Back pain flare-up: what to do in the first hours

When your back flares, check the warning signs first. If none apply, breathe out, move the way that feels easy, and keep a smaller version of your day going: get up and dressed, take a short walk, do what matters most at a slower pace. Heat can ease stiffness. Then, once it settles, write one line for the next time.

You bend for a sock and it catches. Within a minute you're standing very still, holding your breath, wondering whether to cancel the day. Tom Morrison knows the moment. In a 2022 video, How to deal with a back pain flare up, watched more than 116,000 times, Morrison walks through "the exact process that I used when I was recovering from my disc injuries" (0:32). Morrison sells an online mobility program, linked from the video. From 2:38 the video becomes a follow-along routine with set numbers of repetitions. This program doesn't ask you to do it; the parts used here come from the video's first two minutes.

Below: a routine for the first hours, a smaller day you can keep, and a plan for the mornings after.

Is it a flare, or something more?

1. Run the warning-sign check first

Serious causes of back pain are rare. The 1h Protocol to Manage Back Pain puts it this way: most flares pass, but a few signs mean more. If any start, get help:

Get medical help straight away

• Trouble peeing, or leaking pee or poo without meaning to
• Numbness around your genitals or bottom, or sex feeling different
• Both legs weak, numb or tingly, or you can't walk because of the pain
• Pain after a serious fall, accident or blow
• Chest pain or trouble breathing with it; or new pain far worse than before, or getting worse fast

See a doctor first

• A fever, or feeling hot, shivery or unwell
• Cancer in the past, or weight lost without trying
• Pain worse at night or unchanged by moving or resting; high between the shoulder blades; one leg weak or numb

If a new flare isn't getting better after a few weeks, keeps getting worse, or worries you, see a doctor. Your usual kind of flare doesn't count as "far worse than before"; something new, much worse, or quickly getting worse does. If you're pregnant, talk to your midwife or doctor about your back.

2. Call it a flare, and remember that loud isn't harm

Researchers needed a definition people with back pain would recognize. They started from what 130 people with back pain said, refined it with experts in a workshop and a two-round survey, then tested the wording with people with back pain. The result: "A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions" (Costa et al., 2019). Pain going up for a while isn't enough on its own; a flare is hard to settle and changes your day.

That definition has an end built into it. A flare lasts hours to weeks, and then it passes. And how loud it is doesn't tell you how serious it is. NHS inform says "the spine is strong and back problems are rarely due to any serious disease or damage" (NHS inform). Greg Lehman, a clinician in Toronto who also teaches continuing education courses for professionals, puts it another way in a free pain workbook: "even new pain does not regularly mean there is damage" (Lehman, 2017, p. 43). The Alarm is loud, but loud isn't the same as harm. For more on this, read does how much it hurts show how serious it is?

So the question in a flare isn't "how do I protect it?" It's "how do I keep a smaller day going until it passes?"

What to do in the first hours

3. Breathe out before you move

Morrison's first instruction is about breathing. When pain or hesitation hits, Morrison says, "you're going to go and breathe up into your chest and hold your breath and that makes everything much worse. So it's really important that you keep your breathing in check" (1:04 to 1:14). That's a coach's observation, not a study, but it matches public advice: NHS inform tells people with back pain not to "brace or hold yourself still" (NHS inform).

In practice: before you stand, roll over or reach for the kettle, let one long breath out and drop your shoulders. Then move on the out-breath, slowly, as far as feels easy. If you catch yourself holding your breath halfway, stop, breathe out, and carry on.

4. Move early, the way that feels easy

In Morrison's own recovery, the pain was usually worst first thing. "So moving first thing in the morning is actually the most beneficial thing to do and it's going to help set you up for the rest of the day" (0:40 to 0:46). That is one coach's experience of a personal recovery. The research points the same way in broader terms: "Do not wait for all the pain to be gone before you start moving," says Australia's national care standard (ACSQHC).

Easy movement is ordinary movement: getting up and dressed, a few minutes' walk, even to the corner and back. You don't need a routine or anything to buy.

5. Keep a smaller day, not a day in bed

The instinct is to cancel everything and lie down. The trials don't back it. In a Cochrane review, two trials with 401 people with new back pain found that advice to stay active did slightly better than advice to rest in bed, for pain and for getting on with the day; the differences were small (Dahm et al., 2010). In a Finnish trial of 186 employees with new back pain, those told to carry on as usual got back to work sooner than those told to rest in bed for two days. A week in, 20% of the first group were still off work, against 41% of the second; at two weeks, 2% against 19% (Malmivaara et al., 1995).

Short rests are fine. Long spells in bed can slow recovery, and the NHS's advice is to "stay active and try to continue with your daily activities" (NHS). So keep a smaller version of your day. Ease off a little, but don't stop. Pick two or three things you'd keep even on a bad day:

• getting up and dressed
• a short walk, even to the corner
• work, from a different chair or at a slower pace
• what others need from you, like the school run
• a slow shower

Four moves tend to make a flare worse, and each feels sensible at the time: lying down all day, bracing and holding your breath, checking your back all day and expecting the worst, and cancelling everything until your back becomes the day. You won't avoid all four. Pick the one you're most likely to fall into and plan the opposite. Bracing that outlasts the flare is its own trap, and overprotecting your back explains why.

6. Use heat if it helps

"Use a heat pack (or hot water bottle) wrapped in a tea towel to relieve joint stiffness or muscle spasms," says the NHS (NHS). Keep a towel between the heat and your skin. The evidence is modest. A 2006 Cochrane review of nine trials with 1,117 people found moderate evidence that heat wraps gave a small, short-term drop in pain and disability in back pain under three months old; four of the nine trials declared industry funding, three of them from the heat-wrap maker (French et al., 2006). Treat heat as comfort, not a cure: something that makes moving easier, not a reason to stay still with it.

