Be the Boss of Back Pain

Oct 21, 2015

back pain








Pain, it can get in the way of your day, your work, your hobbies, it can be frustrating, depressing, emotional and stir feelings you never knew you had. Would you like to be more in control? Would you like to decide what and when to do something rather than your pain deciding? Then read on!

I have seen a number of patients recently who have had either their first ever episode of low back pain, or a recurrence of a longstanding, or chronic problem. My aim is to give you more insight into your pain, it’s behaviour, and how you can take control of it. In most cases, you can take ownership of the outcome.

Low back pain, spondylosis, lumbago, disc prolapse, hypermobility syndrome, degenerative low back pain, mechanical back pain, sciatica…. The ‘diagnoses’ can go on and on. Does it help you to have a label? Yes and no!

A diagnosis may help alleviate worry or fear that something serious or sinister is going on, but in 97% of cases, an x-ray or mri will not change how your symptoms will be managed.

Approximately 1% of adults presenting with low back pain, with or without leg symptoms, will go on to have surgical intervention – as a physiotherapist, when we see you for your first appointment, we ask a lot of questions. We want to know about how your pain started, how it behaves, and we want to know what aggravates it, what eases it. We also, significantly, ask about your bladder, your bowel, your sensation when passing urine, your balance, your saddle sensation (the area around your perineum and inner thighs). We will ask you about your medical history, your sleep patterns, any medication you are taking, and how your day to day function is affected, if at all. The reason we do this, is not to alarm you, it is to help us build a picture, before we examine you, of what actions we need to take. It is our job to work out if you are in the 1%, if we need to send you to A & E, if we need to send you to your gp with a letter of recommendation, or if we need to send you for a scan/ xray/ blood tests/ or referral to a consultant. In the majority of cases, nothing of any major concern, or need to refer you is established. But you are naturally concerned, and patients are often worried regarding their diagnosis and outcome – pain makes us think differently doesn’t it?

We will examine you, look at how you move, what happens when you move, and how you react. The whole assessment gives us an indication, of your pain mechanism, amongst other things, which will help us, help you.

lumbar ppivm






Generally speaking, for most of us, if we understand our pain, any pain, then it gives us a huge advantage, and an opportunity to change it. There can be confusion, fear, anger even, towards pain, all of which can, and will increase the pain. Pain is certainly complex, but let’s look at acute and chronic pain.

Acute pain is sudden, severe and indicates to the body that potential damage may be caused ( think of stubbing your toe or going over on your ankle) – initially the body will try to protect itself, such as limping, or moving in a certain way. This is normal and helps the body to heal inflamed tissues. Acute pain can take up to 3 months to settle.

If you are still limping 6 months down the line, this is not normal, and your pain has become chronic, or persistent. Chronic does not mean more severe, or more damage is being caused, but refers to the timescale of events.

You feel pain because the nerve signals send messages up our spinal cord to the brain. It is here where we have a choice. Our brain, we, can decide to turn the volume up or down ( more technically it is an area of the brain,  that modulates pain, where it can be ‘ramped’ up or down. )

There are many influencing factors to your pain

  • How worried or scared you were at the time of injury
  • What you believe has happened to you
  • How long you avoided normal activities for
  • Your family history

If we understand our pain, it allows us to move, we feel more confident, more in control, we do our normal day to day activities, our pain reduces. I’m sure you are familiar with the vicious cycle – we don’t move because we’re sore, our muscles get weaker, we stiffen up, our mood lowers, the pain increases.

There is no ‘quick fix’ for chronic pain, but as physiotherapists, we see people in pain every day – the quicker we can ‘turn the volume down’ and more importantly teach you, the quicker you will be able to get on with living your life. BUT you are the one who has to take ownership of it – not me, not your gp, not your spouse, YOU.

Let’s talk a little bit more about how you can turn the volume down on your pain. Remember, chronic pain is not damage or injury, it’s the signals going to our brain have become over sensitive.

We need to try and manage life stresses, get moving, make plans, sleep well, get fitter, stronger. Going swimming once next week won’t suddenly resolve your symptoms, but ‘chipping away’ will start to release endorphins, the feel good chemicals. Generally, these little changes will lead to a more balanced life, and less pain.







I’m sure you’ll have some questions, these are the most commonly asked questions.

1. Should I take painkillers?

This is a personal choice, but I generally advise painkillers if you can’t sleep because of your pain, or you can’t function. Don’t take painkillers to mask your symptoms, or to do something that will slow your recovery. Use pain relief as a ‘window’ to start doing a bit more. Your GP or pharmacist can give you more guidance on what you can take, as different medications are best for inflammatory, mechanical or nerve pain.

2.  Should I rest or exercise?

If your pain levels are high, I say ‘active rest’- which may sound like a contradiction, but it basically means, rest a bit, potter a bit, rest, potter.. as you begin to move a little more, you can think about doing some more exercise, something you will enjoy. This could be simply taking the dog for a walk, going swimming, doing pilates. Some of these decisions will depend on how active you were before you had pain – we can advise you if you’re not sure. But, I would say, do something you enjoy, that will really help.

3.  When should I see my GP?

If your back pain is severe, over the counter medications aren’t helping, your GP can prescribe something for you. If you suddenly have problems passing urine or are unable to open your bowels, or you have no sensation passing water, you need to see a doctor urgently. If your back pain has persisted longer than 6 weeks, your GP can refer you to see a physiotherapist on the NHS, or you can make the choice to see a physiotherapist privately.

4.  How can I book an appointment with you?If you’d like more information about what we do, and how we may be able to help you take control of your pain, contact us on, give us a call on 07983643835 or see

Vicky Smith

Thank you for taking the time to read this blog, I hope you’ve found it helpful, and I wish you well on your journey to becoming pain free. Do let me know if you’d like to know more about how you can manage your symptoms.