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Acute Low Back Pain Advice
If you have had a flare-up of your low back pain and you are in a lot of pain, or struggling to move around, we have put together some advice for you.
It is worth bearing in mind that back pain usually settles in a few days or weeks and that serious or permanent damage is rare.
However, for about 20% of back pain sufferers it becomes ongoing, chronic, persistent, or may come and go for years.
What you do in the early stages is very important to your recovery. The good news is that there are lots of things you can do to help yourself.
We would advise that you read the full page, but feel free to click on the menu below to scroll straight to the section you need:
Page Contents (click to go to section)
Disclaimer
The contents of this page are provided for reference only, do not claim to be complete or exhaustive or to be applicable to any individual’s medical condition.
Users should always consult with a qualified and licensed medical doctor or Chartered Physiotherapist for an individualised treatment plan. Users are warned to follow the advice of their medical professional regardless of anything seen or read on this page.
Reliance on any content is solely at the user’s risk.
Remove the cause of your pain
First, you need to remove the cause of the pain.
Imagine having a cut on your arm. Given time, the cut will scab over and you will naturally heal. However, how well do you think that cut will heal if you constantly pick at the scab?
Repeating postures, movements and activities that aggravate your back is like picking at the scab. Repeated aggravation prevents healing and provokes sensitised nerves, which eventually get triggered with less stimulation.
It is vital to give your body a chance to settle down after an injury.
With that in mind, your first job is to work out all the things that cause your pain, and then to eliminate or modify those activities for a while.
EXERCISE:
1. Write down all the postures, movements and activities that increase your pain through the day.
2. Work your way down the list of aggravating postures, movements or activities on your page and cross out any that you could realistically cut from your life for a week or two.
3. Find a way of modifying any items that are left on your list so that they stop aggravating your pain.
At the bottom of this page, you will find an extended version of this exercise with examples. Click on the button below to go straight to it:
Get your pain under control ASAP
Getting your pain under control as soon as possible opens up a window of opportunity for movement, which has huge benefits (I’ll write about this below) and has been shown to improve your outcome after a flare-up of back pain.
Positions of comfort
If you have high levels of back pain, you will need to find positions that provide you with relief. Below are a few examples
Lying down
Lying down is often the most comfortable place to be after back pain strikes. Lying removes compressive forces through the spine, offloading discs, facet joints and some of the soft tissues.
- If you are experiencing sciatic nerve pain, this position is suggested by Mick Shacklock in his book ‘Clinical Neurodynamics’. This position would be used for left sided sciatic pains. Listen to your body and change position if your pain increases.
- If bending forward and sitting tends to aggravate your pain, you could try lying on your front with your arms crossed under your forehead, as suggested by Dr Stuart McGill in his brilliant book ‘Back Mechanic’. You can also try resting with your fist under your chin. Test for 30 seconds and use the position that helps you most.
- Alternately, you might feel more comfortable resting on your front with a pillow under the chest
- For someone who tends to experience more pain when standing and walking, the ’90-90’ position may feel more relieving. Let your back sink into the floor. Try holding your arms out to the side, with your palms facing upwards and breathing into your belly. Alternately, just let your hands rest gently on your belly.
- Alternatively, you can try lying on one side or the other. Use a pillow between knees to keep your pelvis relatively level. Some people like to use a small roll under their waist to preserve the natural curves of the spine.
Sitting Down
If you find sitting to be the most comfortable position, consider using a lumbar roll to support the curve of your lower back. A rolled-up hand towel usually works well. Relax back into the chair to give your spinal muscles the chance to relax, rest and recover.
Don’t forget……..
In general, it is best to intersperse these pain-relieving positions with short walks and gentle exercises.
Bed rest for severe pain
If you are in severe pain and spasm, a day or two in bed might be necessary to ease muscle spasm and allow the pain to subside enough for exercises or therapy to begin.
This is not a step to be taken lightly. Bed rest for more than 2 days can actually prolong the pain because you get stiff, muscles get weak, bones get weaker, you lose physical fitness and it gets harder to get going again.
If you do decide that you need one or two days in bed to let your pains subside, we suggest that you get up and move for 5 minutes every hour or so.
Medications*
As mentioned above, it is important to get the pain under control as soon as possible when you have an attack of back pain.
NSAIDs such as ibuprofen and naproxen are first line medications. NICE guidelines suggest that you take the lowest possible dose for the shortest time that has a positive effect.
In practice, we find that people who take a relatively high dose early on (usually for less than a week) get moving sooner and need less medications overall.
