Acute lower back pain
Episodes of back pain happen to most of us. How we manage them is important for our quick recovery, return to normal activity and our long term outlook.
There is good scientific evidence on how we should deal with acute low back pain.
Back pain is extremely common and nothing to worry about. It may recur but this does not mean re-injury and there will usually be no permanent problems.
The level of pain you suffer is mostly not related to the level of internal “damage” or inflammation. The nervous system magnifies pain symptoms in the early stages as a protective mechanism.
Managing episodes of back pain successfully can make a difference to your abilities in the long term.
About 90% of normal back pain sufferers can return to work quite quickly and this should be seen as part of the rehabilitation process. If someone cannot get back to their work in 4 to 6 weeks the emphasis of rehabilitation needs altering to minimise time lost out of work and the likelihood of long term pain and disability.
What to do when you have an episode of back pain
- Do not rest unless you have to, and then 2 to 3 days maximum. Rest is not a treatment for low back pain and can lead to stiffness, weakness, loss of fitness, and disability.
- Keep as active as you can. Keep up normal activities by giving yourself small goals to keep to, eg to walk around for a few minutes every so often, sit for a certain time etc.
- Pace your activities - do normal daily activities but cut them up into small blocks of time that you can easily manage. Increase activities by fixed increments and stick to what you plan, not to how your back pain feels.
- Take adequate pain-killing medication. Medication should be taken in fixed doses at fixed times, and not when you feel like it or the pain gets too bad. Drugs used need to be discussed with your doctor or pharmacist.
- Recognise negative beliefs and deal with them. If it’s not your first episode, look upon the episode as a relapse, not a disaster.
- Most treatments are ineffective so don’t worry about arranging therapy, you are not missing out on possible improvement.
- Manipulation may be useful to provide short-term improvement in pain and abilities. As long as you choose a skilled therapist the risks of manipulation are very low.
- Use relaxation techniques, either from classes, books or tapes.
- Go back to work/normal activities as soon as possible. Don’t wait.
- Returning to work early does not increase the likelihood of re-injury or of damaging the painful area. By going back you can reduce the amount of time off and reduce the risks of getting a long term problem.
- Do not expect to be completely pain free before resuming normal activities.
- Join an exercise class under supervision of a therapist from three to five times a week. The most effective kind of exercise is not clear and just exercising regularly may be the key point.
- You should have returned to normal activities and work by six weeks after the start of your episode. If not you may need to join an exercise programme under supervision or at the gym to prevent long term problems.
References include: Clinical Guidelines for the the Management of Acute Low Back Pain. Royal College of General Practitioners (and other organisations). February 1999.