My own experience of chronic lower back pain started around 2000.
At the time, the pain became so persistent that I ended up reducing my clinical workload and moving into a management role at The Wellington Hospital, where I was Physiotherapy Manager for Outpatients and Sports Injuries.
Over the three years I was there, my back became progressively more difficult to manage. At its worst, I had nine caudal epidural injections in three years - roughly three a year - simply to keep the pain under enough control for me to work and maintain some kind of active life.
It was pretty horrendous.
I went from physio to physio, but physiotherapy looked quite different then. Treatment was often much more machine- and hands-on-based, including things such as traction, and there was far less emphasis on progressive exercise and strength than there is today.
Then, around 2003, I met a physiotherapist who looked at my back very differently.
He worked with a lot of dancers and sportspeople and was heavily involved in Pilates. We used dynamic ultrasound to look at the way my abdominal muscles were functioning, and it became apparent that although I did have degenerative changes in my spine, there was another very important part of the picture:
I was weak.
That was the beginning of a completely different approach for me - Pilates, core control, strength, stability and flexibility.
And it wasn't a quick fix.
It probably took nine to twelve months before I really started to feel stronger and for those movements to become natural.
I still remember turning up desperate to get back to running 5K and being told that my first exercise was effectively:
“Sarah, you need to learn how to breathe.”
I thought it was ridiculous.
But I had become so protective of my back that I was holding everything rigid. I was barely allowing my lower ribs and abdomen to move and was breathing almost entirely into the top of my chest.
That lesson has stayed with me.
Years later, it has come full circle as we now have Phil Harris at Physio Remedies, a physiotherapist with a particular interest in breathing and breathwork. It has reinforced something I first discovered all those years ago: pain, movement, muscle tension and breathing can all influence one another.
The moment things really changed
Around 2006/7, I was invited to join a group of women taking part in a charity challenge - paddling a dragon boat across the Channel.
My immediate reaction was:
“There is absolutely no way my back is going to cope with this.”
But I had joined a team, I didn't want to let anyone down, and it forced me to commit.
Every Wednesday morning I would get up at around 5.30am, head down to Mortlake and train in a dragon boat or outrigger.
And, somewhat unexpectedly, this was probably the biggest turning point in my back journey.
I got strong.
Really strong.
And from that point onwards, my back became vastly easier to manage.
I wouldn't describe myself as completely pain-free. I don't think that is necessarily a realistic goal for me. There are days when I don't think about my back at all, and there are other days when I am very aware of it.
More recently, being diagnosed with inflammatory arthritis has also helped explain some of the symptoms I have experienced over the years.
But the biggest thing I have learned is this:
I manage my back rather than expecting somebody to “fix” it.
For many people with recurrent or chronic back pain, that is an important shift.
You learn what tends to aggravate it. You learn what you can adapt. You learn when to push and when to back off. Most importantly, you learn what keeps you strong, mobile and flexible.
Strength, stability and flexibility have become non-negotiable for me
About three years ago, I walked into a CrossFit gym near home and said to the coach:
“If you give me a kettlebell and tell me to start swinging it above my head, or make me do huge heavy lifts, I'm leaving.”
Fortunately, I found an experienced coach who understood exactly what I meant. Later, I also worked with another CrossFit coach who was an osteopath.
So I still go to CrossFit once or twice a week - but I train for my body, not somebody else's.
That distinction matters.
I have realised over the years that if I stop doing strength and stability work for too long, my back usually lets me know. The same applies if I become too stiff and stop maintaining my flexibility and mobility.
But none of this has to mean joining a gym.
A huge amount can be done at home with bodyweight exercises, resistance bands, mobility and flexibility work and a few free weights. I never use traditional gym machines myself.
The important thing is finding something sustainable enough that you actually keep doing it.
But what happens when your back suddenly flares up?
This is the part patients often ask me about.
What do you do when you wake up and can't sit upright in bed? When you're walking slightly bent forwards? When every step hurts?
Sometimes my flare-ups are simply central lower-back pain. Other times I can get severe nerve pain down my leg, and occasionally it can interfere with sleep.
This is where I talk to patients about finding their own “get-out-of-jail” strategy.
What helps you get through those first 24-48 hours and starts you moving again?
That strategy is different for everybody.
