A guide to managing acute lower back pain
Lower back pain is very common and approximately 80% of the population will experience an episode of lower back pain at some point during their life. Fortunately, most of us will make a full recovery within a few days or weeks.
In medical terms and related to back pain, ‘acute’ means the pain is less than 3 months old. Acute lower back pain is often caused by a muscular strain but the pain may also arise from other structures in your lower back. The symptoms you experience will vary and you may feel a burning sensation, a dull aching feeling, tingling or sharp pain. Depending on the cause of your lower back pain, you may also have pain in your hips, buttocks and legs.
The pain may be mild or so severe you find it very difficult to move. It can be very distressing but in most cases it is not due to a serious cause or damage. The spine is a strong, stable structure that is designed to support your body weight in different postures, lift heavy loads, bend and it is unlikely to be harmed by everyday activities.
Our guide below gives you the information you need to manage your acute lower back pain in the best way, which means you are more likely to make a full recovery and at a faster rate.
It is understandable that when you have back pain you may feel you want to rest or lay down to ease your pain but bed rest is no longer considered necessary and can actually slow down your recovery. Bed rest will cause your muscles to become weaker after 48 hours of inactivity and joint stiffness from lack of movement will increase your pain. We advise that you avoid staying in one position for more than 30 minutes during your waking hours, so move around little and often. However, we do recommend you rest from any strenuous activity such as lifting, heavy manual work and high intensity exercise initially.
Normalise and keep moving
It is important to keep moving and continue with your normal daily activities as much as your pain allows. This helps increase blood circulation, nerve recovery and ensures the muscles stay active. You are also giving your brain the message that it is safe to move and this helps 'turn down' the intensity of your pain. Research has shown that people who remain active are more likely to have a quicker recovery.
Use medication if you need it
Medication does not cure back pain but you may feel you need support to get your pain under control and to help get you moving in the short-term. Paracetamol, analgesics such as codeine and non-steroidal anti-inflammatory drugs such as ibuprofen can help relieve the pain. It is always recommended you seek advice from your Doctor or Pharmacist as to whether it is safe to take any medication, especially if you have any other medical condition.
Apply ice and heat
Try an ice pack (frozen vegetables will do) or heat (for example a hot water bottle) and use which ever one gives you most pain relief. You can always alternate between the two. We normally suggest applying these for 10 minutes and they can be used as many times as needed throughout the day and night. Please do not apply these directly to the skin.
Stay positive and take time to relax
Everyone will experience pain differently and this is influenced by what is going on in your life and how you are feeling in general. If you are feeling stressed, tired or low in mood your lower back pain will most probably feel worse. Also, research shows that negative feelings and worrying about your pain will slow down your recovery and put you at higher risk of developing persistent pain, so stay positive. Tell yourself your pain will get better with doing the right things.
Mindful breathing is a good way to relax. To do this sit or lay comfortably and focus all your attention on your breathing. Your eyes can be open or closed but you may find it easier to relax and maintain your focus with your eyes closed. Try not to control or judge it in any way, just let your body breathe naturally.
I often see patients that subconsciously hold their breath when trying to move to support and brace the lower back and prepare for pain. Be aware if you are doing this, as although you may find it helps to ease your symptoms when moving, it will reinforce any muscle spasm/ tension and tells your brain you need protecting, therefore slowing your recovery. Try breathing out (exhale) slowly when doing the most strenuous part of any movement, for example when going from sitting to standing breathe out.
Exercise has been shown to be the most helpful treatment for back pain. The exercises below are basic and not specific to any particular back issue but they will help get you moving. Please listen to your body and never push through pain but it is fine to go to the point of discomfort/ pain. If any of the exercises make your symptoms worse stop doing them.
Lay on your back with your knees bent and feet flat on the bed or floor. Keeping the knees together, slowly roll them to one side as far as possible to the point of discomfort/pain. It is best to breathe out as you do this. Hold for 3 - 5 seconds then return to the starting position whilst breathing in. Repeat to the other side. It doesn't matter if you are only able to move your knees a very small distance at first, this will improve. You may also find it is easier to go to one side compared to the other, which is normal. Repeat 10 times to either side, morning and evening.
