• A muscle, tendon, or ligament getting overstretched or torn. Ligaments are tissues that connect bones to each other. Lifting something improperly can cause a back strain.

• Wear and tear (degeneration) of the spinal discs. Spinal disks are circular tissue that provide cushioning between the bones of the spine (vertebrae).

• Twisting motions, such as while playing sports or gardening.

• A hit to the back.

• Arthritis.

Managing pain, stiffness and swelling

• Take over-the-counter and prescription medicines only as instructed by your healthcare provider. Treatment may include medicines for pain and inflammation that are taken by mouth or applied to the skin, or muscle relaxants.

• Your healthcare provider may recommend applying ice during the first 24–48 hours after your pain starts. To do this:

  • Put ice in a plastic bag.

  • Place a towel between your skin and the bag.

  • Leave the ice on for 20 minutes, 2–3 times a day.

  • Remove the ice if your skin turns bright red. This is very important. If you cannot feel pain, heat, or cold, you have a greater risk of damage to the area.

• If directed, apply heat to the affected area as often as instructed by your healthcare provider. Use the heat source that your healthcare provider recommends, such as a moist heat pack or a heat pad.

  • Place a towel between your skin and the heat source.

  • Leave the heat on for 20–30 minutes.

  • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat or cold. You have a greater risk of getting burned.

Activity

• Do not stay in bed. Staying in bed for more than 1–2 days can delay your recovery.

• Sit up and stand up straight. Avoid leaning forward when you sit or hunching over when you stand.

  • If you work at a desk, sit close to it so you do not need to lean over. Keep your chin tucked in. Keep your neck drawn back, and keep your elbows bent at a 90-degree angle (right angle).

  • Sit high and close to the steering wheel when you drive. Add lower back (lumbar) support to your car seat, if needed.

• Take short walks on even surfaces as soon as you are able. Try to increase the length of time you walk each day.

• Do not sit, drive, or stand in one place for more than 30 minutes at a time. Sitting or standing for long periods of time can put stress on your back.

• Do not drive or use heavy machinery while taking prescription painkillers.

• Use proper lifting techniques. When you bend and lift, use positions that put less stress on your back:

  • Bend your knees.

  • Keep the load close to your body.

  • Avoid twisting.

• Exercise regularly as instructed by your healthcare provider. Exercising helps your back heal faster and helps prevent back injuries by keeping muscles strong and flexible.

• Work with a physiotherapist to make a safe exercise programme, as recommended by your healthcare provider. Do any exercises as instructed by your physiotherapist.

Lifestyle

• Maintain a healthy weight. Extra weight puts stress on your back and makes it difficult to have good posture.

• Avoid activities or situations that make you feel anxious or stressed. Stress and anxiety increase muscle tension and can make back pain worse. Learn ways to manage anxiety and stress, such as through exercise.

General instructions

• Sleep on a firm mattress in a comfortable position. Try lying on your side with your knees slightly bent. If you lie on your back, put a pillow under your knees.

• Keep your head and neck in a straight line with your spine (neutral position) when using electronic equipment like smartphones or pads. To do this:

  • Raise your smartphone or pad to look at it instead of bending your head or neck to look down.

  • Put the smartphone or pad at the level of your face while looking at the screen.

• Follow your treatment plan as instructed by your healthcare provider. This may include:

  • Cognitive or behavioural therapy.

  • Acupuncture or massage therapy.

  • Meditation or yoga.