The seven mistakes to avoid when treating back pain (and what really works)

When back pain hits, the natural instinct – in line with old medical advice – is to stop moving. But spending days lying down could delay your recovery.

Research shows that staying active can lead to better pain relief and a quicker return to normal activities. A 2024 review by the World Federation of Neurosurgical Societies concluded that prolonged bed rest can result in joint stiffness, muscle wasting and loss of bone density.

When your back hurts, “your nervous system turns the protection up by tightening the muscles around the area,” says Mead. “The way you persuade it to stand down is by showing it, gently and repeatedly, that movement is safe.”

Ten minutes of walking twice a day is “a perfectly respectable place to start”, she says. “Most people find they can manage a bit more by the end of the week.”

The landmark WalkBack trial, led by Australian researchers and published in The Lancet, found that walking three times a week had a “profound impact” on people who had experienced lower back pain within the previous six months, almost halving the risk of recurrence.

Paracetamol alone is not recommended for back pain. The UK NHS specifically advises against using it as a standalone treatment, and a major review of evidence found that it was no better than placebo for acute low back pain, with no meaningful improvement in pain, disability, quality of life or sleep.

Dr Lianne Wood, an associate professor and spinal physiotherapy researcher at the University of Exeter, says anti-inflammatory painkillers such as ibuprofen are more useful for treating this type of pain. “They appear to have much more effect than paracetamol on acute back pain, particularly in the early stages,” she says.

And there may be some benefit in taking them alongside paracetamol. Research has found that combining paracetamol with a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen may cause a small additional reduction in immediate-term pain, compared with the NSAID alone.

NSAIDs should not be used long term without medical advice, as they can cause gastrointestinal, kidney and cardiovascular problems. Stronger opioids should only be considered for acute pain when an NSAID is not suitable, has not been tolerated or has not worked. They are highly addictive, however.

“People would rather take something for their pain, as opposed to doing something for their pain,” says Dr Wood. But the advice with any medication is to take the lowest effective dose for the shortest possible time.

The idea of giving your back added support with a brace or belt can feel reassuring, but while these may provide some short-term relief for some, experts generally discourage their long-term use.

“Belts and corsets tend to reduce your muscle activity,” says Dr Wood. “In the short term, it might make your back feel better because you’re reducing any muscle spasms. But in the long term, you’re becoming reliant on it, and very often people then don’t feel safe to move without it.”

This can potentially alter how the muscles work, with some becoming underactive and others overactive.

Mead recommends belts to patients on occasion, but says: “I’d treat one as scaffolding, with a plan to remove it once your muscles can take over.”

Corrective insoles for shoes are also not advised. “The evidence behind off-the-shelf posture-correcting insoles is thin,” says Mead.

In a recent review of 301 trials, spinal manipulation by a chiropractor, osteopath or physiotherapist was one of just six non-surgical treatments out of 56 that were found to have a significant effect on pain.

But Mead says that while this type of treatment can alleviate pain temporarily, it’s vital to try to work out what’s causing the pain.

“The place a body hurts and the place a body is struggling are often not the same – and often the lower back has just run out of capacity to compensate for a problem in another area of the body, such as a stiff hip, a foot that rolls inwards or a ribcage that won’t rotate,” she says. “I go looking for that first and treat the back second.”

The aim is to use hands-on treatment to help you move better, while addressing what is driving the pain.

Some people swear by transcutaneous electrical nerve stimulation (Tens) machines, which send mild electrical currents through the body, for pain relief. The signals are designed to travel down nerve pathways to block pain signals from reaching the spinal cord and brain, and to trigger the release of natural painkilling endorphins.

The scientific evidence for them is weak, and a systematic review for the World Health Organisation found they produced only brief, marginal reductions in pain.

Dr Wood says there may be a place for them, though. “Some people get good relief, particularly if they have a lot of muscle spasm or tension,” she says. “It can calm down the spasms and help the muscles relax.”

She says that if you find Tens beneficial, “it’s not going to do you any harm”. But it’s best to think of it as a tool to help you get back to moving more comfortably, rather than something that will fix the underlying issue.

The instinct to protect a painful back can be overwhelming, but research shows that this fear can negatively impact the way we move, potentially worsening the problem in the long term.

One review published in the journal Physical Therapy found that people with greater fear of movement tended to move their spines through a smaller range when bending. This isn’t what we want, says Dr Wood. “The key message for people with acute pain is try to keep living your life as you normally would,” she says.

Movement has several benefits, helping to release spasms and restore the back’s normal range of motion, keeping the joints healthy.

So, as long as it’s not causing serious or sharp pain, try to continue to bend down to tie your shoelaces or carry a bag of shopping. But if you’re struggling, Dr Wood advises modifying certain activities, bending more slowly, reducing the weight you’re carrying or breaking the task into smaller chunks.

Kate Rowe-Ham, a personal trainer and author of The Longevity Solution, suggests dialing down your exercise regime initially and gently building it back up. “If you have been lifting heavy weights, for instance, use your bodyweight instead,” she says.

“Focus on controlled movement and good technique.” And don’t assume every twinge means you’re causing damage. “Hurt does not always equal harm,” she says.

Once the initial wave of acute pain has eased, building strength can make your back more resilient.

“Working on the core, glutes and the muscles that support the spine will help you to recover fully, and also help prevent the problem recurring,” says Rowe-Ham.

She recommends the following simple, controlled exercises:

Dead bug

Lying on your back with your arms and legs raised, slowly lower the opposite arm and leg towards the floor, keeping your core engaged.

Bird dog

From all fours, extend one arm and the opposite leg, keeping your hips and shoulders steady.

Squats

Stand with your feet hip-width apart, bend your knees and push your hips back as if you’re sitting into a chair, then drive through your feet to stand.

Single-leg Romanian deadlifts

Stand on one leg, soften your knee and slowly hinge forward from the hips, extending the other leg behind you. Keep your back flat and hips level, then squeeze your glutes to return to standing.

The ‘happy baby’ stretch

Lie on your back, bring your knees towards your chest and hold the insides of your feet.