Modifying activities and learning techniques to decrease stress on the back are important to resolving or controlling low back pain and sciatica. Since back pain tends to recur, lifestyle changes should become a way of life if you hope to avoid future episodes.
General Guidelines for Managing Low Back Pain and Sciatica
- Alter your activities
- Practice good posture
- Follow a home exercise program
- Lose weight if you are overweight
- If you smoke, quit
- Manage stress
- Modify your environment
Prolonged bed rest is usually not advised. Bed rest can weaken muscles and slow recovery. In most cases, your doctor will recommend that you continue your normal activities as much as is tolerated. Stay active within the limits of your pain and avoid activities that worsen the pain.
Guidelines for activity include:
- Avoid excessive, prolonged, or forceful bending or twisting of your back.
- Do not lift heavy objects. Learn the proper way to lift even light objects, using your knees rather than your back for leverage. If necessary, have a physical therapist or ergonomic specialist teach you proper body mechanics for daily activities.
- When lifting, squat down next to the object, hold the object close to your chest, maintain a straight back, and use your leg muscles to slowly rise.
- Plan ahead and ask for assistance with lifting or moving heavy objects.
- Avoid sitting for long periods. When you do sit, choose seats with good lumbar support. You may be able to use a standing desk at intervals to help avoid prolonged sitting.
- Avoid standing for long periods as well. If you need to stand, place a low footstool in front of you and alternate placing each foot on it for a period of time. This will take some of the load off your back.
- Consider job retraining if your work requires a lot of heavy lifting or sitting. Ask whether your company has someone who specializes in helping redesign the workplace for the restrictions an individual with back pain requires.
Poor posture and slouching can put more pressure on your lower back. Stand and sit straight, and avoid sitting up in bed.
Exercises to stretch and strengthen the back and stomach muscles should be done regularly. You may also want to include balance exercises that work the trunk muscles.
A low-impact aerobic program will further improve your physical fitness and help you maintain a healthy weight. Choose exercises that you enjoy and that you can do on a routine basis. Activities that are “back-friendly” include walking, swimming, or biking. Exercise also can help you manage stress. Check with your doctor before starting any exercise program. The 2008 USDA Physical Activity Guidelines Advisory Committee Report recommends at minimum two hours and 30 minutes a week of moderate aerobic activity, and strengthening exercises at least two days a week.
Maintenance of good weight is important for your overall health. While scientific evidence is inconclusive as to how much obesity contributes to back pain in general, extra pounds can increase pressure on the spinal muscles and disks. Follow the dietary and exercise plan recommended by your doctor. To lose weight you have to consume fewer calories than you expend. To maintain a healthy weight, eat an equal number of calories to those you expend. Even more exercise than minimum recommendations may be required to lose weight.
Smoking may contribute to degeneration of the discs in the spine. Also, smokers risk possible re-injury to the back during a coughing attack. Smoking can adversely affect healing if you are having a back surgery. To heal properly, you should quit smoking two weeks before a spine fusion and stay tobacco-free for six months afterwards.
Stress can increase muscle tension. Take time out to relax, exercise, and practice relaxation techniques. If you need support or assistance in reducing stress, you may want to try some of the following techniques:
- Cognitive behavioral therapy
- Stress management classes
- Relaxation techniques
- Breathing exercises
Certain changes to your workspace, attire, and home can reduce the stress on your back. Tips include:
- Don't wear high-heeled shoes.
- If you sit for long periods of time, use a stool to bring your knees above your hips.
- Avoid having objects (eg. a wallet) in your back pocket while sitting.
- Use a lumbar support pillow when sitting or driving.
- Sleep on a firm mattress.
- Don't sleep on your stomach.
- Sleep on your side or on your back with a wedge or pillow under the lower part of your legs.
- Some people find that an adjustable mattress is helpful because it allows them to change firmness depending on how their back feels on any given night. Others (generally those who sleep on their sides) find that firm foam mattresses are better for them than conventional mattresses. Finding the best mattress is individual—what works best for one patient may not be good for another.
While some people think that using shoe inserts will prevent back pain, so far there's not a lot of evidence to support this.
When to Contact Your Doctor
More serious symptoms associated with back pain that may require immediate medical attention include:
- Pain that doesn't subside, or worsens with rest
- Pain that is worse when you are reclining
- Pain that is severe or that has gotten dramatically worse
- Progressive weakness or numbness in a leg or foot
- Difficulty walking, standing, or moving
- Numbness in the genital or rectal area
- Loss of bowel or bladder control
- Burning or difficulty with urination
- Fever, unexplained weight loss, or other signs of illness
- If there has been any trauma, fall or impact
- If you have a history of cancer, back pain should be evaluated
- Reviewer: Rimas Lukas, MD
- Review Date: 09/2012 -
- Update Date: 09/27/2012 -