It is more effective to take a regular dose rather than waiting until you are in pain.
Paracetamol is a simple and safe alternative to NSAIDS.
Most people can safely combine ibuprofen with paracetamol if they are not proving to be effective in isolation.
Alternative medications can be effective for back pain. We suggest that you consult with a pharmacist if NSAIDS and paracetamol, combined with the other advice in this guide, aren’t helping.
* Always read the leaflet that comes with your medication to check that they are suitable for you. Don’t take ibuprofen if you are pregnant, if you have had a strong reaction to it in the past, or if you have a stomach ulcer, severe heart failure, severe liver disease or are taking low-dose aspirin for the prevention of cardiovascular disease. Don’t take paracetamol if you’ve had an allergic reaction to it in the past and take advice if you have liver or kidney problems, problems with alcohol or are very underweight.
Other forms of pain relief
It is worth considering other, simple forms of home pain-relief for back pain.
Heat or cold packs can be used for short-term relief of pain and to relax muscle tension. In the first 2-3 days you can try a cold pack on the sore area for 5-15 minutes at a time. A bag of frozen peas wrapped in a damp tea towel works well.
Other people prefer heat, which can reduce spasm and pain. A wheat pack or hot water bottle will usually do the job nicely, although stick-on heat patches are easier to use.
For both hot and cold packs, you should check your skin every few minutes for signs of a burn or irritation.
Whichever you choose, apply the cold or hot pack in a comfortable resting position (see above) and try to relax.
Relaxation
Many people feel anxious about back pain, especially when the pain is severe.
Unfortunately, anxiety and stress can increase the amount of pain you feel and prolong your recovery.
It is worth remembering that serious damage is rare, and the long-term outlook is good. So, take positive steps to reduce your pain and try not to let fear and worry hold back your recovery.
You can’t always avoid stress, but you can learn to reduce its negative effects by controlling your breathing, and using muscle relaxation and mental calming techniques.
You could try the ‘Swedish relaxation exercise’, described in ‘The back book’:
- Don’t try too hard to relax
- Find a comfortable position, sitting or lying down- somewhere quiet
- Take deep breaths ‘slow and steady’; hold for about 10-20 seconds and exhale
- Focus your mind on something calm and repetitive
- ‘Let go’ when exhaling
- Imagine and concentrate on breathing- not on relaxing
The ‘relaxation response’ can sometimes be achieved quite quickly, but deep relaxation can take 10-15 minutes.
Get Moving
Your back is designed to move and it is important to get moving after a flare-up of back pain.
Movement develops your muscles, keeps you supple, gives you stronger bones and releases natural chemicals that reduce the pain and help you feel good.
When you are injured, it can also:
- Ease muscle spasm, which eases pain and reduces compression on joints and discs
- Disperse inflammation and swelling and flush waste products away
- Limit secondary inflammation and scarring
However, some movements and exercises can aggravate your back and increase your pain.
In clinic, we can choose from hundreds of exercise variations that suit you, your diagnosis, your movement patterns and your stage of injury. This is impossible to do perfectly without performing a physical examination and assessing your specific needs.
However, with some common sense and a little trial and error, it is possible to find exercises that help to get you out of pain.
Below I’ve described a few, simple exercises designed to get you moving after a flare up of back pain. I’ve made a note of the type of problem it usually helps.
The best bet is to try an exercise gently at first and build up the intensity as you feel comfortable. Be prepared to experiment a little to find out what works for you and your back.
Specific exercises
McKenzie Extensions (AKA ‘Cobra’)
McKenzie Extension exercises are commonly used to treat acute back pain. They tend to work best if your pain is aggravated by bending forward or sitting down.
The McKenzie exercises are not always used as first described by Robin McKenzie, so we suggest that you read the following progression before watching the simplified video below:
- Lie on your front with your arms next to your body and your head turned to one side. Your arms should be straight but relaxed. Take a few deep breaths and relax completely for 2-3 minutes. On each out breath, feel the tension drain out of your body and imagine your back muscles relaxing fully. Exercise 1 can be performed every 2 hours throughout the day, but can also be used to prepare your body for exercise 2.
- Remain face down. Place your elbows under your shoulders so that you lean on your forearms. Begin by taking a few deep breaths and allowing the muscles in the lower back to relax completely. Remain in this position for 2-3 minutes. As with exercise one, you can repeat the exercise every two hours or so. If you experience pain during this exercise, try moving your elbows further forward until your body is in a comfortable position. Alternatively, you can rest with a pillow placed under your chest.
