A common misconception about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended. If you have no sign of a serious cause for your back pain (such as loss of bowel or bladder control, weakness, weight loss, or fever), then you should stay as active as possible. Here are some tips for how to handle back pain and activity early on:

• Stop normal physical activity only for the first few days. This helps calm your symptoms and reduce any swelling (inflammation) in the area of the pain.
• Apply heat or ice to the painful area. One good method is to use ice for the first 48 to 72 hours, then use heat after that.
• Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
• Sleep in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.
• Do NOT perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins.
• Avoid exercise in the days right after the pain begins. After 2 to 3 weeks, however, slowly begin to exercise again (it's helpful to get advice from a physical therapist). You can start getting back to regular activities after a few days.

EXERCISE AND YOUR BACK PAIN

Exercise is important for preventing future back pain. Through exercise you can:

• Improve your posture
• Strengthen your back and improve flexibility
• Lose weight
• Avoid falls

A complete exercise program should include aerobic activity (such as walking, swimming, or riding a stationary bicycle), as well as stretching and strength training. Always follow the instructions of your doctor or physical therapist.

Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help improve blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do them.

Avoid these exercises during recovery, unless your doctor or physical therapist say it is okay:

• Jogging
• Contact sports
• Racquet sports
• Golf
• Dancing
• Weight lifting
• Leg lifts when lying on your stomach
• Sit-ups with straight legs (rather than bent knees)

PREVENTING YOUR BACK PAIN FROM COMING BACK

To prevent back pain, it is also very important to learn to lift and bend properly. Follow these tips:

• If an object is too heavy or awkward, get help.
• Spread your feet apart to give you a wide base of support.
• Stand as close to the object you are lifting as possible.
• Bend at your knees, not at your waist.
• Tighten your stomach muscles as you lift the object or lower it down.
• Hold the object as close to your body as you can.
• Lift using your leg muscles.
• As you stand up with the object, DO NOT bend forward.
• DO NOT twist while you are bending for the object, lifting it up, or carrying it.

Other measures to prevent back pain include:

• Avoid standing for long periods of time. If you must stand for your work, try using a stool. Alternate resting each foot on it.
• DO NOT wear high heels. Use cushioned soles when walking.
• When sitting for work, especially if using a computer, make sure that your chair has a straight back with an adjustable seat and back, armrests, and a swivel seat.
• Use a stool under your feet while sitting so that your knees are higher than your hips.
• Place a small pillow or rolled towel behind your lower back while sitting or driving for long periods of time.
• If you drive long distance, stop and walk around every hour. Bring your seat as far forward as possible to avoid bending. Don't lift heavy objects just after a ride.
• Quit smoking.
• Lose weight.
• Do exercises to strengthen your abdominal muscles on a regular basis. This will strengthen your core to decrease the risk of further injuries.

Learn to relax. Try methods such as yoga, tai chi, or massage.

Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, van Mechelen W. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine. 2007;32:291-298.

Chou R, Qaseem, Snow V, Casey D, Cross JT Jr., Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.