I hurt my back, how soon can I return to my normal activities?

DEAR DOCTOR K:

I hurt my back a few weeks ago. I’m feeling better now, but not 100 percent. How quickly should I return to normal activities? I don’t want to reinjure my back.

DEAR READER:

You’re wise to be cautious. After an episode of back pain, it’s essential to properly time your return to normal activities. Too rapid a return could lead to a relapse.

But — and this is an important “but” — too timid a return can delay, or even prevent, recovery. It used to be that doctors recommended immobility and bed rest for people with a sudden back injury that was causing a lot of pain. But studies in recent years have shown that getting mobilized actually leads to better outcomes. The trick is how to get mobilized, and at what pace.

If you are recovering from back pain, it’s best to ask your doctor detailed questions about what you can do and when. In the meantime, here are a few general principles for a safe and effective recovery:

  • Symptoms should be your guide. As a general rule, avoid doing anything that hurts. If you feel pain, stop the activity.
  • Increase activities gradually, based on what you can tolerate. For example, you might start by doing four or five repetitions of an abdominal exercise, three times a day. If this doesn’t worsen your pain, you can increase the number of repetitions every few days — and add new exercises — as tolerated. If the exercises increase your discomfort, cut back for a while. When you’re feeling a bit better, resume the exercises and gradually increase repetitions as you can.
  • Avoid twisting your trunk or making sudden off-balance movements. Try to rid your house of clutter that can trip you up. Slippery surfaces and throw rugs are notorious for causing falls. Lifting objects while your body is in an awkward position can also cause problems. When lifting heavy objects, remember to bend at the knees.
  • Exercise regularly. Even after the episode of pain has ended, regular exercise is really important in reducing the risk of recurrent back pain. Certain aerobic exercises are safer for your back than others. These include swimming, walking or cycling (either stationary or regular). Make these exercises a part of your regular exercise routine.

Add back-strengthening exercises to strengthen the muscles that support your spine. (I’ve put examples of some back-strengthening exercises, below.) Finally, add some stretching to your exercise routine. Supple, well-stretched muscles are less prone to injury.

Keep up these good habits even after your discomfort is gone. During an episode of low back pain, a person typically moves cautiously. You’re more likely to bend the knees when picking something up, and sit down and get up with care. Such back-saving maneuvers, along with a back-strengthening exercise program, should become lifelong habits to help reduce your risk of repeat back pain.

Your doctor can prescribe treatments to help you deal with an episode of back pain — pain-killing medicines and physical therapy of various sorts. But more important is what you can do for yourself.

Back-strengthening exercises

The exercises below can help you reduce flare-ups of routine muscle-related back pain. These are standard exercises that are often used in physical therapy. Show this sheet to your doctor and ask if these would be helpful for you. If so, perform each set of exercises every day after acute back pain subsides and your doctor says it’s safe. Take it slow, and stop if it hurts.

Week 1: Getting started

Perform these exercises every day in the first week of your exercise program.

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Starting with the knees bent, pull one knee to your chest and hold it in the stretched position for 5 to 10 seconds. Then return to the starting position and stretch the other leg. Do this with each leg 5 to 10 times.

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Starting with both knees bent and feet on the floor, pull both knees toward your chest and hold for 5 to 10 seconds. Do this 5 to 10 times.

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Starting with both knees bent and feet on the floor, gently flatten your lower back to the floor and hold for 5 to 10 seconds. Do this 5 to 10 times.

Week 2: Take it to the next level

If you do not feel any change in symptoms, such as worsening pain, add these three exercises every day starting the second week.

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Starting with both knees bent and feet on the floor, gently reach toward your knees. Lift your shoulders and head off the floor until your fingertips touch your knees. Hold the position for 5 to 10 seconds and relax slowly to the floor. Do this 5 to 10 times.

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Grasp the back of one leg behind the knee and pull it toward you, then very gently straighten the leg till it points vertically. You should feel the stretch in your hamstring. Hold 5 to 10 seconds and return to starting position. Do this 5 to 10 times with each leg.

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Lie on your back with your legs straight out. Bend your right knee and rotate your hip so that the lower leg is across your chest, pointing to the left. You should feel this stretch in your thigh. Hold for 5 to 10 seconds. Do this 5 times. Do the same with your left leg.

Week 3: Strengthening your core

If you are doing well on your new exercise regimen, add these core-strengthening moves in the third week.

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Lie face down on the floor, your bed, or an exercise mat. Bend your torso upward and rest the weight on your forearms. Gently arch your lower back and hold for 10 seconds. Repeat 5 to 10 times.

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Start on your hands and knees. Lift and straighten one leg, extending gently outward without lifting it above your body level. Hold the position for 5 seconds. Do this with each leg 5 to 10 times.

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Lie on your back with your knees bent and both feet flat on the floor. Gently raise your buttocks off the floor 4 to 6 inches, hold for 5 seconds, and return to the starting position. Do this 5 to 10 times.

Adapted from Sports Medicine Service, Massachusetts General Hospital.