By the time patients come to my clinic with back pain, they are clearly in agony.
I’m an osteopath – a specialist in the spine and movement – but you don’t need to be an expert to tell. You can see it in the guarded, stiff way that they hold themselves.
Back pain, particularly in the lower back, is one of the most common health problems – and it is the leading cause of disability in under-45s.
One-in-six Britons are affected and 84 per cent will suffer from back pain at some point.
And it can be debilitating. Sufferers go from being active to being afraid to do even the simplest of things almost overnight.
The causes are myriad. It might be a muscle strain or sciatica – when the lower-back nerves become compressed, leading to leg pain.
Or it could be a slipped disc – when the interior material from one of the spinal discs has been pushed outwards or prolapsed.
The sensation might be a dull ache or a shooting pain, which may feel worse when standing, bending, lifting or walking.
Whatever the case, it can affect your mental health and the ability to work – around 8 million sick days last year were caused by back pain alone and waiting lists for NHS treatment have risen 11 per cent in a year.
Around 8 million sick days last year were caused by back pain and waiting lists for NHS treatment have risen 11 per cent in a year
Little wonder that people in the throes of it describe feeling ‘broken’.
But as an osteopath with 14 years’ experience treating thousands of people – including professional athletes and celebrities such as BBC Radio DJ Nick Grimshaw and singer Rita Ora – I can tell you it doesn’t have to be like this.
Everyone has the power to end their back pain, and it might not be in the way you’d think.
There’s been a transformation in the way we deal with these issues, so everything that you thought you knew might be wrong.
I’ve had the honour of helping people go from being completely overwhelmed by their pain to being free of it.
With that in mind, this is my four-step plan to make 2025 the year you finally beat back pain…
WHY REST ISN’T REHAB AND EXERCISE IS KEY
FOR years, doctors told patients with back pain to rest and lie down, keeping their spines flat.
But that’s a thing of the past and, if you want to stop the pain, we now know it’s probably the worst thing you can do.
Regular movement cannot only reduce pain but help you recover faster.
A whopping 52 per cent of back pain sufferers say they experience relief via exercise.
It not only strengthens your spine and increases your flexibility but releases feelgood hormones called endorphins, which are a natural painkiller.
It will also increase the amount of oxygen-rich, nutrient-filled blood circulating into your muscles – repairing any injury. In contrast, a lack of movement can cause inflammation to build in the body leading to stiffness.
There is no ‘right’ exercise – ideally, it has to be enjoyable for you so you keep doing it.
Osteopath Anisha Joshi has 14 years’ experience treating thousands of people – including professional athletes and celebrities such as BBC Radio DJ Nick Grimshaw and singer Rita Ora
But swimming is a great non-weight-bearing activity which is effective in reducing pain and improving movement for those with chronic lower-back pain.
Yoga and pilates are also great for improving flexibility and strength. Even running – which many blame for their lower-back problems – can strengthen your core and support your back.
What counts as movement is broad. Just walking up and down the stairs, going for a stroll or dancing in the kitchen will help when battling back pain. It’s all about consistency. Start by doing just a few minutes a day. If you can’t manage a full squat, do a half squat. If you’re used to running 5km every day or lifting 20kg weights, scale it right back.
The reality is that you should expect it to hurt a bit, I’m afraid.
Don’t let that be your cue to stop. Lean into the pain.
The important thing to remember is discomfort doesn’t mean you’re making things worse.
Obviously, if moving in a certain way causes extreme pain, then don’t do that. See if you can find ways to move that are bearable.
Taking anti-inflammatories before exercising will also help.
REDUCE STRESS TO CUT THE PAIN DOWN
Whatever the cause, stress can make back pain worse.
Stress causes the release of the hormone cortisol, which in small doses is a powerful anti-inflammatory that can promote healing in injured tissue.
The problem comes when it’s released all the time, like a constantly leaking tap.
This increases inflammation and can cause pain in our joints and muscles. It’s like your body has a pain-alarm system which is overly sensitive.
Chronic stress doesn’t just exacerbate pain – it will lead to fatigue, depression and memory problems, none of which will help you to feel any better.
Mindfulness helps you to relax and focus on things other than the pain. Take a few minutes out of your day and concentrate on breathing in for a count of seven, then out again for seven
This feeds into a vicious, negative cycle regarding how you think about your back problems.
Many come to me and say they see their pain as inevitable because ‘bad backs run in the family’ or are certain they’ll have to quit their jobs.
This catastrophising is bad for any injury. It prolongs the release of cortisol and magnifies the pain. This cycle is difficult to break. Mindfulness is one approach, which helps you to relax and focus on things other than the pain. Take a few minutes out of your day, sit somewhere comfortable and concentrate on breathing in for a count of seven, then out again for seven.