Lay on your back with your knees bent and feet flat on the bed or floor. Tighten your stomach muscles (by pulling your belly button in towards the spine) whilst you lift your buttocks and tilt the pelvis back to flatten your lower back against the floor/ bed. It is best to do this whilst breathing out. Hold for 5 seconds and repeat 5 times, morning and evening.
Knee to chest
Lay on your back with your knees bent and feet flat on the bed or floor. Whilst breathing out slowly bring one knee up and pull it gently into your chest with your hands. Hold for 5 seconds whilst breathing in and then slowly lower the leg down whilst breathing out. Repeat 5 times on each side, morning and evening. You can progress to hugging both knees to the chest if you feel comfortable doing so.
Gluteal/ buttock contractions
The buttock muscles are called the gluteal muscles. There are three gluteal muscles which are strong and powerful and sit right below the lower back. They can offer a lot of support to the lower back especially when in pain. The issue is that pain can inhibit these muscles working properly so it can be helpful to consciously contract them whilst you have acute lower back pain. Start in sitting or lying and gently squeeze your buttock muscles whilst breathing out. Hold for 5 seconds and gently let go. If you can contract the gluteals without pain or discomfort then you can try this is standing or even when going from sitting to standing.
Get a good night sleep
Getting a good night sleep is important to enable the body's tissues to heal and reduce any inflammation. You may be finding it difficult to fall asleep and/ or stay asleep because of your pain and this will leave you feeling tired, which will most likely make your back pain feel worse. If pain is preventing you sleeping then speak to your GP.
Release your endorphins
Endorphins are 'feel good' hormones made naturally by your body. What many people don’t know is that endorphins help to block pain signals from registering in your brain. Endorphins also help alleviate stress, anxiety and depression, which are all factors that slow down your recovery, increase the risk of developing persistent pain and often make back pain feel worse.
To boost your endorphin levels, do an activity you enjoy that your pain will allow you to do, such as painting, meditation, calling a friend, walking in your garden or watching a comedy. Also, these activities will distract you from your pain.
When to seek medical attention
Most of the time your pain will ease within two to three weeks and completely resolve within six weeks. If your symptoms are severe and unchanged after one week it is recommended you see your Doctor or Physiotherapist. Please be reassured that 99% of acute lower back pain does not have a serious cause but if you are in doubt or things don’t feel right then see a medical professional.
This video offers guidance on when you should seek help for your back pain: https://www.macpweb.org/Resources/86f5045c-3423-4f29-b21c-492a5f77e265
To summarise the points in the video, the below symptoms are very rare but you should seek immediate medical attention if you experience any of them:
- Difficulty passing urine, loss of sensation when you pass urine or not knowing when your bladder is full or empty
- Loss of sensation or tingling between your inner thighs or genitals (saddle area)
- Numbness in and around your back passage or buttocks (altered feeling when wiping your bottom)
- Loss of sensation when passing a bowel movement
- Loss of bladder or bowel control
- Impaired sexual function or loss of sensation during intercourse
- Loss of power in your legs
- Pain that runs down the back of both legs
- Feeling unwell, such as a fever or significant sweating
- Have experienced unexplained or unintentional weight loss
How to prevent future episodes of lower back pain
Many scientific studies have confirmed the biggest risk factors for developing back pain are a sedentary lifestyle, being overweight and a general lack of movement. Our backs are designed to move, bend and lift heavy loads but if we are too inactive the muscles of the back become deconditioned and weak and then cannot cope with the demands of these activities, which is more likely to lead to pain or injury.
Research has proven that those who do regular exercise and are physically active get less back pain and recover faster if they do. Specific exercises such as 'core strengthening' will target the muscles in the lower back, abdomen and hips. However, studies have shown that there is no single exercise form that is better than another. We recommend you find something you enjoy doing and be consistent doing it.
So, stay active, stay mobile and stay pain free!
Arthritis Research UK (2014). Back Pain. www.arthrtisresearchuk.org
Bee, Peta (31st January 2020). How to cure back pain – what the experts say. The Times.
Chartered Society of Physiotherapy (2020). Back Pain exercises and advice.