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Non-specific Low Back Pain

Approximately, 90% of Low Back Pain is ‘non-specific’. This means it is difficult to determine the exact pain-sensitive structure. Often pain is not related to tissue damage. It is associated with movement and activity. It can last several days to months. Sometimes this can settle and return at a later stage. Although it can be unsettling not knowing the exact cause, it should be reassuring to know that your LBP is manageable and unlikely due to serious illness.

Causes and symptoms

Often it is difficult to determine the exact structure which is injured. Pain will be experienced in the low back area between the bottom ribs to the top of the buttock. Risk factors for non-specific LBP include low physical activity levels, smoking, obesity and high physical stress at work.

Self-management

It is important to stay as active as possible as you can tolerate. This includes regular posture changes and continuing with normal daily activities as able.
You may consider a trial of over the counter non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen. Try and use as little as possible to allow you to function. If you have a complex medical history, they make you feel unwell or you find these ineffective- discuss medications with your GP.
Other considerations include: Optimising mental wellbeing. Stopping or reducing smoking. Maintaining a healthy body weight. Being engaged in social and work activities. Making ergonomic adjustments in the workspace.

Exercises

Discomfort with exercise is normal and you should try to work within a range of movement that is tolerable and allows you to breathe normally. Most types of exercise are good. Walking, swimming, cycling as well as classes such as yoga, pilates and general strength training are healthy for LBP and should be done to a tolerable level which you can gradually build from. Exercise should be frequent and consistent and the intensity can be built as your pain allows and your strength increases.

Try the following exercises as a starting point:

Mobility Exercises

Use these exercises to relieve flare-ups of pain and to increase your flexibility. They can be done regularly throughout the day, within the range of movement available to yo

Cat-Camel

Begin in four point kneeling on your hands and knees either on your bed or exercise mat. Try and spread your weight evenly between your hands and feet. Keep your knees and hands shoulder width apart. Spread your fingers. Round your back upwards whilst tucking your chin to look towards your legs. Hold for a moment. Now lower your back into an arched position with your bottom lifted. Allow your head to lift to look to the ceiling. Return to the starting position and repeat.

Go to the range of movement available to you and continue between these positions for approximately 1-2minutes.

If you have stiff or painful wrists try a towel under your palm or to make a fist on the floor.

Knee Rolls

Begin by lying on your back with your knees bent and feet together. Allow your knees to drop to one side in the range of movement available to you. Pause and repeat to the opposite side.

Continue for approximately 1-2minutes.

Side bends

Begin in standing (or sitting if required) with your arms by your side. Reach one arm overhead and allow your back to bend to the opposite side and your opposite hand to move towards the floor. Move back to the starting position and repeat to the opposite side.

Go to the range of movement available to you and continue between these positions for approximately 1-2minutes.

Seated Flexion

Begin seated (or standing if able) with your legs slightly spread apart. Keep your hands inside your legs. Allow your back to round, taking your hands towards the floor. Pause for a moment to allow a slow breath. Return to the starting position and repeat.

Go to the range of movement available to you and continue between these positions for approximately 1-2minutes.

Puppy Pose

Begin in four point kneeling on your hands and knees either on your bed or exercise mat. Take your arms further out in front. Keep your bottom up in the air above your knees. Allow your head and chest to sink towards the ground. Keep your arms straight or with a slight bend. Allow your back to arch and extend. Hold this stretch for 3 or more slow, relaxed breaths. Return to the starting position or gently move before repeating approximately 3 more times.

Alternatively, standing by a countertop with feet hip width apart and hands shoulder width apart on the counter. Push your hips backwards allowing your chest to sink towards the floor. Hold and repeat as above.

Cobra

Begin by lying face down. Keep hands at shoulder width apart. Use your arms to push your chest off the ground whilst keeping your hips down. Allow your back to arch. Try to keep your shoulders low, away from your ears. Pause for a breath and return to the starting position.

Go to the range of movement available to you and continue between these positions for approximately 1-2minutes.

Alternatively, in standing with feet hip width apart and hands on hips. Arch backwards letting your hips move forwards. Pause and repeat as above.

