This phase is normally the first 24-72 hours after the symptoms start and its aim is to settle any lower back pain whilst maintaining the range of motion and function you have. We will give you some basic lower back treatment options to show you how to relieve lower back pain.  

When performing the exercises it is OK for there to be a little discomfort or the sensation of stretching to occur. Any feeling of discomfort or dull pain should settle within 30 minutes of performing the movements, and over time the exercises will become easier. If you experience any sharp pain, attempt another exercise in the phase, and reattempt this movement at another time. Perhaps reducing the range you perform the movement or the amount of repetitions will help your symptoms. Remember the aim is to perform some mobility as this will help the lower back to return to its normal function.

Medication

In the initial phase the use of over the counter medication may be an option. Medications such as simple pain relief and anti-inflammatories may allow the condition to be more manageable.  Please consult your family doctor if you have any concerns with this impacting your current medication, or if any medical history may be impacted by the option of including this medication.

Wheat Bag

Depending on the level of discomfort in your lumbar and loss of range, you may find it helpful to use a wheat bag to ease any irritation and also help with any muscle spasm in the area. The heat generated from the wheat bag may help reduce any tightness in the muscles of the lumbar region which can go into spasm as they try to protect the area. Using the wheat bag two to three times during the day, especially applied before performing the mobility exercise may make things a little easier. Be careful the bag isn’t too hot and check your skin for any signs of a reaction.

Exercises

The focus of the exercises in this phase is to maintain the movement you have in your lumbar, whilst trying to ensure the muscles and joints surrounding the lower back remain as mobile as possible. These exercises are low intense lower back stretches that may act as a lower back pain reliever.  

With lower back pain it's quite common for the surrounding muscles and joints to tighten up which can result in further discomfort. You also may find that any reduction in movement has a knock on effect on your general torso and hip mobility, as you are generally less active.

We have included some basic torso and hip mobility exercises which will hopefully address this.    

Some things to consider with the exercises:

• The first exercise is a low level thoracic mobility exercise. During this movement you will also be moving your lower back to some degree, but because it is unloaded with small movements, it shouldn’t be too challenging. 
• The second exercise aims to apply a gentle stretch to the lower back muscles which may help ease any tightness, and hopefully improve the mobility of the area. Aim to do these in both directions increasing the range slowly over each set, and over the first few days. 
• How long and how often you do the exercises at this stage is not too important. The key is little and often, and as long as you get something done every couple of hours to maintain the range of movement that will be beneficial. 
• You may find it helpful to do these exercises in a circuit type fashion, where you start off with exercise 1, have a rest, complete exercise 2 followed by a rest, continue this pattern until you complete all the exercises, and then restart.

This phase we are looking at increasing the lumbar mobility exercises whilst still being mindful that certain movements could still be irritable, along with introducing a strength exercise to help maintain the strength in your back muscles.  This will be roughly the first 2-4 weeks of your rehab. Everyone wants to know how to cure lower back pain fast and in this phase you should notice a big improvement in your symptoms.

Education

When someone is suffering from lower back pain, it can be difficult not to irritate it with daily activities, such as picking items off the floor, simply standing up from a chair or they may have lower back pain walking. Try initially to avoid repeatedly performing movements or tasks which consistently aggravate your symptoms. As the lumbar pain settles down these irritations will become less frequent, but you may have to initially adapt how you perform certain tasks. There will be some activities which you cannot avoid and others which it takes you by surprise, don’t be too hard on yourself here as sometimes it is unavoidable. But where you can, try and reduce activities which will repeatedly cause you pain. It is not uncommon for someone to have pain when coughing or pain when sneezing, but this should settle over time. If you have lower back pain when standing, try and give yourself some breaks so that you don’t have to stand too long at any one time. 

As you improve the range of movement in your lumbar and the pain starts to settle, you should find that your general mobility improves throughout the day, and the activities which were causing you the most irritation will also settle. As you become less irritable with these movements you will be irritating the tissues surrounding your lumbar spine less, which will cause your symptoms to settle over time.

If the exercises make things worse you should stop doing them and make an appointment with your family doctor or physiotherapist to ensure you are doing the right exercises, as they could in fact be making things worse.  If you do not experience any increase in pain then you are OK to continue.