For some people, appropriate pain relief or anti-inflammatory medication may form part of the initial management, where it is safe and has been recommended for them. If pain is severe, unusual or not settling, it is important to speak to a GP or another appropriate healthcare professional.
But for me, doing absolutely nothing and staying in bed is rarely helpful.
I try to keep moving.
Initially that may mean very small movements and very gentle activation of muscles around the abdomen, hips and legs. I am deliberately not prescribing specific exercises here because there is no single exercise programme that is right for everybody with back pain.
And this brings me to something I stumbled across this summer.
My rather accidental discovery
I already use Compex muscle stimulation regularly in clinical practice, particularly following surgery when we are trying to encourage muscle activation.
Earlier this year I saw the Compex CoreBelt advertised.
My original reason for buying it was considerably less scientific.
I was going on holiday and, being brutally honest, I felt my abdominal muscles had become slightly soggier than I would have liked.
So I thought: why not?
The belt has electrodes positioned around both the abdominal and lower-back muscles, allowing them to be stimulated together.
I started using it alongside my usual core exercises - planks, side planks and other strengthening work - and I could feel myself getting stronger.
A session lasts around 20 minutes. The belt produces a muscle contraction followed by a rest period, and I perform my exercise during the contraction phase.
Then, after a period of travelling over the summer and doing far less training than usual, I woke up one morning with a significant back flare-up.
I couldn't sit up properly in bed.
Standing was possible, but every step hurt.
My immediate reaction was:
“Oh no. Here we go again.”
After taking the medication I already use and am prescribed for my inflammatory condition, I wondered what else I could do.
Then I remembered the CoreBelt.
As well as its muscle-strengthening programmes, the belt also has lower-back massage and relaxation settings.
So I put it on.
After around 20 minutes, I felt that my pain had eased.
That gave me an idea.
I switched to a muscle activation programme and tried some of my usual exercises.
What I had been able to do easily a few days earlier was suddenly far too painful, so I modified everything substantially.
But I could still move.
And as the 20-minute session went on, the exercises became easier and easier.
By the end, I was much closer to the plank and side-plank level I had been doing before the flare-up.
Subjectively, I felt dramatically better.
I still had some leg and nerve pain, but the acute back pain had reduced enough for me to move much more normally.
I took the remainder of the day relatively easily and did another massage/relaxation session later that afternoon.
One useful aspect of that setting is that I don't need to exercise while using it. I can wear the belt sitting at my desk or while moving around.
I repeated the process over the following two days and, in my case, I was back to my usual baseline.
My new “get-out-of-jail” tool
I certainly did not buy the belt expecting it to become part of the way I managed a back flare-up.
But it has.
I think of things like this as useful tools rather than miracle cures.
What surprised me was how helpful it felt during that particular flare-up, but that is very much my own experience rather than something I would assume will be the same for everyone.
And, like many people, once September arrived, work became busy, my daughter went back to school and my routines slipped. The belt ended up back in the cupboard.
I've now pulled it out again and restarted using it alongside my strength work - even when my back is feeling good.
That, for me, is probably the bigger lesson.
Don't wait until everything hurts before you look after yourself.
We now also have a CoreBelt available at Physio Remedies for patients to try, and we rent it out for £15 per week. That gives patients the opportunity to see whether they find it useful before deciding whether they want to buy one themselves.
What would I tell someone with chronic back pain?
After more than 25 years of managing my own back, my advice is not that everyone needs a CoreBelt.
Far from it.
Back pain is highly individual, and what works brilliantly for one person may do very little for somebody else.
My bigger message is to work out your own toolkit.
keeping strong
maintaining flexibility and mobility
continuing to move
modifying activity rather than stopping it completely
understanding the things that tend to trigger my symptoms
having a plan for flare-ups
using pain-relieving strategies when I need them
getting back to strengthening as soon as I reasonably can
And perhaps most importantly, I no longer expect my back never to hurt.
I expect to be able to manage it.
There is a very big difference.
A flare-up does not necessarily mean you are back to square one. With the right approach, it may be possible to shorten that period of pain, maintain movement and gradually return to normal activity.
For me, staying strong, mobile and flexible has been the single most important part of that journey.
And after all these years, I am still learning new tricks.