Core Strengthening Exercises (for active individuals)

Use these exercises to improve your strength. Some amount of core strength is required for the normal lifting involved in everyday life. Progress to these exercises once your discomfort has improved. Strengthening exercises require some recovery time, so begin with 2 sessions of these exercises per week and increase how many you do and how often slowly over time.

If any of these exercises are too difficult or painful, try the easier alternative or simply continue with the mobility exercises.

Bird-dog

Begin in four point kneeling on your hands and knees on a bed or exercise mat. Keep hands and knees shoulder width apart. Try to maintain the natural curves of the spine throughout the exercise. Try lifting one leg and the opposite arm. Push your heel away and contract your bottom muscles. Hold for 10secs. Return to the start position. Repeat 6 times on each side.

Alternately, just lift either your leg OR arm to begin. If your wrists are stiff, place a towel under your palms or make a fist with the supporting hand.

Alternatively, standing by a countertop, with feet hip width apart and hands on the countertop. As before, lift one leg back and opposite arm up. To progress difficulty, take your feet further away from the bench.

Modified Curl-Up

Begin by lying on your back on a bed or exercise mat. Keep one leg straight with your heel push away. Bend your opposite leg and keep this foot flat on the floor. Place your hands under the small of your back. Lift your head and the top of your shoulder blades off very slightly. Try to keep a fist distance between your chin and chest. Hold for 10secs. Return to the start position. Repeat 6 times on each side.

Side Plank

Begin by lying on your side with your body in a straight line from shoulder to ankle. Push up onto your elbow and forearm and outside of your foot. Keep your hips and outer thighs off the floor. Try and maintain your natural spinal curves and keep your shoulders and hips stacked on top of each other. Hold 10secs. Return to the start position. Repeat 6times on each side.

Alternatively, keep your knees bent to 90degrees. Use the outside of your knee to push up rather than your outer foot.

Functional Strengthening Exercises

Use these exercises to increase your functional ability and make daily tasks easier. Try to complete between 6-20 repetitions and 3-4 times (sets) of each exercise, in each session. These exercises may be more difficult and you may find you need some rest time (1-2mins) between sets to recover your breath. Stay consistent, try these 2-3 times per week. Remember to keep challenging yourself by increasing the difficulty or increasing the weight or number of repetitions, slowly over time.

If any of these exercises are too difficult or painful, try the easier alternative or simply continue with the mobility exercises.

Squat

Begin by standing with your feet hip width apart. Push your bottom out and bend your knees as if to sit in a chair. Keep your knees apart and your chest up. Keep your weight spread equally through your feet. Having your arms in front may give you better balance. Begin slowly and work to a depth that is comfortable for you.

If required, begin with a chair under you and sit and stand to the chair. Once you are able to complete more than 20repetitions with ease, add a small weight by holding it either to your chest or between your legs.

Forward Lunge

Begin by standing with your feet hip width apart and take a step forward. Allow both knees bend. Go to a depth that is comfortable for you. Keep your foot, knee and hip in a straight line. Push through your front foot and return to the starting position. Remember to switch feet.

If required, begin by using a support on either side. Once you are able to complete more than 20repetitions with ease (without any support), add a small weight by holding it by your sides (one side or both).

Deadlift

Begin by standing with your feet hip width apart, holding a light weight. Pull your shoulders back and down. Try to maintain the natural curves of your spine and brace your core (tummy) muscles. Bend forward by hinging at your hips rather than rounding your back. Keep the weight close to your body. Keep your knees slightly bent and your head up.

If required, begin by using a small box to place the weight onto.

Use a very light weight to begin allowing you to complete the exercise with ease over the initial sessions.

What’s next?

If your LBP has not improved with self-management you may need to be assessed further. You can self-refer to physiotherapy (LINK) or alternatively speak with your GP or first contact practitioner (FCP) physiotherapist in your GP practice.

If your back pain has lasted more than three months, it is worth considering the other factors which contribute to your pain experience by following the link to persistent pain.

In some instances further imaging such as XR and MRI may be indicated but often these findings can be misleading. Rarely is surgery or injections required for LBP.

It is important to seek immediate medical attention if you are having significant progression of symptoms.

When to seek urgent help