You also need to be aware if the pain changes by becoming constant or not reducing with medication or exercise, or perhaps you start noticing other symptoms which are not common with musculoskeletal injuries, such as a fever, unexplained weight loss or any changes in your bladder or bowel movements. If this occurs, this is when to see a doctor for lower back pain. 

Be aware as well if you have lower back pain radiating down your leg, or if you notice any pins and needles or numbness developing, as these are lower back pain and sciatica symptoms. If these symptoms resolve or settle with the back exercises this is a good sign and you should continue doing the movements. However if the exercises make things worse, or produce lower back pain and hip pain, you should stop doing them and make an appointment with your family doctor or physiotherapist to ensure you are doing the right exercises, as they could in fact be making things worse. This is generally the difference between lower back strain and a herniated disc. These symptoms are however different from low back to the right, or low back pain to the left of the torso, which is not uncommon and generally settles as you improve.

If you do not experience any pain down your legs, or altered sensations, then you are OK to continue. 

The aim for these first few weeks is to make sure we improve the movement in the lower back and remain as active as possible, you should find that as this improves your symptoms will settle. 

The timelines here are merely a guide and you may find you can progress from this phase before 2 weeks, but equally it may take longer than 4 weeks, and this will depend on the level of restriction and the amount of tissue damage caused. A good marker on when to progress to Phase 3 is when you can perform the exercises pain free.  

There will be some movements which you find easy and may even offer some relief in the discomfort you are experiencing, others may be more challenging. You may also find it helpful to offer some variety on the angle you perform these exercises as it may make things a little easier. The point here is there is no set way to perform mobility exercises, and no two days will be the same. Don’t get discouraged by this and just make sure that you get something done at least once a day. 

These movements shouldn’t cause any spike in pain, but a little bit of discomfort is expected as you move into the restricted range.

Exercises

The aim of these exercises is to offer some basic mobility to the lumbar without increasing your pain. Remember to start off easy and only increase the range after performing a few reps of each movement as a warm up. These are some of the best exercises for lower back pain, but not everybody will find them helpful straight away, and you may need to slowly build up to them. If you have lower back pain when sitting or lower back pain when driving, performing these lower back stretches during the day may help reduce your lower back pain. 

You can continue the thoracic and lower back mobility exercises from Phase 1 if you find these helpful. 

Some things to consider with the exercises:

• The side lying thoracic rotation is attempting the same thing as the thoracic exercise from Phase 1. This is simply making sure that the thoracic portion of your spine remains mobile. This exercise offers an easy way to maintain movement in your spine without putting it under too much pressure. Perform these in both directions.
• The second exercise is focusing on your lower back range of movement. This movement should help you with activities such as walking, and going from sitting to standing. Start off on low reps and then slowly build up. You may find this exercise is easier initially with a pillow or two under your hips. If so, perform this with the pillows to start with and then over time remove them, this will help you get an increased range of motion with the movement. 
• The third exercise ensures that the muscles on the back remain strong. When you find this exercise too easy you could progress onto a single leg.  
• The final exercise not only helps keep your hip joints mobile but will also create a low level stretch on your lower back muscles. If you notice low back pain into the hip, keeping them mobile and active can be beneficial. Slowly increase the amount you pull and only hold it at the top of the movement for a brief 1-2 seconds before releasing. You can do this on both sides.
• You may find it helpful to do these exercises in a circuit type fashion, where you start off with exercise 1, have a rest, complete exercise 2 followed by a rest, continue this pattern until you complete all the exercises, and then restart.

Acupuncture

Both Western and Chinese acupuncture is a popular treatment choice for lower back pain. Unfortunately it has poor evidence of its success, and should probably not be your first line of treatment. Acupuncture may be helpful in this stage to alleviate some muscular tightness you may be experiencing and there could also be a place for acupuncture should you be struggling with sleep as it has been shown to aid sleep later in the day after the session. However, lower back pain generally will not be improved by acupuncture alone, and the exercises will be best placed for this. The evidence for acupuncture as a chronic lower back pain treatment is also not very encouraging. 

Contacting your local Acupuncturist who is appropriately trained may help you here if progress is slow and it is something you wish to consider.

Strapping

Kinesiology strapping is very popular for many musculoskeletal injuries. The idea is that the tape helps support the muscles and tendons at the point of pain, and therefore causes less pain when doing exercises or general daily activities. The evidence for kinesiology strapping is mixed, and because of that some people find it’s really helpful whereas others find it doesn’t offer them much at all. 