What about the days after?

7. Mark each morning, and let the mark set the day

The next morning, the flare may still be there. Ask one question: is my back no worse than yesterday morning? A no doesn't mean you did it wrong. If it's no worse, add one thing back from your usual day. If it's worse, ease off a little more and keep the smaller day, and keep walking, even a few minutes. That rule is the program's starting point, not a tested one.

A flare may not ease in a straight line; you may have a better day, then a stiffer one. "You should see the biggest change in your symptoms within the first couple of weeks," says NHS inform (NHS inform). If it isn't getting better after a few weeks, see a doctor.

8. Hand over a little, and tell people in one sentence

In an online survey of 130 adults with back pain, people described flares as changing what they could do and how they felt, and a common theme was that others didn't understand (Tan et al., 2019). One sentence saves you explaining it every time. Here's one: "My back's flared. I'm keeping moving, just doing less for now."

For a day or two, hand over what you can: the heavy lifting, the shopping, the long drive. Stay at work if you can, changing how you work rather than whether. NHS inform's advice is that "you don't need to be pain and symptom-free to return to work."

9. Make the first bend an easy one

A few days later comes a small test: the first time you bend to pick something up. In a 2017 study of 44 adults with long-lasting back pain, a quick reaction test showed that, as a group, they linked round-back bending with danger, whether they reported much fear of bending or little (Caneiro et al., 2017). Morrison's video uses two checks, a toe touch and bending into a lifting position, and says both should feel "totally normal for you to do. And you shouldn't have any sort of hesitation or fear going on there" (2:12 to 2:24). So breathe out, stay loose, and bend only as far as feels easy. If you've ticked any warning sign, see a doctor before you build up what you lift; our guide to lifting with back pain covers the way back.

Back to the sock

The sock may catch again one day. What changes is the first minute: a breath out instead of a held one, a smaller day instead of a cancelled one, and a plan you wrote when your back was quiet. Write it now, in words that sound like you. The program suggests: "When my back goes, I'll breathe out, remind myself a flare passes, and keep a smaller version of my day going." Lehman's workbook puts the aim plainly: "We should not expect to always avoid flare-ups. Rather you can manage them and keep doing what is important" (p. 69).

For the bigger picture, read lower back pain; for more on resting, rest or move with back pain; and if your flares follow big jobs, back pain after a busy day.

To plan your own flare before it comes, try the 1h Protocol to Manage Back Pain, a wellness program of practical education. Its free first chapter starts with a quick check for warning signs, then finds your back-day pattern (one of four, or the Tune-up) and gives you one thing to do tomorrow. The full program takes about an hour. Two of its seven chapters are about flares: the first hours, a smaller day you can still keep and one line in your own words, then the days after, with what to hand over, what to tell people and how to build back from one step lower. You leave with your plan on one page, a flare card for your lock screen, and fourteen days to try it, with a sheet, reviews on days 7, 14 and 30, and four one-tap check-ins by email if you're signed in. Start free

Frequently asked questions

What should I do when my back goes?

Check the warning signs first. If none apply, breathe out, move the way that feels easy, and keep a smaller version of your day rather than going to bed. With new back pain, advice to stay active did slightly better than bed rest in a Cochrane review (Dahm et al., 2010).

How long does a back pain flare-up last?

Researchers define a flare as a worsening that lasts from hours to weeks (Costa et al., 2019). NHS inform says the biggest change usually comes in the first couple of weeks, and that in many cases a flare of a long-standing back problem begins to settle within six weeks. If a new flare isn't getting better after a few weeks, keeps getting worse, or worries you, see a doctor.

Should I use heat on a flare?

If it helps, yes, as comfort: a heat pack or hot water bottle wrapped in a towel can ease stiffness (NHS). In trials the effect was small and short-term (French et al., 2006), so use it to make moving easier, not as a reason to stay still.

Is it OK to move when my back has gone into spasm?

Public advice is to keep as active as you can and not to brace or hold yourself still. Start with small, easy movements on an out-breath, as far as feels easy. If you can't walk because of the pain, or both legs feel weak, numb or tingly, get medical help straight away.

When is a flare a reason to see a doctor?

Get medical help straight away for any sign in the first group of the check above, such as changes in your bladder or bowels. See a doctor first for any sign in the second, such as a fever or pain that is worse at night. And if a new flare isn't getting better after a few weeks, keeps getting worse, or worries you, see a doctor.

Sources

This article draws on Tom Morrison's video on dealing with a back pain flare-up, Greg Lehman's pain workbook, and the studies and guidance listed below.

• How to deal with a back pain flare up, with Tom Morrison (YouTube video, 2022)
• Greg Lehman, Recovery Strategies: Pain Guidebook (clinician's pain-science workbook, free PDF, 2017)
• Costa et al, A definition of "flare" in low back pain (consensus study with people with back pain and experts, 2019)
• Tan et al, Impact of flare-ups on the lives of individuals with low back pain (qualitative online survey, 130 adults, abstract only, 2019)
• NHS inform, Back problems (health information page, Scotland, 2026)
• NHS, Back pain (health information page, 2026)
• Australian Commission on Safety and Quality in Health Care, Low Back Pain Clinical Care Standard, information for consumers (national care standard, 2022)
• Dahm et al, Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica (Cochrane systematic review, 10 trials, 2010)
• Malmivaara et al, The treatment of acute low back pain: bed rest, exercises, or ordinary activity? (randomized trial, 186 employees in Helsinki, 1995)
• French et al, Superficial heat or cold for low back pain (Cochrane systematic review, 9 trials, 2006)
• Caneiro et al, Implicit evaluations and physiological threat responses in people with persistent low back pain and fear of bending (experimental study, 44 adults, 2017)