Managing the physical and mental effects of back pain

Are you sitting comfortably? In the context of back pain, and especially the past two years of, for many of us, more sedentary and home-based working, the word 'sitting' in this question is increasingly a problem.

Even back at the beginning of the pandemic, the charity Versus Arthritis was highlighting its concerns that the switch to home working could be storing up a whole load of musculoskeletal (in others words back and joint) problems for many of us.

Its survey, at the time, concluded that four out of five desk workers (81%) who had switched to working from home during the first lockdown had since had back, neck or shoulder pain, with a quarter (23%) affected often or all the time. Increased sitting, less exercise but also badly designed or cramped workstations were all taking their toll.

Of course, back pain is not solely caused by too much sitting and was a growing health and wellbeing concern even before the pandemic.

Back pain can be caused by lifting, carrying or twisting, degenerative conditions (including simply ageing) or injury, or even too much standing. In fact, back pain has long been estimated to be the most common disabling musculoskeletal condition in the UK, accounting for some 11% of total disability.

The bad news, as anyone who has ever had back pain will undoubtedly tell you, is that when you do have it, it can become all-consuming.

Back pain can affect not just your movement, mobility and ability to live, work and socialise, it - and the pain associated with it - can spill over into mental health problems if you're not careful as well, which we will come to shortly.

The good (or better) news is that whatever your job or role - whether you're in an office, working from home, working manually or on your feet all day in, say, a factory or shop - there is nowadays a lot you can do yourself to manage back pain when it occurs or prevent it in the first place.

However, we ought to stress that if you're concerned about your back pain, in severe pain or your back pain is not improving, please do seek out professional medical advice.

As the NHS makes clear, one of the big changes in recent years when it comes to managing back pain is the recognition that simply resting is not the answer and may in fact make things worse.

Rest can have a part to play (especially immediately following an injury) but for most back pain, especially lower back pain, the answer - counter-intuitively - is keeping active as much as you can and mobilising your back.

NHS England recommends the following four tips for relieving back pain:

The charity Backcare has good daily exercises you can do to enhance mobility and maintain strength in your back.

In line with our cautionary words, the NHS recommends, quite rightly, that you should see a GP or other medical professional if the pain does not start to improve within a few weeks, if it stops you from doing your day-to-day activities, if is very severe or gets worse over time, or if you're worried about the pain or struggling to cope.

A GP will be able to refer you on to more specialised support, such as physiotherapy or osteopathy or for an X-ray to see if there is an underlying issue or injury that needs addressing.

While back pain can be caused by a whole host of reasons, it is up to your employer to ensure that where you're working and what you're doing at work is not causing or contributing to back pain.

This can include things such as lifting, carrying, pushing or pulling heavy loads; doing repetitive manual tasks (such as stacking items); bending, crouching, stretching, twisting and reaching; having a poorly set-up workstation if you're working at a computer; or driving long distances.

Working to constant tight deadlines or in a demanding environment, where you may be more likely to rush or hunch or not take breaks, can also often cause or exacerbate musculoskeletal problems. The Health and Safety Executive has good guidance on this for employers to follow.

It may also be that your employer will be required - by law - to make 'reasonable' adjustments to accommodate your needs as an employee. For example, if you have a disability affecting your back, your employer may need to provide a more suitable desk chair.

WPA has a useful factsheet here, especially around maintaining and improving posture if you are doing a sedentary job, and the importance of moving about and taking breaks during the working day. Business in the Community also has a good general musculoskeletal health toolkit for employers here.

There is advice here from the NHS on how to sit at a desk properly, and why it is important not to spend too much time each day sitting down.

Finally, back pain is, clearly, a physical problem. Yet, as touched on earlier, it is also important to recognise how quickly it can spill over into being a mental or emotional health problem.

It stands to reason that if you're in pain and unable to do things that you love, whether that be hobbies, work, taking exercise or simply lifting up the kids, that's likely to affect your mood, your mental health and your emotional wellbeing.

If you are unable to work because of your back pain, or even if you’re just limited in what you can do at work, this can spill over into worries about job and financial security which, in turn, can affect sleep and mood and even spiral into depression and anxiety.

If your back pain becomes chronic (in other words long term), the mental impact of dealing with this can become severe. This discussion paper outlines very clearly the links between back and musculoskeletal pain and mental health. As an employee, it makes sense to recognise this and that, once again, the NHS may be able to help, initially via your GP. However, do also recognise that your employer may be able to make a difference here, too.

Access to counselling or cognitive behavioural therapy, perhaps via an employee assistance programme or other pathway, may help. Equally, an employer may be able to provide fast-track access to psychotherapy.

More generally, access to an employer-funded private GP or other medical specialist may be able to unblock NHS delays to accessing support (as may be case at the moment, given the pandemic pressures the NHS is working under).

On the physical side, an employer may be able to provide fast-track access to physiotherapy (virtual or face to face).

Ultimately, one way or another, the key message when it comes to managing back pain is that self-help and preventative approaches can go a long way towards protecting your long-term musculoskeletal health.

However, if things get too much, whether physically or mentally, don’t just suffer in silence - your employer, alongside the NHS, can often help.

Nic Paton is one of the country's foremost journalists on workplace health, safety and wellbeing, and is editor of Occupational Health & Wellbeing magazine. He also regularly writes on the health and employee benefits and health insurance markets.