- Exercise 3 is the classic McKenzie extension exercise (see video below), but it should only be attempted if you are comfortable with exercises 1 and 2. Remain facedown. Place your hands under your shoulders in the position you would use for a push up. Straighten your elbows and push your body up from the pelvis as far as pain allows. It is important to completely relax your glutes, abdominals and legs, allowing your back to sag. Once you have held the position for a second or two, lower yourself to the starting position. Each time you repeat the cycle of movement, try to raise your body a little higher. If pain allows, aim to fully lock out your elbows. If you are unable to fully straighten the elbows and the exercise is hard on your arms, you might find it easier to move your hands forward so that you can lock out your elbows, but in a position that is comfortable for your back.
The Static Extension Posture
The Egoscue method provides a useful alternative to the McKenzie exercises for those of you who are unable to lie down or to get up from lying down. The Static Extension Posture is described below:
- Start on your hands and knees.
- Move your hands about 6 inches forward and then move your upper body forward so that your shoulders are above your hands. Your hips are now forward of your knees about 6 inches.
- Keep your elbows straight and allow your shoulder blades to collapse together while your pelvis rolls forward and your low back arches. Drop your head.
- HOLD for 2-3 minutes
Rocking Knees to the Chest
Rocking your knees to the chest is a useful exercise to release spasm in the lower back muscles and relieve acute pain.
But be warned… it can aggravate an acute problem if you experience most of your pain when sitting or bending forward.
Rocking the knees to the chest tends to be of particular benefit if you have a problem with extended positions such as standing, walking, and lying on your back with your legs straight.
- Lie on your back on the bed or on a soft surface on the floor.
- Brace your low back by gently sucking in your navel.
- Pull one leg up towards the chest.
- Support that knee with one hand and pull the other leg towards your chest with the other.
- You can rest with your thighs at 90 degrees.
- Pull your knees towards your chest slowly and rhythmically, then release to the 90-degree resting position.
- Oscillate gently for 10-30 seconds
The Cat-Camel
The Cat-camel is one of my favourite exercises to mobilise a painful back. It gently moves your mid and lower back and encourages you to activate your core muscles. However, because it moves you into both flexion and extension, it doesn’t suit everyone. Consequently, you should start gently and gradually build up the size of your movements.
- Start on your hands and knees, with your back in a neutral position.
- Round your back into a hump (the Camel) as you pull in your abdominal muscles. Let your head gently drop during this motion.
- Next, let your abdominals relax and gently tilt your pelvis so that your back falls into an arch. Gently lift your head during this movement.
- This is designed to be a slow, controlled motion. Each cycle should take 4-5 seconds.
- If you are in acute pain, this is not supposed to be a stretch. In fact, it is best to limit the range of motion so that you remain comfortable.
- The exercise should create gentle movement that reduces spasm in your back muscles and disperses inflammation around your joints.
- Repeat the movement 5 to 20 times in each direction.
Reminder
Please remember that the goal of these simple exercises is to get you out of acute pain. Do not expect them to fix your back.
Consider making an appointment to see a qualified therapist who can work out what tissues are causing your pain and the underlying problems that led to those tissues being under strain. They can then set to work on settling down the sensitive tissues and fixing the underlying stiffness, tightness, weakness, or faulty movement patterns that led to your flare-up in the first place.
General movement and exercise
Your goal is to find just the right balance between rest and activity.
Don’t forget, in the early days of a flare-up, your priority is to get the pain under control. It is good to get moving, but it is important to find movements and activities that don’t aggravate your pain.
That said, getting stiff joints and inflamed muscles working can make you a bit sore at first- like when athletes train hard. The key is to listen to your body, and to try to feel the difference between a flare-up of your normal pain, and the discomfort from exercise.
Walking is a great general exercise for most people, especially people who get more pain when they sit or bend down.
Swimming is another exercise that can maintain your cardio fitness while sparing your back.
If your normal sports make your back pain worse, consider doing something different to help you maintain your fitness. For example, people who experience pain when they run could try riding a bike, and visa versa.
You should ease back into normal, everyday activities, as pain allows. Start gently and try to do a little more each day, steadily increase your level of activity.
Ideally you want to feel a little better every day. If you feel worse, it’s a sign that you might have overdone it.
So, start moving and exercising as soon as you can, but without aggravating your pain. The longer you put it off, the harder it will be to get going again.
When to contact your GP
Remember, back pain is rarely due to any serious disease. It is usually the result of muscle or joint pain.
