knees. If you sleep on your side, put as pillow between you knees.
gradually increase your fitness by walking, cycling or swimming for 20 to 30 minutes every day. Avoid sitting or lying down all day.

Returning to work

You may ned some time off work, but remember the sooner you get back to work, the sooner you will make a full recovery. The longer you stay off work, the greater the chance you will never return.

While you are off work, stay in touch with your employer and work mates. Let them know how you are getting on. Most people find that going to work for even a part of the day is worthwhile. it helps you keep up with what is going on, allows you to feel you are still a part of the place and lets others see your steady and gradual progress.

When you first return to work you may need some help for a while, especially if you have a heavy job. Making some simple changes at work may make the job easier and you may need to build up strength gradually over a week or two. Talk it over with your boss or supervisor.

Fill in the action plan and my return to work plan and discuss either or both with your treatment provider.

What if it happens again?

Many people have more than one episode of back pain, but that does not mean that it is serious. You have a better chance of having a healthy back, if once you have recovered, you get fit and stay fit. Being fit may stop you getting back pain again, although it may not make your pain less severe or help you recover more quickly.

Walking, swimming or cycling are good for you. Nearly everyone can do these forms of exercise and they are free or cost very little. Try doing exercise to music or with a friend.

The keys to making exercise a success are:

setting aside a little time every day
keeping going

If you get another episode of back pain, remember it will go away. It did last time. Use the same skills and methods again.

Remind yourself, the Green Light means:

stay active
continue normal activities
stay positive
take medication if necessary
manipulation may help in the first month

References

New Zealand Acute Low Back Pain Guide. Wellington, New Zealand. Accident rehabilitation & Compensation Insurance Corporation of New Zealand, and the National Health Committee, Ministry of Health. January 1997

Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss. Wellington, New Zealand. Accident rehabilitation & Compensation Insurance Corporation of New Zealand, and the National Health Committee, Ministry of Health. January 1997

The Back Book. The Stationary Office Ltd, St Crispins, Duke St, Norwich, U.K. September 1996.

Understanding Acute Low Back Problems. U.S. Department of Health and Human Services. AHCPR Publication No. 95-0644. December 1994.