Acute Low Back pain? Early intervention can get you back to recovery quickly and safely.

Back pain can be extremely uncomfortable. Statistics show 80% of adults will show significant low back pain during their lifetime.  For some, this becomes recurrent and often worsens over time.  Due to the high levels of nociceptive input (pain sensory cells) in the posterior structures of the back and the proximity of the lower extremity nerve roots , acute low back pain can be extremely painful and  interfere with your ability to work and perform normal tasks at home.  Knowing what to do early on can be the difference between a quick recovery or prolonging healing and limiting activity.  This article offers some guidelines to help ease your discomfort and manage your symptoms at home.  The typical acute inflammatory phase can last a few days to 2 weeks.

General Guidelines:

Avoid any position or activity that caused the onset of your symptoms.

Limit Sitting! Sitting increases pressure on the lower section of the spine where low back problems often originate and increased pressure worsens inflammation, especially with discogenic pain. If you must sit, use a cushion or pillow to try and maintain the natural forward arch (lordosis) of your back. Interrupt your seated posture at regular intervals (every 15-30’) and get up and move around. Make sure you have a good chair, both feet are on the floor and your knees and hips are at a 90 degree angle.

Periodic unweighting helps: Upright postures and activity increases the vertical loading of the spine which is especially painful during the acute inflammation phase (up to 10-14 days). Lying down reduces loading and allows for space around the posterior joints of the back and the nerve roots. Positions can vary dependent on which structures are involved. Most common positions of comfort are Lying down with the knees bent and feet flat (hooklying) or lying on back with the legs in a 90/90 position supported on a chair (of proper height) or cushions (couch cushions work great). Alternatively, you can lie on your side in the “fetal position” with pillow support between your legs and the knees flexed up. Frequency is dependent on level of acuity. For some, you may need to do every 1-2 hrs for up to 15 min, especially if you are experiencing sciatic symptoms. For others, unloading after activity or at the end of the day is indicated.

Avoid lifting, bending or twisting! If you have to lift, try to do so as carefully as you can. Make sure to lift with your legs and avoid bending at your back. Keeping a neutral back and bending at the hips/legs is best. This is known as “hip hinging”. Get a wide base of support and keep the object as close to you as possible. Use symptoms as a guideline to what is ok and what you should avoid. Being mindful of twisting, especially with transitional activity is important.

Use ice the first 24-48 hours after the injury. Ice will help to decrease the swelling and inflammation that occurs with an acute injury.   Application 15 min every 1-2 hrs is indicated. After that time you can alternate between heat and ice. Start with heat for 10-20minutes, then ice for the same amount of time. This can be repeated as often as you like just remember to start with heat and end with ice. If ice is uncomfortable after the first 24-48 hours you can use heat alone.   Heat draws blood flow to an area which can help muscles relax and decrease pain. Analgesic creams (Biofreeze, Icy-hot, and Tiger Balm, etc) are great to use during the acute phase.

Early return to walking is a great indicator of a quick recovery. Try to go for short walks (15-20 minutes) a few times a day. This will increase circulation to your muscles and encourages normal mechanics throughout the spine. If walking increases your symptoms, find the threshold that you can walk without aggravating symptoms, or you may need to wait a few days.

Sleep in a position that is the most comfortable for you. Try on you back with a pillow under your knees. This puts your spine in a neutral position and decreases the stress on the ligaments and joints. Positions of sleeping are the same as the positions of unweighting.

Back pain can increase with coughing and sneezing. Using a small pillow in front of you to brace yourself will help with this. Do not bend over when you cough or sneeze.

Take a break from your normal exercise routine until symptoms resolve. Early on, avoid aerobic activities that increase compressive forces/impact on your back. Weight lifting is also contraindicated as this places increased strain on the muscles and joints in the lower back. As symptoms resolve ease back into the exercise as tolerated. Focus on early return of motion and less force.

Remember, these are general guidelines that offer some education on the early phase of managing an acute low back pain onset. If you are having progressive weakness in your legs or any difficulty controlling when you go to the bathroom, consult medical care immediately.  These are signs that something more serious is going on in your spine and symptoms should be addressed.

** If you are not improving, research also shows that early intervention (ie. Do not wait!) with your primary care provider and physical therapy treatment leads to quicker recovery, fewer missed days from work and reduces overall medical costs of prolonged (>6-12 wks) lower back pain.

The team at Alpine Physical Therapy specializes in the treatment of back and neck pain and can get you back to recovery and activity. Feel free to contact us if you have any further questions: 541-382-5500 or