Low back pain – acute : Treatment

Treatment

To get better quickly, take the right steps when you first get pain.

Here are some tips for how to handle pain early on:

  • Stop normal physical activity for the first few days. This helps calm your symptoms and reduce inflammation.
  • Apply heat or ice to the painful area. Try ice for the first 48-72 hours, then use heat.
  • Take over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol).
  • While sleeping, try lying in a curled-up, fetal position with a pillow between your legs. If you usually sleep on your back, place a pillow or rolled towel under your knees to relieve pressure.

A common misbelief about back pain is that you need to rest and avoid activity for a long time. In fact, bed rest is NOT recommended.

You may want to reduce your activity only for the first couple of days. Then, slowly start your usual activities after that. Do not perform activities that involve heavy lifting or twisting of your back for the first 6 weeks after the pain begins. After 2 – 3 weeks, you should gradually resume exercise.

  • Begin with light cardiovascular training. Walking, riding a stationary bicycle, and swimming are great examples. Such aerobic activities can help blood flow to your back and promote healing. They also strengthen muscles in your stomach and back.
  • Stretching and strengthening exercises are important in the long run. However, starting these exercises too soon after an injury can make your pain worse. A physical therapist can help you determine when to begin stretching and strengthening exercises and how to do so.

AVOID the following exercises during initial recovery unless your doctor or physical therapist says it is okay:

  • Ballet
  • Football
  • Golf
  • Jogging
  • Leg lifts when lying on your stomach
  • Sit-ups with straight legs (rather than bent knees)
  • Weight lifting

Prognosis (Expectations)

Many people will feel better within 1 week after the start of back pain. After another 4 – 6 weeks, the back pain will likely be completely gone.

Calling Your Health Care Provider

Call your doctor right away if you have:

  • Back pain after a severe blow or fall
  • Burning with urination or blood in your urine
  • History of cancer
  • Loss of control over urine or stool (incontinence)
  • Pain traveling down your legs below the knee
  • Pain that is worse when you lie down or that wakes you up at night
  • Redness or swelling on the back or spine
  • Severe pain that does not allow you to get comfortable
  • Unexplained fever with back pain
  • Weakness or numbness in your buttocks, thigh, leg, or pelvis

Also call if:

  • You have been losing weight unintentionally
  • You use steroids or intravenous drugs.
  • You have had back pain before, but this episode is different and feels worse.
  • This episode of back pain has lasted longer than 4 weeks.

References

US Preventative Services Task Force. Primary Care Interventions to Prevent Low Back Pain: Brief Evidence Update. Rockville, MD: Agency for Healthcare Research and Quality; February 2004.

Anema JR, Steenstra IA, Bongers PM, de Vet HC, Knol DL, Loisel P, van Mechelen W. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine. 2007;32:291-298.

Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463-472.

Chou R, Loeser JD, Owens DK, Rosenquist RW, et al; american Pain Society Low Back Pain Guideline Panel. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine. 2009;34:10660-1077.

Jüni P, Battaglia M, Nüesch E, Hämmerle G, Eser P, et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. 2009;68:1420-1427.


Review Date : 8/3/2010
Reviewed By : Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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