If you feel you are struggling to progress, or you feel your rehab is a little stagnant, or that general daily activities are still irritable, then it may be helpful to try this. 

You can leave the tape on for up to 5-7 days but at any point if it feels hot and itchy take it off straight away. Have a day's rest of no tape before reapplying, and ideally test with a small strip before applying a big amount to you. 

This video shows a general strapping method which you may find helpful in offering some support to the lumbar muscles which may make daily activities and these new exercises less painful.

It’s likely that used alongside some of the other treatment methods it may offer some relief, but realistically on its own will not help completely alleviate your pain. 

Often people ask “Do lower back braces work?” and trying to understand what is the best lower back brace is difficult. Generally for the vast majority of lower back pain, a brace is not needed, but instead a gentle selection of exercises to help improve mobility and return to normal function.

Symptoms

During this phase your symptoms whilst resting should start to settle, it will not be as achy, and generally you will only find an increase in pain when performing movements which are restricted, perhaps bending over. You will also notice that general daily activities which were once limited, will slowly become a little easier. 

If you are struggling to progress through this phase, or if you have lower back pain during pregnancy, or notice lower back pain after sleeping, that might be when to see a doctor for lower back pain, this will ensure you are on the right path and if required and any additional lower back treatment can be offered. If you have had low back pain for months with no improvement and no exercise or treatment reduces your symptoms, again you should probably seek medical advice to ensure that there is nothing underlying cause for your pain.

If however your symptoms are reducing and function improving, you can continue with this programme and onwards onto Phase 3 when you are ready.

Pacing

At this stage you should find you can do more day-to-day activities pain free. The temptation here is to go a bit overboard. A nice reminder to pace activities so that you don’t over do it, and that you spread these activities out as much as possible throughout the day.

This phase will be roughly 4 weeks from the start of your rehab and its aim is to build on the increased range from Phase 2.

Education

A good marker on when to progress onto this phase is when the exercises from the previous phase are pain free. At this stage the pain in your lower back should have settled but it is not uncommon that certain movements could still be irritable. We will address any potential further loss of range or strength in this phase. 

The timelines on when to start this phase are only a guide, where some people can start before the 4 weeks but others may take a little longer. If you want to know how long does lower back pain last, the vast majority will have an improvement within 6-8 weeks from when their symptoms started. So in this phase you should start to see a big improvement in your lower back pain. As there are many lower back pain causes, this timeline can be shorter or longer, depending on the scenario. 

After a period of reduced activity due to the pain you have been experiencing, you would expect there to be a general loss in strength in your back muscles. We have included another strength exercise and you could continue the hip bridging exercise from the previous phase also if you find it helpful. 

When someone suffers from lower back pain it has been shown that the muscles in the back can become weaker. There is obviously a focus on mobility when someone has lower back pain, and with the exercises in this programme you should hopefully see this improve. However, we need to make sure that there are also some strengthening exercises alongside the mobility exercises, so that your back remains strong. 

The thoracic mobility exercises from Phase 1 and 2 may help act as a warm up before performing the new exercises. 

Exercises

In this phase we have increased the sets you complete for each exercise, along with progressively making certain movements more challenging. 

Some things to consider with the exercises:

• The first exercise is introducing flexion, or bending forwards, into the programme. This movement is often the most irritable for those suffering lower back pain so having some time for the lower back to settle down before reintroducing it can be helpful. Ease into the movement and build up the reps over the first few days. Once you can complete this pain free you can perform this movement in standing as it will be more challenging. This exercise will help improve mobility, reducing the chance of any low back pain after picking something up. 
• The second exercise is continued from the previous phase, however what we should aim to do is to make it a little harder. Hopefully by this stage you should have removed any pillows you may have been using underneath your hips, if not, try and wean off the pillows over the next few days. You may hopefully now be able to perform 10 repetitions of this movement with your arms completely locked out at the top of the movement. To get more range into the lumbar spine, at the top of the movement hold it briefly in this position and let out a big breath. This will cause your lower back to gently move into a bit further range of movement. 
• The final exercise is working on the lower back muscles as they will need to stabilise during the movement, along with moving the lumbar spine in a weight bearing and functional pattern.  If this exercise is too easy, you could hold some weight in front of to make it more challenging, using a dumbbell or simply holding a rucksack with some heavy items in. 
• You may find it helpful to do these exercises in a circuit type fashion, where you start off with exercise 1, have a rest, complete exercise 2 followed by a rest, continue this pattern until you complete all the exercises, and then restart.