Focus on your senses and what you can see, hear and smell. Taking deep breaths stimulates the vagus nerve, which will slow your heart rate and change the way your body perceives pain.
Reconnect with things that you enjoy – you’ll be amazed at what picking up an old instrument, listening to music or talking to an old friend can do to mitigate feelings of stress.
My top tips are to go for a five-minute walk, put on an upbeat song and dance or write ‘my body is fierce and strong’ ten times. I have found it has helped my patients to be much less fearful and, instead, more positive about their back pain.
BANISH HEAVILY PROCESSED FOODS
THEY’VE been linked to everything from dementia to cancer – and the key thing is that ultra-processed foods (UPFs) increase inflammation. If you are suffering from back pain, these could be making it worse.
Following a diet that restricts pro-inflammatory foods – which, along with UPFs, are anything made from refined carbohydrates such as white flour and rice, sugary food and fizzy drinks, alcohol and processed meat – can help to reduce back pain. Other food is said to possess some anti-inflammatory properties.
Oily fish such as salmon, mackerel and sardines are rich in omega-3 fats. This kind of fat can benefit those with inflammation-linked conditions, from rheumatoid arthritis to asthma.
Berries, leafy green vegetables such as kale and cabbage, nuts and the spice turmeric have similarly healthy properties. While the evidence isn’t conclusive, incorporating these foods into a balanced and varied diet may reduce inflammation and therefore pain.
Changing how you eat may also help in this situation.
Intermittent fasting can decrease the level of inflammatory markers – reducing pain. This means only eating within an eight-hour window every day and ‘fasting’ for the remaining 16 hours, or only consuming 500-600 calories for two non-consecutive days every week. This also increases the production of endorphins, which may again reduce pain.
If you don’t want to completely overhaul your diet, make small changes – even if it’s just choosing one processed food to cut out.
If you’re eating better you will feel better. You may lose weight – and that will also help to reduce the strength of your back pain. Being overweight puts pressure on the spine and joints – particularly the hips and knees. Obesity and weight gain also cause inflammation, thereby exacerbating chronic pain.
BACK PAIN MATTRESSES? IT’S JUST MARKETING HYPE
Patients with back pain often blame their mattress or pillow – while some have spent thousands on special bedding but it hasn’t helped their situation.
The truth is, it doesn’t matter. Claims mattress firms make that their products are better for your back are little more than marketing hype.
While studies show there are some sleep positions that can put more pressure on the back, they also show that the kind of mattress you have makes little difference and is unlikely to give you back pain.
It can be firm or soft, but the most important factor is that you find it comfortable. The act of sleeping and the fact sleep is vital to help heal the body is what counts most.
I appreciate if you’re in pain it can be hard to drop off – and there’s no magic wand I can wave to make it better. It’s a vicious cycle, because a lack of sleep has been linked to an increase in back issues and can lower your pain threshold.
But there are some basic sleep rules which might help to mitigate problems.
Ideally, avoid lying on the same side on which your pain is worst.
While studies show there are some sleep positions that can put more pressure on the back, they also show that the kind of mattress you have makes little difference
Try also using a pillow between your legs or underneath them if you’re on your back, or hugging one if you’re a front sleeper, for more support.
Just experiment to find exactly what makes you most comfortable in bed.
The usual advice for getting a good night’s sleep applies. Make sure your bedroom is cool, dark and quiet, turn off your mobile at least an hour before going to sleep, do some exercise during the day and hop in bed at the same time each night to regulate your body clock.
I also recommend a bedtime routine, which is a combination of gentle stretches, deep breathing, journalling and chanting. Many find it makes a difference to their back pain and hence to the overall quality of their sleep.
Sit on the edge of your bed, close your eyes and inhale deeply and slowly through your nose. Then hold for a moment and exhale through your mouth.
Repeat this routine for as long as you like.
Afterwards, perform some simple stretches – starting with a seated forward fold by extending your legs and reaching forward, and the ‘cat/cow’ stretch on all fours, arching your upper back and shoulders before releasing to push up your head and hips.
Dedicate a few minutes to chanting a calming phrase, such as ‘my body is strong’ or ‘my back is sore right now… but it will get better’.
Some patients look at me as though I’m mad when I suggest this during sessions. But chanting helps to break the cycle of negative thoughts and worrying, particularly in the run-up to your bedtime.
Take a few minutes before nodding off to write what is on your mind in a special notebook, including any fears you might have about falling asleep and your pain.
Then lie down, focus on your breath and relax.
- Heal Your Back: 4 Steps To A Pain-free Life, by Anisha Joshi (Penguin Books), is available from Waterstones, priced at £16.99.