However, you should see your doctor if:
- You have severe back pain which gets worse over several weeks instead of better
- You have a fever or unexplained weight loss
- The pain started after a major trauma e.g. a car accident or a fall
- You have unexplained back pain AND a history of cancer, injecting drugs or prolonged use of corticosteroids
- You experience numbness around your back passage or genitals
- You have trouble passing or controlling urine
- Abdominal pain accompanies your back pain
- The pain is worse when you lie down and regularly wakes you from deep sleep
Need more help?
The advice on this page can help get you through an acute flare-up of back pain, but it is not designed to address the root cause of your pain.
If you would like an assessment so that we can help establish a diagnosis and your major underlying problems, book using the button at the bottom of the page…….
What to book
If you’re having a flare-up, your pain is severe, or you’re struggling to move, book in for a standard 45 minute assessment session (or 60 minute session if you have 2 or more injuries) so that we can get basic treatment under way.
If your back pain is stable you can move relatively comfortably, it is best to book in for the Back Pain MOT (90 minutes). This will give us time to fully assess the painful area and all the potential underlying problems, and to get treatment and rehabilitation under way.
If you’re pain-free but have have a long history of back pain, and want to reduce your chances of getting another flare-up, book in for the Back Pain MOT (90 minutes). This will give us time to examine your whole body for any underlying weaknesses, stiff/ tight areas and movement control issues that could cause problems in the future. We will then get you started with exercises to address any potential problem areas.
Click HERE for current prices
Not sure if we can help? – Free phone consultation available
You may like to take advantage of our FREE 10 minute phone consultation service to talk with a Physiotherapist prior to booking any treatment. The consultation will not involve an examination but it will be an opportunity to discuss your particular problem and whether you feel we can help you. Email info@physio7.com to set up your call.
ACTIVITY MODIFICATION EXERCISE (extended version)
1. Write down all the postures, movements and activities that increase your pain through the day.
This exercise isn’t as easy as it sounds. Some aggravating factors are obvious, but others aren’t. The kind of minor damage that accumulates over time often goes under the radar, so you might not even realise that those activities are causing you problems.
Consider not only how your back feels during those activities, but how it feels in the 24 hours afterwards as well.
Here are some common examples to get you thinking: lifting and carrying children or car seats, Washing up dishes, Hoovering, Changing your bed sheets, Weeding, Digging, Decorating, Sitting at work, Sitting on your sofa, Sleeping, Standing still, Walking fast, Walking slowly, Manual work, Stressful situations, Wearing High Heels, Weightlifting, The leg press machine at the gym, Playing football, Doing Sit ups, Riding a bike……
Be as specific as you can. If sitting for 40 minutes on an office chair is fine but sitting for an hour in the same chair always causes you a problem, make a note of that. If sitting on your sofa watching movies is fine for 20 minutes, but causes pain after half an hour, note it down.
2. Work your way down the list of aggravating postures, movements or activities on your page and cross out any that you could realistically cut from your life for a week or two.
Remember, this is a short-term solution. We just need to let your back calm down and unwind the sensitivity in order to create a window of opportunity for you to work on your pain-relieving postures and exercise- which we will talk about below.
As an example, if your back is more painful when you sit down in the morning, you could try eating breakfast standing up and avoid sitting down until you get to work. Perhaps you could walk to work or stand on a train instead of sitting in your car.
If your back is painful after walking the dog, you could hire a dog walker for a few days or ask a family member to take on the job for a while.
It’s not always realistic to cut out ALL of those aggravating activities. If you can’t cut them out entirely, can you modify the activity to reduce the impact?
3. Find a way of modifying any items that are left on your list.
Let’s take 2 common examples.
- If sitting down at work all day aggravates your pain, you could set an alarm to make sure you stand up or walk every 20 minutes. You could try drinking more to force you to get up and use the loo more often. You might decide to take all of your phone calls standing up, or you could even look into setting up a temporary standing desk. You could also try using a lumbar roll to support the curve in your lower back. A rolled-up hand towel usually works well.
- If you experience an increase in your pain after walking for 20 minutes, you could split your walks into manageable chunks, with a rest or a sit down between walking intervals. Instead of one, painful 20-minute walk, you might do 4 pain-free 5 minute walks, with a sit down between each interval. For some people, walking faster and really swinging the arms can help. Feel free to experiment and test what works for you.
To recap:
- What postures, movements or activities aggravate your pain?
- Can you avoid any of those for a few days while your back settles?
- How can you modify the remaining postures, movements and activities to reduce their impact on your back pain?
