It is one of the more frustrating things that happens.
You have been looking forward to a break for months, partly because you assumed a week away from work and a bit of rest would do your back good.
Instead it is worse. You are stiffer in the mornings than you are at home, something nags all day, and you spend the last few days managing it rather than enjoying yourself.
There are specific reasons for this, and once you know them most of it is manageable.
The assumption that causes the problem
A great many people go away expecting rest to help.
Rest is not usually what a painful back needs. Prolonged inactivity tends to make things stiffer and more sensitive, and for most back problems gentle regular movement does considerably more.
Which means the plan of lying by a pool for a week to let your back recover is frequently the opposite of what would help.
That does not mean you have to spend your holiday exercising. It means the thing you expected to help may not, and knowing that changes how you approach the week.
The bed
This is the single biggest factor and it is the one people have least control over.
You are sleeping on an unfamiliar mattress, with unfamiliar pillows, for seven nights.
Hotel mattresses are frequently softer or firmer than you are used to. Villa and apartment beds vary enormously. Airbeds and sofa beds are worse again. And a bed that is fine for one night may not be fine for five.
What helps.
Take your own pillow if you can. It is bulky and it is one of the more reliable ways to protect your neck and your sleep, and it helps your back more than people expect.
Experiment with position rather than persisting. A pillow between the knees when side lying, or under the knees when on your back, helps most people and costs nothing.
If the mattress is too soft and sagging, a folded blanket or towels under the sheet can firm up the worst of it.
If it is far too firm, a folded duvet or blanket on top takes the edge off.
And if the bed is genuinely unmanageable, ask. Hotels frequently have a firmer or softer option, or a board, and they are asked more often than you think.
The activity change
This goes in both directions, and both cause problems.
Some people suddenly do far more. Sightseeing involves walking considerably further than an ordinary day at home, frequently on hard surfaces, in unsuitable shoes, carrying a bag, for several days in a row. Somebody who walks fifteen minutes a day at home may do five or six miles a day on a city break.
Others suddenly do far less. Somebody who is normally on their feet all day spends a week sitting on a lounger, and their back stiffens from the inactivity.
Both are a change in loading, and backs tend to object to changes in loading.
The fix for both is the same. Something in between, spread across the day, rather than a dramatic swing in either direction.
If you are doing a lot of walking, build in sitting breaks before you need them rather than after.
If you are mostly sitting, get up and move regularly, and take a walk each day.
Loungers, beaches and sofas
The furniture on holiday is rarely designed for backs.
Sun loungers put most people into a slumped position for hours, which is a sustained flexed posture that a lot of backs dislike.
Sitting on sand with no back support is harder work than it looks.
Holiday sofas and apartment chairs are frequently too soft or too deep.
Nothing dramatic is needed. Use a rolled towel in the curve of your back on a lounger. Get up and walk every half hour or so. Swap position regularly. And do not spend the entire afternoon in the same chair reading, however appealing that sounds.
The things you only do on holiday
Worth naming, because they account for a good number of the backs we see in September.
Watersports. Paddleboarding, kayaking, water skiing, and the business of getting on and off boats.
Cycling, frequently on a hire bike that does not fit you.
Long hikes, particularly downhill.
Carrying children considerably more than usual, in and out of pools and around resorts.
Lifting and carrying beach equipment.
And sleeping on a sun bed in an awkward position.
None of those is a problem for a well conditioned back. Doing all of them in one week, having done none of them for a year, is where it goes wrong.
Build into it. Do the shorter version on day one.
What genuinely helps
Some things on holiday are actually good for backs.
Swimming, and simply being in water, which many people find considerably more comfortable than being on land.
Walking, in reasonable amounts and in decent footwear.
Warmth, which a lot of people with persistent back pain find helpful.
Sleeping more, if you manage it.
And being less stressed, which influences pain more than people expect.
So it is not all working against you. The trick is getting the balance right rather than swinging to an extreme.
Keep doing your exercises
This is the one that gets abandoned, every time.
People with an ongoing back problem who are doing a programme at home stop entirely for a fortnight, in precisely the week when their back is dealing with an unfamiliar bed and unusual activity.
It does not need to be the full programme. Five minutes of the key movements, most days, maintains what you have and makes a genuine difference to how the week goes.
Do them before you leave the room in the morning, which is the time most likely to actually happen.
What to pack
A short list.
Your own pillow, if you can manage it.
Whatever you take for pain relief, in adequate quantity, in your hand luggage.
Comfortable, supportive footwear for walking, rather than only flip flops.
A rolled towel or small cushion for lumbar support, or just plan to use one from the room.
And anything you normally use at home that helps.
If it flares while you are away
Keep moving, little and often, rather than taking to your bed.
Reduce rather than stop. A shorter walk, a quieter day.
Use heat if that helps you, which hotels can usually supply in some form.
Take whatever you normally would.
And remember that a flare settles. It is a bad few days rather than the end of the holiday, and treating it that way frequently shortens it.
Seek medical attention for
Go to A&E or the local emergency service immediately for numbness in the groin, genitals or inner thighs, new difficulty controlling your bladder or bowels, or weakness in both legs.
Seek prompt medical assessment for progressive weakness in a leg or foot, back pain with fever, severe unrelenting night pain, or back pain following a significant fall.
Before you travel, check your travel insurance covers any existing condition, and know how you would access care where you are going.
Get it sorted before the summer
The backs we see in September are frequently the ones that were already grumbling in June and were expected to improve with a rest.
At Ed Voss Physio, you will get a thorough assessment, a clear explanation of what is actually driving your symptoms, and a plan that means you spend your holiday enjoying it rather than managing it.
