• Overdoing it
You are not in pain, so you run around getting all the jobs done that you haven’t been able to do because of previous back pain. Because you feel good, you keep going, happily ticking things off your list. As you carry on you feel increasing pain until you can’t keep it up and you have to rest. Unfortunately the pain is worse after your rest and worse still the next day, sometimes for two or three days. As the cycle continues, you have to rest for longer periods, putting you off doing the activity again. You lose fitness, and become frustrated and depressed.

• Underdoing it
You are in pain and only get relief when you rest. You have had to stop working as a result of your pain and now spend much of your time resting, unable to go out or to the gym as a result of your pain. Your family are supportive and do your shopping for you or run errands. You have become unfit and have put on weight but can’t do anything about it because of your pain. You may lose confidence, start to feel that you don’t have a role within the workplace or family, and may feel depressed and have difficulty sleeping.

Both of these are common ways that people try to manage their back pain. Unfortunately, neither is effective and in the long run the pain and disability increase. Learning how to pace yourself can be hard, but if you follow these four easy steps you will be able to use the pacing principle in all areas of your life.

Step 1: Measure your activity
You probably have very little idea how long it takes you to perform various tasks before you start to experience pain. To control your pain, you need to know how long you can continue with a task or activity before your pain will increase. The key to this is to time yourself and work out how many minutes it takes to bring on your pain.

Step 2: Set yourself a limit
To set yourself a limit, take the time you measured and take off 20%. This is your limit. For example, if your pain comes on after 10 minutes of ironing your limit is 8 minutes. You must not go over your limit: use a timer to make you stop.

Step 3: Stick to the limit
This is the hard bit – when the timer says stop, go and do something else or rest. How long for is for you to decide – it may vary from a few minutes if you have been ironing to a few days if you were gardening. The idea is to find your happy medium. It may be frustrating but I guarantee it will work.

Step 4: Increase your limit
Once you know your limit and you can stick to it and get the job done without increasing your pain, it is time to increase your limit. Decide before you start how much more time you will allow and only increase gradually. Jumping from 8 minutes of housework to 30 minutes is likely to be too much too soon – 15 minutes may be more realistic and keep you active and pain free.

In time you will see an increase in what you are able to do without pain. It often helps to keep a record, so that you can look back and see how far you have come.

Use pacing to increase:
• how long you can spend doing housework
• how long you can spend gardening
• how long you can stay at work when you first go back
• how many days a week you can work when you first go back
• how long you can exercise or how many exercises you can do
• how long you can drive before you need to get out and stretch.

Active rest
In the past it was thought that bed rest was the best thing for a bad back, but it is now known that this is not the case. Research over a number of years has shown that rest is not helpful for treating back pain, and may even be a factor in making pain and fitness worse. The more active you can be while respecting your pain the better. This is what is called ‘active rest’.

You may need a few days off work when your back pain is severe – but this does not mean you need to stay in bed. It is important to remain active around the house, get dressed, take short walks, have short rests and do exercises advised by your physiotherapist or featured in this book. Consider working part-time if your symptoms are severe: this allows you to stay at work while being realistic about needing time to allow pain to settle. GPs now issue ‘fit to work’ notes rather than sick notes, to inform employers about the importance of returning part-time and pacing an increase in activity, rather than encouraging people to be off work for extended periods.

Returning to work
The average amount of time taken off work for each episode of back pain is 19 days. The cost of this to business is huge, but this doesn’t take into account the emotional and personal cost to you. Taking responsibility for your back through simple, sensible precautions at work and at home can reduce the misery of back pain and how it impacts on your life. Long-term sickness is not appropriate for back pain. If necessary, seriously consider changing your job to allow you this flexibility. For further information check out these websites:

• www.betterbacks.hse.gov.uk
• www.backinaction.co.uk
• www.realhealth.org.