Electrotherapy

It’s worth highlighting at this point the effectiveness of electrotherapy in improving lower back pain. Electrotherapy is a broad term to describe treatment methods which use some form of electricity to have an impact on an individual's pain. This could be ultrasound, laser therapy, magnetic field therapy or short-wave diathermy. The general principle with most electrotherapy is that they believe the treatment is heating up the tissues where it is applied, and it will in turn increase your rate of healing. They are generally rather expensive treatment options which have to be completed over multiple sessions. The evidence for these treatments is poor. They are a passive lower back pain treatment option in which you lay down and someone else does something, and over the decades multiple studies have shown that they are not effective. Some people still use them because they can charge for the treatment, and as an extremely frustrated person who is suffering from lower back pain, you may want to give anything a try. Be cautious of using these treatments as they are incredibly unlikely to be as effective compared to appropriate exercises and improving your knowledge on lower back injuries.

This phase would be roughly 8 weeks from the initial start of your rehab.

Education

This phase may not be appropriate for everyone and if you can perform all your daily activities pain free or you have no intention of returning to sport, you can stop at Phase 3. However after a period of reduced activity you would expect your general strength to be reduced and perhaps a restriction or apprehension performing some movement, so it may help with certain activities you are struggling with. If you previously had lower back pain after lifting weights, these exercises will help build the muscles surrounding the back.

If you intend to return to sport you should continue with these exercises. 

Similar to Phase 3 the timelines here are merely a guideline and may vary. You may find that you are able to start this phase before 8 weeks if the symptoms have settled and you aren’t challenged by the exercises in the previous phase.

You should continue the mobility exercises from Phases 2 and 3, with the aim to maintain full range of motion. However you would not necessarily need to do as many sets as you previously did, and you may not need to do all the mobility movements every day, you could potentially alternate which days you perform certain movements. 

The aim in this phase is to increase the strengthening exercises through range.

Exercises

You should continue the mobility exercises from Phase 3, and you can use the exercises from Phase 3 as a warm up before attempting these new exercises. 

The focus of these exercises is to further challenge the strength of your back muscles, and introduce more functional movements which will help with daily activity or a return to sport. 

Some points to consider with the exercises. 

• All the strength exercises should be performed in a slow and controlled manner. 
• The first exercise is challenging both the large and small muscles in your back. 
• The second exercise is a progression from the exercise we completed in phase 2, and will be working the muscles in your back and leg. As it is single leg it will be more challenging. If this is too difficult you can perform this movement on two legs to start with. 
• The third exercise is a progression from the sit to stand exercise in the previous phase. As you are doing this on one leg your trunk muscles will have to work harder to stabilise the movement.  
• The final exercise is not only working your leg muscles, but will also be working your trunk and back muscles in a dynamic and functional movement. To make this exercise more challenging you can perform this whilst holding onto some weight, but you should remain in good form and control throughout.
• These exercises should not cause a spike of pain, but you may find that there is a bit of discomfort for roughly 30 minutes after exercising, which is OK.

Return to Sport or Activity

Depending on your sport or activity of choice, you may want to perform some upper body weight bearing exercises such as a plank or press ups. It may also be suitable to do higher level dumbbell strengthening exercises to further increase your strength. 

As a general rule, try and aim for two pain-free training sessions at a reduced duration or intensity before increasing. If you are still getting lower back from running, it may be helpful repeating a few more days or weeks of the exercises in Phase 4 before returning to sport. 

For example, if you normally play 60 minutes of tennis, aim to play for 30 minutes in a non-competitive environment for two non-consecutive days. 

Having a day's rest between sessions allows you to have appropriate rest and for your body to repair and become stronger. 

Once you have found a duration or intensity you can tolerate with no flare up, aim to increase the next session by 10%. This can seem like a slow and conservative process however the research has shown this is the optimum level of increase to avoid an overuse injury. Increasing duration or intensity by more than 10% significantly increases your chance of injury, so only increase one or the other by this amount. As you will have been away from your sport for a number of months, you will have lost some of your fitness conditioning in this time and will need to build up slowly.

Over time you will be able to slowly return to your pre-injury level of activity without regressing back to any acute flare-up.